Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceDespite a surge in the volume of evidence assessing the safety and efficacy of biologics for the treatment of chronic rhinosinusitis (CRS), nuances relating to geographic variations in this literature remain insufficiently elucidated.ObjectiveTo assess the diversity and representation of populations within the literature investigating the use of biological agents for CRS.Design/SettingSystematic review.ParticipantsAdults ≥18 years with CRS treated with biologic agents.InterventionsFollowing PRISMA guidelines, 2 complementary analyses of all studies published between 2006 and 2023 (analysis A), and randomized controlled trials (RCT) and real-world (RW) studies published between 2006 and 2025 (analysis B) were performed.Main outcomes measuresPatients' number and country of origin, race/ethnicity, authors' affiliated countries and Human Development Index (HDI). Types of biologics agents and metrics of the publications were collected.ResultsOut of 2768 studies reviewed, 169 were included in the final analyses. Dupilumab was the most studied biologic agent (37.8%), followed by mepolizumab. The United States had the highest absolute representation and Belgium the highest number of authors per capita, which was correlated with patients' nationality. The majority of the journals' and authors' country of origin was the United States. Only 19 (11.2%) studies disclosed patients' race/ethnicity, with Asian and Caucasian subjects most commonly represented. The authors' HDI correlated with journals' H-index and impact factor. Sixty-seven studies (39.6%) had industry funding, with dupilumab representing the highest number (15.9%).ConclusionAlthough the use of biologics has shown promising results in the management of CRS, most of the evidence comes from the United States and Europe. There is a paucity of representation from certain regions, including Africa, Latin America, and Asia, and inadequate overall disclosure of race/ethnicity in existing studies. This warrants further high-quality investigation of biological agents' safety and efficacy among these underrepresented populations.RelevanceAddressing gaps in clinical studies is important for furthering understanding of the pathophysiology and pharmacology of biologic agents for CRS, and bridging treatment disparities.

ImportanceNasopharyngeal cancer (NPC) is a strikingly age-specific and region-specific malignancy whose disproportionate and changing burden among younger people in the Western Pacific Region (WPR) has yet to be comprehensively quantified.ObjectiveThis study aimed to evaluate the burden and trends of NPC in individuals under 55 years in the WPR from 1990 to 2021 and project future trends up to 2035.DesignPopulation-based study.PopulationIndividuals under 55 years in the WPR, as part of the Global Burden of Disease Study 2021, spanning from 1990 to 2021.Main Outcome MeasuresAge-standardized rates of incidence, mortality, prevalence, disability-adjusted life years (DALYs), and average annual percentage change (AAPC) of nasopharyngeal cancer among people younger than 55 analyzed by regions and countries in the WPR from 1990 to 2021.ResultsBetween 1990 and 2021, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDLR) of NPC in individuals under 55 years in the WPR significantly decreased (all P < .001), whereas the age-standardized prevalence rate (ASPR) increased (P < .001). The NPC burden increased with age, peaking in the 50 to 54 age group, and was higher in males. Singapore exhibited the highest age-standardized incidence rate (ASIR) but low ASMR and ASDLR and China showed a decline in the ASIR and the ASMR, though the ASPR increased (all P < .001). Aging and population growth contributed to the rising NPC burden in the region. From 2022 to 2035, the ASIR is projected to rise to 2.85 per 100,000 [AAPC 95% CI = 2.04% (1.97%, 2.09%), P < .001], and the ASPR is expected to increase to 18.54 per 100,000 [AAPC 95% CI = 2.36% (2.24%, 2.44%), P < .001].ConclusionThe growing NPC burden among young populations in the WPR underscores the need for countries to adopt effective prevention strategies based on the experiences of peers with similar demographic profiles.

