Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceInterest in equity, diversity, and inclusion (EDI) in medicine is growing, with women now making up 54% of Canadian physicians under the age of 40. Despite this, women in surgery remain underrepresented, facing challenges such as professional isolation. In response, a Women in Surgery in (WISE) Ear Nose and Throat (ENT) group was created to foster EDI. This is the first journal club of its kind described in the literature.ObjectiveOur objective was to describe the creation and program evaluation of a WISE group.Design(1) Setting and Intervention: A quarterly journal club meeting was created in a hybrid format to discuss peer-reviewed articles on EDI. Grant funding was obtained from a physician association's wellness budget. (2) Participants: Responses were from members of a Canadian University's otolaryngology mailing list attending these sessions. There were multiple responses from some of the same individuals across the 7 meetings. (3) Outcome Measures: An anonymous web-based survey with Likert-style questions was administered to participants 1 week after each session. General self-efficacy scale (GSES) was also administered. Moore's pyramid of effectiveness in continuing medical education was used as a framework for program evaluation.ResultsEighty-two responses to the survey were collected over 7 meetings. Among the 75 who responded to the gender identification question, 57 (76%) identified as women and 18 (24%) identified as men. Responses included 38 (46%) attendings, 8 (10%) fellows, 29 (35%) residents, and 7 (9%) medical students. Ninety percent of the responses "agreed" or "strongly agreed" that the group promoted collegiality, 82% of the responses "agreed" or "strongly agreed" that the group supported the participants' well-being, and 89% of the responses "agreed" or "strongly agreed" that the group provided a safe environment for discussion. The responses showed that the initiative was rated as outstanding by 48% and above average by 46%. From the responses, the GSES was high at 31.0 ± 4.3.ConclusionsA WISE group has been created and highly rated. This initiative represents one step of the university's ENT division's commitment to EDI.

ImportanceThe genetic variation in patients with sensorineural hearing loss (SNHL) in the Nordic countries has not been previously reported.ObjectivesThe aim was to describe the genetic variation in a Swedish population and identify factors in favor of a high diagnostic yield.DesignThis was a prospective cohort study. Children with bilateral SNHL and adults with bilateral SNHL and clinically suspected genetic SNHL underwent genetic testing. A gene panel with ~200 genes was applied on whole genome sequencing (WGS) data. Variants were classified according to American College of Medical Genetics and Genomics criteria. Personal health data were extracted from medical records.Setting and ParticipantsEighty-five patients (aged 0-73 years) from Lund and Örebro University Hospitals, 2 tertiary referral centers for audiology in Sweden, with mild to profound SNHL.ResultsIn almost half (45%, n = 38) of the cases, a genetic cause was identified across 24 different genes. Eleven cases had syndromic hearing loss. A majority (n = 57) had prelingual onset (<2 years) of SNHL and most of them had moderate-to-profound hearing loss (n = 52). Prelingual onset was associated with higher yield than postlingual onset (OR 6.3, 95% CI 2.1-19.0). In patients with moderate-profound prelingual SNHL, the diagnostic yield was 60% (n = 31/52).ConclusionThis is the first reported cohort of hearing loss patients undergoing genetic testing with WGS from a Nordic country. Early onset of hearing loss favored a higher diagnostic yield than postlingual, and a genetic cause was found in a majority of cases in patients with prelingual, moderate-to-profound SNHL.

