Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceTinnitus is a prevalent condition among noise-exposed workers, with significant implications for hearing health and quality of life. Identifying associated factors can inform prevention and management strategies.ObjectivesTo identify factors associated with tinnitus prevalence among noise-exposed workers and assess the effectiveness of hearing protection in mitigating tinnitus.DesignCross-sectional study.SettingData from the National Health and Nutrition Examination Surveys database.ParticipantsThis study included 4931 noise-exposed workers (mean age 48.9 ± 0.3 years). Participants were categorized into speech-frequency hearing loss (SFHL; n = 1032, mean age 67.2 ± 0.4 years) and high-frequency hearing loss (HFHL; n = 1634, mean age 62.9 ± 0.3 years) groups based on hearing threshold levels.Intervention or ExposuresNoise exposure duration, hearing loss severity, demographics, and medical history. Hearing protection usage was assessed for its effectiveness in preventing tinnitus.Main Outcome MeasuresPrimary outcome: tinnitus prevalence. Associations were analyzed using logistic regression, with factors including self-reported noise exposure, hearing loss severity, demographics, and medical history.ResultTinnitus prevalence was 32.85% in the group with SFHL and 29.99% in the group with HFHL. Prolonged noise exposure and greater hearing loss severity were associated with tinnitus in both groups. Hearing protection usage was potentially linked to a lower tinnitus prevalence in HFHL but not in SFHL. For SFHL, univariate analysis showed lower tinnitus prevalence in older age and females, while Caucasian ethnicity and higher income were associated with higher prevalence. Multivariate analysis indicated that older age was positively associated with tinnitus (P < .05). In HFHL, factors such as higher BMI, higher educational level, and elevated Patient Health Questionnaire-9 (PHQ9) scores were significantly associated with tinnitus prevalence.ConclusionsProlonged noise exposure and hearing loss severity among noise-exposed workers were associated with tinnitus prevalence in SFHL and HFHL. Hearing protection showed tendency to reduce tinnitus prevalence in HFHL but had a limited effect in SFHL. Higher BMI, higher education levels, and elevated PHQ9 scores were significantly associated with tinnitus in HFHL, warranting further research into protective strategies.RelevanceFuture studies should explore alternative protective strategies for SFHL patients and refine tinnitus prevention approaches in noise-exposed workers.

ImportanceOral cavity squamous cell carcinoma (OCSCC) is rare in patients ≤40 years, and their risk factors, presentation, and outcomes may differ from older patients.ObjectiveTo assess the epidemiology, risk factors, and oncologic outcomes of young patients (≤40 years) with OCSCC compared to those >40 years.DesignA multi-institutional retrospective cohort study.SettingNine Canadian institutions from 2005 to 2019.ParticipantsIn total, 4506 adults with OCSCC, of whom 205 (4.55%) were young and 4301 were older than 40.Interventions or ExposuresThe primary outcomes were overall survival (OS) and disease-free survival (DFS), comparing young and older patients. The identification of risk factors for OCSCC development in young patients was a secondary outcome.Main Outcome MeasuresOS, DFS, and risk factor identification.ResultsOral tongue cancer was the most common subsite (48.9%), with a significantly higher proportion of cases in young patients (73.4% vs 47.7%, P < .01). Young patients were more likely to present at an earlier clinical stage (T1: 44% young vs 31% old, P < .01) and were less likely to smoke (57% young vs 31% old, P < .01) or consume alcohol (72% young vs 58% old, P < .01). Multivariable analysis showed that smoking status, previous head and neck cancer, and advanced stage were significantly associated with decreased OS and DFS (P < .05). No significant differences were found in local (P = .61), regional (P = .67), or distant (P = .50) disease failure between age groups.Conclusions and RelevanceYoung patients with OCSCC were less likely to smoke or drink and presented at earlier stages, but they did not experience improved OS or DFS compared to older patients. These findings emphasize the need for further research into biological differences in OCSCC between young and older patients.

