Journal of Otolaryngology - Head & Neck Surgery最新文献

BackgroundThere has been a recent increase in the publication of articles evaluating outcomes of balloon dilation of the eustachian tube (BDET) as a treatment for chronic eustachian tube dysfunction (ETD). Our objective was to evaluate the overall efficacy of BDET for treating ETD, with a subgroup analysis of BDET performed under local anesthesia (LA) versus general anesthesia.MethodsPUBMED, EMBASE, and Cochrane databases were searched for English articles from January 2010 to October 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Only randomized controlled trials and prospective studies evaluating BDET for ETD were included. All articles evaluating BDET performed under LA were assessed.ResultsOur search identified a total of 23 articles after screening (365 articles). Only studies using homogeneous and validated outcome measures were included. A total of 6 studies met criteria for meta-analysis of preoperative and postoperative outcomes of BDET as assessed by the ETD Questionnaire (ETDQ-7). Other reported parameters include LA protocols and surgical complications. Seven studies used LA protocols. A meta-analysis using the random effects model demonstrated a decrease in mean ETDQ-7 scores by 2.03 up to a year following BDET (309 patients, CI -2.59 to -1.47, P < .001). Descriptive statistics were used to analyze studies where BDET was performed under LA due to outcome heterogeneity. The results demonstrate no significant differences in otologic post-BDET outcomes (tympanometry/ETDQ-7 scores), minimal complications, and high patient-reported willingness to choose LA.ConclusionsBDET is effective for treating chronic ETD. BDET performed under LA with careful patient selection and an established LA protocol is safe and comparable to BDET in the operating room.

ImportanceThe role of artificial intelligence (AI) within medicine has increased exponentially over the last decade. However, adoption across medical specialties remains variable, influenced by institutional support, availability of tools, and concerns about accuracy, privacy, and legal liability. Addressing these barriers is necessary to achieving the full clinical capacity of AI.ObjectivesThis study aimed to explore current AI usage patterns among pediatric otolaryngologists and highlight perceived benefits and barriers to adoption.DesignCross-sectional survey design.SettingAll aspects of the present study were conducted remotely, with the survey link being distributed within a private group chat.ParticipantsParticipants were recruited via an international pediatric otolaryngology WhatsApp group chat. Admission is through invitation only.Intervention or ExposuresThe survey sought to characterize a variety of themes regarding AI, including utilization patterns, attitudes, motivational factors and barriers to adoption, and extent of institutional support.Main Outcome MeasuresResponses were evaluated using chi-squared tests and descriptive statistics.ResultsSurvey responses were analyzed from 50 individuals, reflecting a response rate of 15.2%. More than half of survey respondents (60.9%, n = 28/46) use AI in practice, relying on tools like ChatGPT, iScribe, and Gemini to improve workplace efficiency (71.4%, n = 20/28) and address administrative burdens (64.2%, n = 18/28). Despite current adoption of AI, participants identified a lack of institutional guidelines (66.7%, n = 30/45) and support (54.3%, n = 25/47) as major barriers to widespread integration across the subspecialty. No statistically-significant association was found between age and likelihood of AI adoption (P = .095) nor was between geographic region and likelihood of AI adoption (P = .505).ConclusionsPediatric otolaryngologists are interested in and enthusiastic about AI tools. This study highlights prominent institutional and educational gaps, limiting widespread integration.RelevanceThe findings guide future efforts to support AI adoption in pediatric otolaryngology through tailored training, policy, and institutional support.

ImportanceHypopharyngeal squamous cell carcinoma (HPSCC) is an aggressive cancer with poor outcomes. Neoadjuvant therapy (NAT) may allow organ preservation, but determining safe surgical margins after NAT is a critical challenge.ObjectiveTo evaluate the safety of reduced surgical margins after neoadjuvant tislelizumab and afatinib in locally advanced HPSCC by comparing pathological margins to an upfront surgery control group.DesignProspective, single-center pilot cohort study.SettingTertiary referral center in Western China.ParticipantsForty-one patients with locally advanced HPSCC; 32 received NAT (treatment group), and 9 served as an upfront surgery control group.Intervention or ExposuresTreatment group: 2 cycles of neoadjuvant tislelizumab plus 6 weeks of afatinib. Control group: upfront surgery. Both groups underwent resection with a 1.5 cm naked-eye surgical margin.Main Outcome MeasuresPrimary outcomes were minimal peripheral surgical margin (MPSM) and minimal deep surgical margin (MDSM). Secondary outcomes included radiological (RECIST v1.1) and pathological tumor response.ResultsThe NAT group had a 20/32 (62.5%) radiological objective response rate and a 16/32 (50.0%) major pathological response rate [including 9/32 (28.13%) pathological complete response]. The mean MPSM was significantly greater in the treatment group versus control [3.38 mm vs 1.71 mm; 95% Confidence interval (CI): 0.10-3.24; P = .038]. The mean MDSM was also significantly greater in the treatment group versus control (2.09 mm vs 1.04 mm; 95% CI: 0.12-1.97; P = .029).ConclusionsCombined immune-targeted NAT effectively downstages HPSCC. The significantly larger pathological margins observed support that reducing clinical surgical margins after this regimen is generally safe.RelevanceThis NAT regimen may allow for less extensive resections, facilitating laryngeal preservation and improving quality of life without compromising oncologic safety. Larger validation studies are needed.