ImportanceSingle sided deafness (SSD) results in difficulties for comprehension in noise and spatial localization. Ponto is a percutaneous bone anchored implant (BAI) proposed to improve the auditory benefit in noise.ObjectiveThe main objective was to evaluate the auditory benefit in noise Ponto system brings to patients suffering from SSD. In addition, the complications within the 6 months after Ponto implantation whatever the initial indication were evaluated.DesignRetrospective and multicentric study.SettingThree different French tertiary referral centers.ParticipantsPatients who underwent surgery between 2012 and July 2021 with a Ponto BAI.InterventionAll patients with SSD underwent the speech in noise test, "Vocale Rapide dans le bruit" (VRB) in a condition with the sound signal from the front and the noise from 4 lateral loudspeakers. The test was performed in 2 conditions: aided and unaided. The Bern Benefit in Single-Sided Deafness (BBSS) Questionnaire and a subjective Spatial-Visual Analogic Scale (S-VAS) evaluated the patients' perception of benefits.Main Outcome MeasuresVRB Speech Reception Threshold score, BBSS and S-VAS scores, complications within 6 months after surgery mostly skin complications, chronic pain, and loss of the BAI.ResultsUsing the VRB, a gain of -1.55 dB signal-to-noise-ratio was found with the Ponto system. Moreover, the unaided VRB score was correlated with the unaided/aided difference and by that predicative of BAI treatment benefit. The BBSS showed mean scores between 1.45 and 3.47 for each question and the S-VAS mean score was 3.32. These results confirm a subjective benefit brought to patients especially as 74.3% were without cutaneous complications.ConclusionThe Ponto BAI is a reliable implant and together with a Ponto sound processor it provides good auditory in noise results.RelevanceThe VRB is a useful test for predicting the post-operative results that could be expected after surgery.

ObjectivesThe middle turbinate (MT) was considered related to olfactory function. Whether the MT should be partially resected during relevant surgery is still debated. Our primary objective was to compare the olfactory outcome between partial MT resection (MTR) and MT preservation (MTP).MethodsA search was performed on the Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases from their inception through February 10, 2024. Eligible studies included those that compared the olfactory outcome between partial MTR and MTP. Data were extracted manually, and a random-effects model was used to evaluate it. We calculated the standardized mean differences (SMD) in the scores for the olfactory function. Further subgroup analysis was also performed for variables of interest. The pooled results were examined using influence analysis.ResultsAfter systematically reviewing all relevant articles, 7 studies were qualified for inclusion. The pooled results showed no significant difference in olfaction between the partial MTR and MTP (SMD, 0.140; 95% CI, -0.159 to 0.438; P = .359; I² <1%). Subgroup analysis preferred partial MTR in the objective test (SMD, 0.370; 95% CI, 0.17-0.56; P < .001; I² = 0%). No significance was observed in studies with subjective test (SMD, -0.271; 95% CI, -0.604 to 0.63; P = .112; I² <1%), undergoing functional endoscopic sinus surgery (0.10; 95% CI, -0.35 to 0.54; P = .67; I² = 85%), undergoing skull base surgery with endoscopic endonasal approach (SMD, 0.25; 95% CI, -0.04 to 0.53; P = .09; I² = 0%), and following up more than 6 months (SMD, 0.09; 95% CI, -0.21 to 0.39; P = .57; I² = 75%).ConclusionOur findings showed that MTR does not deteriorate olfactory function compared with MTP. Considering the potential benefit, partial MTR might be prioritized in clinical settings.

ImportanceDuring the COVID-19 [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] pandemic, reports emerged of croup secondary to SARS-CoV-2 in the pediatric population. Children with croup and concurrent SARS-CoV-2 infection seemed to require a greater number of doses of dexamethasone and nebulized epinephrine and were more likely to need hospitalization and intensive care unit (ICU) admission compared to pre-SARS-CoV-2 croup.ObjectiveThis study aimed to compare the outcomes of children presenting with SARS-CoV-2-associated croup and those with conventional croup.DesignObservational, retrospective review.SettingTertiary care pediatric hospital.ParticipantsChildren (age <18 years) presenting with croup between January 2019 and February 2022.ExposureSARS-CoV-2Main outcome measureNumber of doses of dexamethasone and nebulized epinephrine, need for hospital admission, ICU admission, assisted ventilation, and length of stay.ResultsTwo thousand and three hundred ninety-eight children [68.2% male, median (interquartile range) age 25 months (15-42 months)] were included. Twenty-seven patients (1.1%) tested positive for SARS-CoV-2, 467 (19.5%) tested negative for SARS-CoV-2, and 1904 (79.4%) were not tested for SARS-CoV-2. Dexamethasone was given to 27 (100%) SARS-CoV-2-positive and 457 (98%) SARS-CoV-2-negative patients at an average of 1.4 (±1.2) and 1.1 (±1.0) doses, respectively. SARS-CoV-2-positive patients were more likely to require nebulized epinephrine (41%) compared to SARS-CoV-2-negative (12%, OR: 4.2; 95% CI 1.8-9.6, P < .001) patients, and were more often admitted (30%) to hospital than SARS-CoV-2-negative (3.4%) patients (OR: 12; 95% CI 4.4-37.7, P < .001). ICU admission was required for 3 SARS-CoV-2-negative patients, but none of the SARS-CoV-2-positive patients. Length of stay was similar across groups.ConclusionPatients with croup and SARS-CoV-2 infection were found to have an increased need for nebulized epinephrine and an increased frequency of admission to the hospital. However, there was no increased need for ICU admission or longer length of stay in the hospital.Level of EvidenceIII.