ImportanceChildhood recurrent anterior epistaxis (RAE) commonly coexists with allergic rhinitis (AR), causing significant symptoms and distress to patients; however, treatment remains controversial.ObjectiveTo compare the clinical outcomes of pediatric patients with RAE and AR treated intraoperatively with silver nitrate cauterization (SNC) or radiofrequency coagulation (RFC).Study DesignProspective, randomized controlled study.SettingTertiary referral center.ParticipantsPediatric patients presenting with RAE and AR.Exposure or InterventionPatients received SNC or RFC in a double-blind, prospective cohort study.Main Outcome MeasuresThe Epistaxis Severity Score (ESS) and Visual Analog Scale (VAS) scores for AR-related symptoms were recorded at baseline, 4thweek, 3rd month, and 12th month.ResultsThe rebleeding rate in the SNC group was 18.0% at the 4th week, 46.0% at the 3rdmonth, and 58.0% at the 12th month, whereas the RFC group demonstrated rates of 2.0%, 0%, and 0%, respectively (P < .05). At each follow-up time point, the mean ESS was significantly lower in the RFC group than in the SNC group. In addition, mean VAS scores for nasal crusting and impact on daily life (IDL) were significantly lower in the RFC group at all postoperative time points. Moreover, the RFC group exhibited significantly-lower mean VAS scores for runny nose and itchy nose at the 3rd and 12th month postoperatively. Similarly, the mean VAS score for nasal obstruction was significantly lower in the RFC group at the 12th month postoperatively. No cases of septal necrosis or perforation were observed in the SNC group. However, septal perforation occurred in 1 patient among the 4 who underwent RFC using the ablation mode.Conclusion/RelevanceThe thermocoagulation mode of RFC is a safe and effective treatment modality for bilateral RAE in pediatric patients. It significantly improves epistaxis and alleviates associated nasal symptoms. Furthermore, compared with patients treated with SNC, those receiving RFC exhibited a significantly-prolonged nosebleed-free period and a reduced likelihood of recurrent epistaxis within 1 year of treatment.

ImportanceIntraoperative narrow-band imaging (NBI) has been used to improve superficial (mucosal) resection margin clearance in oral squamous cell carcinoma (OSCC). However, no study has been conducted in a randomized controlled trial comparing OSCC resection using NBI and standard white light (WL).ObjectiveTo compare the rate of pathological margin clearance between NBI-guided and WL-guided resection in OSCC patients.DesignParallel-design, single-center, randomized controlled trial.SettingTertiary care center, Department of Otolaryngology.ParticipantsOne hundred and four OSCC patients undergoing surgical resection were included in the study.InterventionPatients were randomly assigned to have either NBI-guided (n = 52) or WL-guided (n = 52) resection.Main Outcome MeasuresFinal pathological margin status and clinical outcomes, including type of defect reconstruction and functional outcomes (persisting tracheostomy and tube feeding), were compared between the 2 groups.ResultsA significantly higher rate of clear superficial margin was achieved in patients in the NBI group than in the WL group (96.2% and 80.8%, respectively, P = .014). The locoregional or free flap reconstruction rates between the 2 groups were indistinguishable. Oral tongue and floor of the mouth primaries were detected more frequently in the NBI group, which may affect the postoperative deglutition function, leading to insignificantly higher rates of persistent tracheostomy and feeding tube (11.5% vs 5.8%, P = .488, and 19.2% vs 13.5%, P = .597, respectively).Conclusions and RelevanceThe study demonstrated that intraoperative NBI-guided resection in OSCC resulted in a more precise definition of superficial tumor margin than the standard WL-guided resection. In addition, the reconstruction method and functional outcomes were comparable between the 2 groups.