ImportanceSudden sensorineural hearing loss (SSNHL) is often accompanied by vestibular dysfunction, yet the relationship between patterns of peripheral vestibular organ involvement and hearing prognosis requires systematic evaluation. Clarifying this association is essential for guiding clinical assessment and prognosis.ObjectiveTo explore the prognostic value of vestibular function tests in patients with SSNHL by assessing the functional status of peripheral vestibular receptors.DesignRetrospective cohort study.SettingInpatient departments of Jiaxing Second Hospital and the Hospital of the China Coast Guard (September 2020 to September 2021).ParticipantsA total of 76 inpatients with unilateral SSNHL were enrolled and divided into a vertigo group (n = 29) and a non-vertigo group (n = 47).Exposures or InterventionsAll patients underwent pure-tone audiometry (PTA), cervical vestibular-evoked myogenic potentials (cVEMP), ocular VEMP (oVEMP), video head impulse test, and caloric testing to assess peripheral vestibular involvement.Main Outcome MeasuresHearing recovery, defined by improvement in PTA thresholds.ResultsPatients with vertigo had significantly-worse baseline PTA thresholds compared with those without vertigo [67.91 ± 31.67 degrees of hearing loss (dBHL) vs 54.98 ± 29.03 dBHL, P = .001]. Vestibular dysfunction was common, most frequently involving semicircular canal lesions (49/76), followed by abnormal cVEMP (41/76) and abnormal caloric testing (39/76). Univariate analysis showed that cVEMP, oVEMP, and caloric testing results were significantly associated with treatment outcomes (all P < .001), with the combined assessment of oVEMP and caloric testing demonstrating particular prognostic value (P = .007). Multivariate logistic regression further identified vertigo (OR = 0.132), cVEMP abnormality (OR = 6.460), and oVEMP abnormality (OR = 0.147) as independent predictors of hearing prognosis (all P < .05).ConclusionVestibular dysfunction reflects the extent of inner ear involvement in SSNHL, with semicircular canal impairment being the most common, followed by saccular and utricular lesions. Combined oVEMP and caloric testing appears to be an optimal approach for evaluating vestibular function and predicting hearing prognosis.RelevanceThis study supports the integration of multiple vestibular assessments to more comprehensively characterize inner ear involvement in SSNHL and to provide clinicians with reliable prognostic reference tools.

ImportanceThe learning curve for robotic thyroid surgery (RTS) remains incompletely characterized when considering the surgical approaches (axillary, transoral, transareolar, and facelift).ObjectiveThis systematic review investigated the learning curves and required case volumes for achieving proficiency according to the surgical approach.DesignPubMed, Scopus, and Cochrane Library systematic review using the PRISMA statements.SettingPublished clinical studies investigating learning curve outcomes related to the implementation of RTS.ParticipantsPractitioners.InterventionRTS.OutcomesLearning curve outcomes related to the implementation of RTS. The bias analysis was conducted with the MINORS.ResultsOf the 450 identified studies, 34 studies met our inclusion criteria (6438 patients). The mean minimum number of cases for achieving proficiency in axillary robotic partial and total thyroidectomies was 46 cases (range: 20-66) and 34 cases (range: 20-50), respectively. The minimum number of cases for reaching proficiency of transoral robotic and facelift approaches were 31 (15-55) and 32 (15-50) cases, respectively, with limited evidence for facelift approaches based on only 4 studies. Learning curves of facelift and transoral robotic approaches may be faster than the axillary one. While operative time significantly reduced in most approaches, the reduction of complication rates is inconsistent, with complications occurring in 16.7% of axillary, 11.1% of transoral, and 16.2% of facelift approaches throughout the learning process. There was substantial heterogeneity across studies for inclusion criteria, surgeon experience, and surgical outcomes.ConclusionThe number of cases required to achieve proficiency in robotic thyroid surgeries may depend on the surgical approach, with facelift and transoral approaches suggested as faster than axillary ones. Future prospective studies are needed to standardize learning definitions and analyze how surgeon-specific factors (experience, age, prior training) impact the learning curves.

ImportanceDizziness/vertigo is a common symptom that can lead to falls and reduced confidence in daily activities. It can result from vestibular, non-vestibular, or unidentified etiologies. Effective treatments with minimal side effects are essential to improving patient outcomes.ObjectiveTo compare the efficacy and safety of Ginkgo biloba extract EGb 761^® with Betahistine in patients with dizziness/vertigo of unclear etiology.Study DesignRandomized, double-blind, controlled trial conducted from October 2022 to August 2023.SettingEar, Nose, and Throat Outpatient Department at Burapha Hospital.ParticipantsEighty-six individuals aged ≥20 with dizziness/vertigo lasting >1 month without a specific etiology.InterventionPatients were randomized to EGb 761^® (120 mg/day) or Betahistine (36 mg/day) with matched placebos for 12 weeks, assessed at weeks 2, 6, and 12.Main Outcome MeasuresPrimary outcome: change in dizziness severity as assessed by the 11-Point Box Scale and Dizziness Handicap Inventory (DHI) scores. Secondary outcomes: safety.ResultsRepeated-measures ANOVA showed significant improvement over time in both groups (P < .001), with no group × time interaction, indicating comparable efficacy. For DHI, Betahistine showed a transient advantage at week 2 (P < .01, Cohen's d = 0.96), but no significant difference between treatments was observed at week 12. Both treatments were well tolerated, with only mild gastrointestinal side effects.ConclusionEGb 761^® and Betahistine demonstrated comparable efficacy and good safety in treating dizziness or vertigo of unclear etiology. Clinical improvement was most evident within the first 2 weeks of therapy.RelevanceEGb 761^® is a safe and effective alternative to Betahistine with comparable efficacy and good tolerability.