ImportancePerioperative efficiency is an increasingly important consideration in head and neck surgery, yet comparative evaluations of surgical techniques for benign parotid tumors remain limited.ObjectiveTo evaluate the perioperative efficiency of extracapsular dissection (ECD) compared to superficial parotidectomy (SP) for benign parotid tumors.DesignSystematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.SettingStudies retrieved from PubMed, Embase, and the Cochrane Library.ParticipantsPatients with benign parotid tumors who underwent either ECD or SP. Fifteen studies encompassing 2399 patients were included.InterventionsECD and SP as primary surgical techniques for the removal of benign parotid tumors.Main Outcome MeasuresParameters related to perioperative efficiency were defined in this study as operative time, anesthesia time, duration of drain placement, length of hospital stay (LOS), and medical costs. Tumor size was also included as a comparative parameter.ResultsECD was associated with significantly shorter operative time [mean difference (MD), -48.95 minutes; 95% confidence interval (CI), -66.40 to -31.50], anesthesia time (MD, -73.17 minutes; 95% CI, -81.61 to -64.73), drain placement duration (MD, -2.10 days; 95% CI, -3.82 to -0.38), and LOS (MD, -0.91 days; 95% CI, -1.34 to -0.48) compared to SP. Tumor size did not significantly differ between groups (MD, -0.14 cm; 95% CI, -0.33 to 0.05).ConclusionsECD demonstrates superior perioperative efficiency compared to SP.RelevanceThese findings support the use of ECD as a more efficient surgical option for benign parotid tumors in appropriately selected patients.

ObjectiveThe aim of this study was to investigate the psychological distress associated with long-lasting COVID-19 olfactory dysfunction (OD).MethodsPatients with an OD lasting for more than 6 months were consecutively recruited from the Dour Medical Center (Belgium) from August 2023 to January 2024. The olfaction was investigated with the Olfactory Disorder Questionnaires (ODQ) and the threshold, identification, and discrimination (TDI) testing. General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to investigate the psychological distress of patients. The olfactory and psychological outcomes of patients were compared with a group of individuals without OD.ResultsA total of 220 patients and 102 asymptomatic individuals completed the evaluations. The mean duration of OD was 31.1 ± 25.1 months. The mean GAD-7 and PHQ-9 scores were significantly higher in OD patients than in asymptomatic individuals (P < 0.008). The OD patient prevalence of mild-to-severe depression (51.2% vs. 44.1%) and mild-to-severe anxiety (39.5% vs. 32.4%) disorders was significantly higher than asymptomatic individuals. Severe anxiety was associated with the presence of anosmia. GAD-7 and PHQ-9 scores were higher in females than in males. The severity of depression (PHQ-9) and anxiety (GAD-7) was significantly associated with the severity of OD (ODQ) and nasal symptoms (SNOT-22).ConclusionThe presence of a long-lasting OD in patients consulting in otolaryngology is associated with psychological distress. While the causality relationship remains unclear, depression and anxiety symptoms must be investigated in this subgroup of patients with long COVID-19.