ImportanceFew centers globally use transoral laser microsurgery (TLM) for primary treatment of T3 glottic squamous cell carcinoma (SCC); consequently, data on its use in this setting are sparse.ObjectiveThe aim of this study was to evaluate the oncologic and functional outcomes in T3 glottic SCC following TLM, including the impact of anterior commissure (AC) involvement.DesignRetrospective chart review.SettingSingle Canadian tertiary care hospital in Halifax, Nova Scotia, from January 2006 to December 2021.ParticipantsAdult (>18 years old) patients with T3 glottic SCC treated with TLM. Patients were excluded if they were previously treated for laryngeal cancer.Intervention or ExposuresThis study used prospectively collected data for patients treated with TLM for T3 glottic SCC.Main Outcome MeasuresOncologic outcomes were assessed using disease-specific survival (DSS), local control (LC), and laryngectomy-free survival (LFS). Functional outcomes were measured using the Voice Handicap Index-10 (VHI-10).ResultsIn total, 28 patients (mean age = 68.4 years) underwent curative TLM for T3 glottic SCC. Sixteen of the cases involved the AC and 22 had paraglottic space involvement. Two and 5-year DSS were 79.2% (CI = 62.3%-100%). Two and 5-year LC were 80.2% (CI = 65.9%-97.4%) and 52.6% (CI = 27.4%-100%), respectively, and 2- and 5-year LFS rates were 86.1% (CI = 72.6%-100%) and 64.6% (CI = 35.8%-100%). AC involvement had no significant impact on DSS, LC, or LFS. There was no significant difference in preoperative and 3-month VHI-10 scores (P = .6632); however, there was significant improvement noted at the 6 (P = .042) and 12-month (P = .037) periods.ConclusionsTLM is a viable surgical option for appropriately selected patients with T3 glottic SCC, with or without AC involvement, achieving favorable oncologic and functional outcomes.RelevanceThese findings further contribute to the limited evidence supporting the use of TLM in the management of advanced-stage glottic cancer.

ImportanceThis systematic review determines that the patients with obstructive sleep apnea (OSA) can undergo upper airway surgery in ambulatory surgical centers (ASCs) safely and determines which patients with OSA are appropriate for this environment.ObjectiveThe systematic review aimed to determine the safety of conducting upper airway surgeries on patients with OSA in ASCs.DesignThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform a systematic review on ambulatory upper airway surgery studies. A comprehensive search was conducted from MEDLINE, Embase, CENTRAL, and Scopus from inception through February 2024. A descriptive analysis was conducted. Risk of bias was assessed using the Murad Tool and the Newcastle-Ottawa Scale.SettingHospital outpatient department or ambulatory surgical center.ParticipantsAdult patients with OSA.InterventionUpper airway surgery.Main Outcome MeasuresUnplanned admission rates and 24 hour complications.ResultsFrom 9313 studies, 11 upper airway surgery studies with 5714 participants were identified. Studies observed a 5.4% admission rate for medical reasons, predominantly stemming from avoidable admissions for desaturations. There was a 9.2% 24 hour complication rate. By initiating an oxygen discontinuation trial, OSA patients with controlled comorbidities can confidently proceed with OSA surgery at ASCs feasibly and safely. Patient selection is paramount in the ASC environment, with a focus on age, body mass index, apnea-hypopnea index, and controlled comorbidities.Conclusions and RelevanceOSA patients with mild or controlled comorbidities can safely undergo ambulatory OSA surgery in ASCs without sacrificing the cost-effectiveness of the ASC model. Future studies should use larger populations and prospective study designs.OtherThe protocol for this review was registered with the PROSPERO database (registration number: CRD42023415162).