ImportanceAdenotonsillectomy is one of the most common pediatric surgeries, and postoperative pain management remains variable. Despite recommendations favoring non-opioid regimens, opioids continue to be prescribed, highlighting the need to better characterize current prescribing practices.ObjectiveTo evaluate self-reported opioid prescribing practices among Canadian otolaryngologists following pediatric adenotonsillectomy and to identify surgeon-level factors associated with opioid-sparing preferences.DesignNational cross-sectional survey.SettingMembers of the Canadian Society of Otolaryngology-Head & Neck Surgery.ParticipantsPracticing Canadian otolaryngologists involved in the perioperative care of pediatric patients undergoing adenotonsillectomy.Intervention or ExposuresSurgeon characteristics, including subspecialty training, practice setting, and surgical volume.Main Outcome MeasuresThe primary outcome was self-reported use of opioid-sparing postoperative analgesia following pediatric adenotonsillectomy. Secondary outcomes included opioid type prescribed and reported minimum age thresholds for opioid use.ResultsOf 517 eligible otolaryngologists, 100 responded (19.3%). Overall, 73% reported preferential use of opioid-sparing analgesia. Pediatric otolaryngologists showed strong evidence of opioid-sparing practice, with a 95% posterior probability of opioid avoidance, followed by academic (87%) and high-volume surgeons (91%). Morphine was the most-commonly-prescribed opioid (82%), whereas codeine was least preferred. Reported minimum age thresholds for opioid prescribing showed a bimodal distribution.ConclusionsMost Canadian otolaryngologists surveyed reported a theoretical preference for opioid-sparing analgesia following pediatric adenotonsillectomy.RelevanceObserved practice variation, including bimodal age thresholds, highlights opportunities for opioid stewardship initiatives and quality improvement efforts. Future studies evaluating real-world prescribing behavior are needed to inform standardized postoperative pain management strategies.

ImportanceGalvanic vestibular-evoked myogenic potential (gVEMP) elicited by galvanic stimuli to assess the audiovestibular disorders has garnered less attention.ObjectiveThis systematic review aims to explore the clinical application of the gVEMP test in audiovestibular disorders, with the potential for widespread promotion in the future.DesignThis review was developed from peer-reviewed articles published in those journals listed on Journal Citation Reports.SettingUniversity hospital.ParticipantsArticles were collected from the PubMed database of the US National Library of Medicine, Scopus, Embase, Google Scholar, and Cochrane Library.InterventionResults of vestibular-evoked myogenic potential (VEMP) elicited by either acoustic, vibratory, or galvanic mode were compared.Main Outcome MeasuresBased on the guidelines (PRISMA 2020 statement) for reporting reviews.ResultsInitially, 1076 articles were retrieved from 1994 to 2023. Following the exclusion of duplicate reports, unrelated articles, non-SCI journals, and papers covering a similar topic published in a later period, 43 relevant papers were ultimately selected.Conclusions and RelevanceThe ocular and cervical VEMP testing using galvanic stimuli should be accompanied by testing with acoustic or vibratory stimuli to precisely delineate the affected receptors and/or afferents in audiovestibular disorders. Clinical application of the gVEMP test in audiovestibular disorders includes: (1) Evaluating the involvement of vestibular afferents; (2) Assessing the residual function of the vestibular system; and (3) Predicting the outcome of audiovestibular disorders.

ImportanceOpening the cochlear‒carotid recesses through the endoscope-assisted modified translabyrinthine approach to treat lesions in the petrous apex has been demonstrated to preserve the cochlea and hearing. The objective parameters of recesses and their relationships with vital structures were fundamental to the effective application of this technique.ObjectiveHerein, we present a quantitative analysis of cochlear‒carotid recesses on high-resolution computed tomography (HRCT) images and discuss their implications for hearing preservation in the surgical management of massive petrous bone cholesteatomas (PBCs).DesignObservational study.ParticipantsTwenty samples (40 sides) obtained between April and June 2021 radiographically via HRCT.MethodsHRCT images of 40 ears were acquired at 0.60 mm thickness and processed via Mimics. The intrinsic structures of the temporal bone were reconstructed in a 3D view. The morphological data were precisely measured on multiplanar reconstructed images. In addition, clinical implications were demonstrated in one patient with massive temporal bone cholesteatoma.ResultsA 3D model of the cochlear‒carotid recesses was reconstructed. The recesses were essentially divided into 2 parts, namely, the triangle anterior and superior to the cochlea (TASC) and the triangle anterior and inferior to the cochlea (TAIC). The size of the cochlear‒carotid recesses varied widely among the samples. The TASC was accessible in 80% of the samples via a conventional ear endoscope with a diameter of 3 mm, while the applicability of the TAIC was 62.5%. We further discovered that the low position of the trigeminal nerve impression and the small distance between the cochlea and the jugular bulb suggested narrow recesses. The thickness of the compact bone shell of the cochlear lumen acted as a safe drilling divider.ConclusionsHRCT and 3D reconstruction clearly displayed cochlear‒carotid recesses. For patients with massive PBC, the use of an endoscope to open recesses is feasible in the majority of cases and increases the possibility of preserving the structure and function of the cochlea. Individualized preoperative measurements of cochlear‒carotid recesses via HRCT could help surgeons perform safe and accurate dissection.