ImportanceThe technique combining a crescent-shaped costal framework with the biomechanical properties of residual auricular cartilage is expected to enhance the structural stability and aesthetic outcomes of the reconstructed ear in mild conchal-type microtia.ObjectiveTo present a technique that integrates a crescent-shaped costal framework with the biomechanical properties of residual auricular cartilage to reconstruct mild conchal-type microtia, aiming to improve structural stability and aesthetic outcomes.DesignRetrospective study.SettingAuricular Reconstruction Center, Plastic Surgery Hospital, Peking Union Medical College, between January 2023 and January 2024.ParticipantsPatients with grade I or II conchal-type congenital microtia underwent auricular reconstruction using this refined technique. The procedure integrates a crescent-shaped costal framework with residual auricular cartilage to achieve single-stage ear reconstruction.InterventionThe surgery technique combining a crescent-shaped costal framework with the biomechanical properties of residual auricular cartilage was used.Main Outcomes and MeasuresPostoperative outcomes were assessed based on the integrity of auricular subunit structures, bilateral symmetry, scar visibility, complication rates, Ear-Q (Appearance), and patient satisfaction.ResultsThe study included 26 unilateral microtia cases (20 right ears and 6 left ears) with a mean follow-up period of 9.43 ± 3.57 months. According to aesthetic evaluations, 23 patients (88.46%) received 4 points (indicating an excellent aesthetic effect). Patient satisfaction was high, with 24 patients (92.31%) and their families reporting favorable outcomes. The mean Ear-Q (Appearance) score was 62.23 ± 18.68. Aesthetic results were rated as the highest score in 23 cases (88.46%). There were no significant dimensional differences between the reconstructed and unaffected ears, and no significant changes between immediate postoperative and final follow-up measurements.Conclusions and RelevanceThe combination of a crescent-shaped costal framework with residual auricular cartilage offers a reliable, aesthetically-refined, and technically-efficient approach for the repair of mild conchal-type microtia.

ImportanceAdenoid enlargement in preschool children is commonly cited as a cause of nasal obstruction and sleep-disordered breathing, yet age-related lymphoid development complicates differentiation between physiological growth and clinically significant hypertrophy. Existing endoscopic grading schemes lack consensus on age-specific normative limits and clear management thresholds.ObjectiveThis study aimed to determine endoscopic adenoid-to-choanae (A/C) ratio cut-offs that discriminate symptomatic from asymptomatic preschool children and to propose a practical, management-oriented grading scale.DesignSTROBE.ParticipantsWe performed a retrospective analysis of 225 preschool children (age 3-7). Standardized history-taking, flexible nasopharyngoscopy, MASNA (Mucus on Adenoid Scale by Nasopharyngoscopy Assessment) mucus scoring, and tympanometry were performed.InterventionChildren were classified as symptomatic (≥2 "yes" responses to core symptom items) or asymptomatic (no more than one "occasionally" response). Adenoid size was quantified from blinded video review as the A/C ratio.Main Outcome MeasuresReceiver operating characteristic (ROC) analysis identified an optimal A/C threshold for symptomatic status; multivariable logistic regression evaluated independent predictors.ResultsMedian A/C ratio was greater in symptomatic versus asymptomatic children. Symptomatic children also had higher MASNA mucus scores, greater reported rhinorrhea frequency, and less favorable tympanometric profiles. ROC analysis identified an A/C ratio of 60% as the optimal cut-off to discriminate symptomatic from asymptomatic children. An A/C ratio >60% emerged as the sole independent predictor of symptomatic status.ConclusionIn this cohort, the endoscopic A/C ratio strongly discriminated symptomatic from asymptomatic presentations. An A/C threshold of 60% reliably separated predominantly asymptomatic from symptomatic children.RelevanceThese findings, in conjunction with clinical experience and results from our previous studies, form the basis for a proposed three-tier, management-oriented endoscopic scale for preschool patients: Degree I (A/C ≤60%)-within age-appropriate norm; Degree II (A/C 65%-75%)-hypertrophy amenable to conservative management/observation; Degree III (A/C ≥80%)-hypertrophy for which we suggest that surgical intervention ought to be considered.