BackgroundChoosing Wisely Canada recommends against the use of nasal bone X-rays for the evaluation of nasal fractures. The goal of this quality improvement project was to reduce the number of nasal bone X-rays ordered at our institution by 50% by 1 year.MethodsThe Institute for Healthcare Improvement Model for Improvement was used, and a pre- and post-intervention study was conducted. Change ideas included the following: a clinical decision support tool, provider surveys, and education. The number of X-rays ordered monthly was monitored. Financial cost (labor, materials, and overhead) was assessed. Environmental impact was extrapolated based on carbon dioxide equivalent emissions (CO₂e). Balancing measures included the use of computed tomography (CT) scans. Analysis included summary statistics, statistical process control charting, and unpaired t-tests.ResultsThere was a 73% reduction in total X-rays ordered from 197 pre-intervention (September 2021-November 2022) to 58 post-intervention (December 2022-February 2024). There was a statistically-significant decrease in difference of means of 2.6 X-rays/month (4.9 vs 2.3, pre vs post; P < .001), an average monthly reduction of 53%. There was special cause variation after implementation. Cost savings was $5534.98, and environmental footprint reduction was 111.2 kg of CO₂e. There was no compensatory increase in the number of CT scans ordered.ConclusionImplementation of a clinical decision support tool and education resulted in a significant reduction in the number of nasal bone X-rays ordered for the evaluation of nasal fractures. This Choosing Wisely Canada project ultimately reduces unnecessary investigations for patients, saves health care costs, and reduces environmental impact.

ImportanceAdvancements in medical education have led to the adoption of virtual learning. Certain medical fields, including Otolaryngology-Head and Neck Surgery (OHNS), are underrepresented in undergraduate medical education curricula. LearnENT, an OHNS educational app, addresses this gap and has gained a global user base through its active social media presence.ObjectivesTo investigate the efficacy of the LearnENT social media team in disseminating OHNS educational resources and engaging users.DesignA longitudinal observational study with data collection conducted over an 8 month period surrounding the implementation of the social media team.SettingThe study utilized 2 platforms: Instagram Business tools and the LearnENT application dashboard.ParticipantsInstagram followers and LearnENT app users globally, with data segmented by demographics and professional backgrounds.Exposures or InterventionAnalysis of Instagram Business data, including trends in followers, accounts reached, accounts engaged, impressions, and activity on the LearnENT application dashboard.Main Outcome MeasuresFollower demographics, audience activity patterns, account interactions, and app usage trends.ResultsThe Instagram account achieved a 49.7% increase in followers (900 total) over 8 months. Engagement metrics showed an 87% rise in accounts reached and a 70% increase in impressions. App usage increased by 12%, reaching a total of 8257 users across 36 countries. Key content types, such as "Question of the Week," received the highest engagement rates.ConclusionThe LearnENT social media team has effectively disseminated OHNS educational resources and engaged learners, as evidenced by a 49.7% increase in followers and 12% increase app users.RelevanceThe global reach and diversity of the LearnENT Instagram community highlight its potential to connect individuals worldwide. Strategies to further enhance engagement include creating visually-appealing graphics, addressing audience preferences, and collaborating with other OHNS-related accounts.

ObjectiveThere is a lack of consensus regarding postoperative care for pediatric patients with obstructive sleep apnea (OSA) following adenotonsillectomy. At our institution, all patients with severe OSA are routinely admitted to the pediatric intensive care unit (PICU), raising concerns about the optimal use of health care resources. The objective of this study was to identify the risk factors necessitating PICU admission for pediatric patients who underwent adenotonsillectomy for OSA.MethodsAn 8 year retrospective cohort study was conducted at a tertiary care pediatric hospital among consecutive patients with confirmed OSA undergoing adenotonsillectomy. All patients for whom a preoperative PICU request was made were included. A patient requiring PICU-level care was defined as needing respiratory support, such as intubation, positive pressure ventilation, or high-flow nasal cannula.ResultsA total of 112 medical charts were included in the analysis. Only 13 patients (11.6%) had respiratory complications requiring PICU-level care. No preoperative or intraoperative variables were predictive of need for PICU. Early-postoperative need for supplemental oxygenation (P = .002, OR = 6.7) and respiratory retraction (P < .000, OR = 27.4) were significant predictors of PICU-level airway escalation. Nearly all patients (11/13) requiring escalated airway measures were identified in the first 4 hours postoperatively.ConclusionA small subset of subjects with OSA required PICU-level care after adenotonsillectomy. Our data suggest that pediatric patients with OSA undergoing adenotonsillectomy may be safely monitored outside of an ICU setting for an extended period before determining eventual care setting.