Importance: Depression and anxiety affect a significant portion of head and neck cancer (HNC) patients. Furthermore, depression has been shown to result in decreased survival and worse functional outcomes.

Objective: The purpose of this study is to determine the prevalence of depression and anxiety in a cohort of HNC patients at all subsites.

Design: This is a retrospective review of prospectively gathered data in a cohort of patients aged 18 years of age and over, diagnosed with HNC, between August 2011 and December 2017, treated at the Princess Margaret Cancer Centre in Toronto, Canada.

Setting/participants: Adult Patients with a new diagnosis of HNC treated at the Princess Margaret Cancer Center/University Health Network between August 2011 and December 2017 were included in the study.

Exposures: Patients were initially screened using the Direct Assessment and Response Tool (DART), which includes the Edmonton Symptom Assessment Scale (ESAS) to identify psychosocial distress.

Main outcome measures: If positive on DART, patients were then asked to complete the Generalized Anxiety Disorder 7-Item Scale and the Patient Health Questionnaire-9. Associations with anxiety/depression and variables were assessed using univariate and multivariate logistic regressionResults:A total of 586 patients were included in our study. The median age of the group was 60 (22-89 years), with a male predominance (78.2%). Most patients (78.8%) had advanced disease at diagnosis. The oropharynx was the most common site (46.5%). The prevalence of depression and anxiety was 13.1% and 9.9%, respectively. Multivariate analysis showed that nonmarried status, non-white ethnicity, disease progression, lower income, and increased out-of-pocket costs were associated with depression. Definitive surgery, ECOG ≥1, and lower income were associated with anxiety. Disease stage, smoking/drinking history, and HPV status were not associated with anxiety/depression.

Conclusions: A portion of patients are at higher risk of developing sustained depression and anxiety at 12 months following treatment, which may be predicted early, facilitating early mental health intervention.

Relevance: Identifying factors associated with depression and anxiety in HNC patients will aid in providing early intervention.

ImportanceSelective, modified radical, and radical neck dissections are common surgical procedures that can result in significant musculoskeletal issues of the neck and shoulder. Quality-of-life evaluations after neck dissection must assess and quantify these dysfunctions to allow subsequent comparison of outcomes after different treatments.ObjectiveThere is no validated Spanish-language questionnaire designed to evaluate neck and shoulder dysfunction after cervical lymphadenectomy. We therefore sought to translate a version of the Neck Dissection Impairment Index (NDII) into Spanish.Design, Settings, and ParticipantsA three-phased approach was used. Phase 1: The NDII was translated from English to Spanish using a "forward and backward" translational technique following international guidelines. Phase 2: The questionnaire was administered to six patients from our head and neck surgery clinic who were bilingual and fluent in both English and Spanish. Phase 3: The final version was administered prospectively to 34 patients with prior history of neck dissection (ND). These patients were asked to complete the questionnaire a second time 3 to 6 weeks after their first response. Test-retest reliability was calculated with Spearman's correlation. Internal consistency was elicited using Cronbach's alpha.Main Outcome(s) and Measure(s)NDII score at initial administration and follow-up administration 6 weeks later, demographic data.ResultsNDII was successfully translated and validated into Spanish. Cronbach's alpha revealed high internal consistency at both the first time point 0.95 (mean standardized score: 95 (88.1, 97.5), 95% CI: 0.89, 0.97) and at the second time point 0.90 (mean standardized score: 92.5 (80.6, 100.0), 95% CI: 0.81, 0.95). The Spearman's correlation for test-retest reliability of overall score was strong (rho = 0.772, P < 0.001). The intraclass correlation coefficient of the overall score was moderate (ICC = 0.683, P < 0.001).Conclusions and RelevanceNDII is a recognized, previously validated quality-of-life (QOL) tool for the identification of ND-related dysfunction. This validated Spanish version will allow clinicians to adequately assess the neck and shoulder-related QOL for the Spanish-speaking population who are under-represented in head and neck research.