ObjectiveGraft outcomes and complications were compared in patients who received a cartilage-perichondrium composite graft via perichondrium reinforcement (CPPR) and those treated using only a cartilage-perichondrium composite graft underlay (CPGU) technique, including raising a tympanomeatal flap, in the repair of a subtotal perforation.Materials and MethodsPatients with subtotal perforations were semi-randomly allocated to the CPPR and CPGU groups. The graft success rate, hearing outcomes, operation times, postoperative visual analog scale (VAS) values, and complications were compared for up to 6 months postoperatively.ResultsThe sample consisted of 67 ears from 67 patients. The mean operation time was 33.1 ± 2.8 min in the CPPR group and 56.2 ± 1.8 min in the CPGU group. At 6 months postoperatively, the VAS scores were 1.4 ± 0.9 and 3.7 ± 1.2, and the graft success rates were 97.0% and 88.2% (P = .371), respectively. There were no significant differences in the mean gain in the air-bone gap (16.2 ± 5.3 vs. 14.7 ± 6.2) between the two groups, but hearing improvement was greater in the CPPR group. Ear fullness was reported by 21.2% patients in the CPPR group and 91.2% of patients in the CPGU group. Temporary hypogeusia developed in 3.0% of patients in the CPPR group and 38.2% of those in the CPGU group. Myringitis was seen in 9.1% patients in the CPPR group and 2.9% in the CPGU group.ConclusionIn patients undergoing subtotal perforation repair, the 6-month graft outcome in patients treated with the perichondrium reinforcement technique without raising a tympanomeatal flap and external ear canal packing was similar to that of patients who underwent a flap-raising technique. The advantages of the perichondrium reinforcement technique are that it is simple, time-saving, and minimally invasive, with less ear fullness and better hearing recovery.

ImportanceSeptoplasty, turbinoplasty, and septorhinoplasty are common and generally-safe procedures. However, their effects on the olfactory system, despite its anatomical proximity, are not well documented. Given the importance of olfaction for quality of life, evaluating the olfactory impact of these surgeries is warranted.ObjectiveThis study aimed to assess the olfactory sequelae of nasal surgeries.DesignSystematic review with meta-analysisSetting and ParticipantsA search equation used in PubMed/Medline, Cochrane Library, Web of Science, and Embase identified 7780 articles published since 1990, evaluating the adverse events of nasal surgeries.ExposureThe studies included evaluated adult patients exposed to one of the following nasal surgeries: septoplasty, septorhinoplasty, and/or inferior turbinoplasty.Main outcome measuresOlfactory assessment results and number of patients presenting with preoperative or postoperative hyposmia were extracted, as well as the number of patients presenting with surgery-induced hyposmia.A meta-analysis was conducted to compare different surgical subgroups.ResultsOne hundred and two studies were ultimately included in the analysis, centralizing data from 16,072 patients. Surgery-induced hyposmia was identified in 2.7% of cases, regardless of the surgical intervention performed. Overall, nasal surgeries led to a postoperative improvement in hyposmia scores [3.73 (±1.58) vs 2.39 (±1.45), P < .001] and a reduction in the number of patients with hyposmia [22.2% (945/4254) vs 14.5% (380/2620), P < .001]. The meta-analysis revealed no significant difference between the surgical subgroups.Conclusion and RelevanceThe present systematic review and meta-analysis suggest that nasal surgery may impair olfaction in a non-negligible number of cases and highlight the need for objective and systematic olfactory assessment in nasal surgery studies.

ImportanceSingle-entry models (SEMs) may decrease wait times as they place patients in a common queue to see the first available physician. Accordingly, SEMs are a potential strategy for managing wait times in pediatric otolaryngology. No study has assessed SEMs in pediatric otolaryngology or evaluated the perspectives of patients and caregivers.ObjectiveTo evaluate the views of patients and their caregivers on the role of SEMs in managing surgical backlogs for high-volume procedures and to capture information regarding their suggestions for optimal SEM design and implementation.DesignA qualitative study using semi-structured interviews (according to COREQ and SRQR guidelines).SettingAcademic and community pediatric otolaryngology settings across Ontario, Canada.ParticipantsEight patients, along with their caregivers, were recruited through purposive sampling. Eligibility criteria included Ontario residents who are fluent in English and were scheduled for, or already had, a routine pediatric otolaryngology procedure.Intervention or ExposuresThis study investigated the perceptions of pediatric otolaryngology patients and their caregivers on the concept of implementing SEMs for pediatric otolaryngology.Main Outcome MeasuresPediatric otolaryngology patients and their caregivers' perceptions of SEMs as a method of managing wait times in pediatric otolaryngology.ResultsAcross the patient and caregiver stakeholder group, four thematic domains were established: (1) challenges of long wait times, (2) current perceptions and hesitations of SEM, (3) enablers and patient buy-in, and (4) additional wait time reduction strategies.ConclusionsPatients and caregivers agreed that implementing an SEM would effectively decrease wait times for routine procedures in pediatric otolaryngology. They felt that it would likely promote patient equity and accessibility and improve patient healthcare experiences.RelevanceEmphasizing communication, transparency, patient autonomy, and funding will be imperative to patient and caregiver satisfaction and SEM longevity.