ImportanceAngelman syndrome is a rare genetic disorder characterized by developmental delay, sleep disturbances, and a happy demeanor. Tonsillectomies are common procedures for individuals with Angelman syndrome, and their postoperative recovery may be complicated by challenging pain assessments, respiratory complications, or feeding difficulties. Inappropriate laughing may mask perioperative pain and anxiety.ObjectiveThe objective of this study is to review postoperative outcomes and complications of children with Angelman syndrome undergoing tonsillectomy.Methods (Design, Setting, Participants, Intervention, Measures)We conducted a retrospective review of patients with Angelman syndrome undergoing tonsillectomies from 2000 to 2024 in a quaternary pediatric hospital. Demographic, clinical, and surgical outcome variables were collected.ResultsTwelve children with Angelman syndrome underwent tonsillectomy: 7 for sleep-disordered breathing, 4 for sialorrhea, and 1 for recurrent tonsillitis. Median (IQR) duration of stay was 4.0 (3.0-5.3) days. The most common reason for prolonged hospital stay was inadequate oral intake. Nine (75.0%) children experienced postoperative complications, most frequently pooling of secretions and oxygen desaturations. Three children (25.0%) experienced severe postoperative complications, including 1 opioid overdose, 1 respiratory distress, and 1 aspiration pneumonia. Two patients were readmitted to the hospital: 1 for irregular breathing and poor pain control, and 1 for epistaxis.ConclusionThe postoperative course following tonsillectomy in children with Angelman syndrome can be complicated by a prolonged recovery, inadequate pain control, opioid toxicity, respiratory complications, and poor oral intake. Caregiver input on pain behavior is critical to develop an effective postoperative management strategy.RelevanceBased on our results and a literature review, we have created recommendations for post-tonsillectomy care in children with Angelman syndrome.

Introduction: Vestibular migraine (VM), particularly its chronic variant, poses a diagnostic challenge. Patients suffering from VM may not have the characteristic headaches associated with the dizziness. In these cases, a marker for migraine pathology in general could help appropriately diagnose certain types of dizziness as migrainous despite these patients not meeting current diagnostic criteria for VM. Migraine patients in general (headache and vestibular) are known to share a tendency toward intolerance of certain stimuli, including busy visual stimuli. True optokinetic stimulation, measured by the production of optokinetic after-nystagmus (OKAN) simulates these busy visual stimuli.

Methods: Prospective observational study comparing response to optokinetic stimulation between migraine patients and controls. Questionnaires regarding general sensitivities to busy visual stimuli were completed prior to beginning the study. Both subjective and objective markers of stress were measured before and after exposure to the stimulus. Initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN were compared between the 2 groups.

Results: The groups differed only with regard to sensitivity to blinking lights and history of motion sickness on initial questionnaire. Regarding subjective symptoms of discomfort, migraine patients tended to report higher scores than controls both before and after testing, but there was no significant difference from before to after stimulus in each group's scores. There were no statistically-significant differences between initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN between groups.

Conclusions: In this study, OKAN measurements were not useful in differentiating migraine patients at large from control subjects. We hypothesize that there may be a distinct subgroup of migraine patients that are more sensitive to visually-disturbing situations that may differ from other migraine sufferers. Future studies will aim to identify such patients and compare them to controls.

BackgroundNew patient referral models are needed to reduce long wait times for otolaryngology surgical procedures, such as a Single-Entry Model (SEM). However, patient perspectives about SEM in otolaryngology remain unexplored.MethodsIn this mixed methods study, a retrospective chart review was conducted to examine the times from referral to consultation (T1) and from consent to surgery (T2) for all elective otolaryngology surgical procedures at a large community hospital between 2020 and 2023. We then conducted journey mapping interviews with 10 patients and parents of pediatric patients who underwent otolaryngologic surgeries to understand their experiences of waiting for their own or their child's procedure, and perspectives on how an SEM might impact patient experiences. Data were analyzed using descriptive statistics and thematic analysis.ResultsWe identified that average wait times among 2414 elective (oncologic and non-oncologic) otolaryngology procedures often exceeded provincial target wait times. On average, oncology procedures had the shortest wait times (T1: 34 ± 47; T2: 101 ± 161 days), and otologic procedures had the longest (T1: 67 + 72; T2: 355 ± 285 days). While patients often did not wait as long to have a consultation with their surgeon, the time between consenting to and receiving surgery tended to drive wait time duration. Patients who had endured extended wait times experienced poor quality of life, worsening symptoms, and often worried about how long they would need to wait. Systems such as an SEM that could shorten wait times were generally well-perceived. However, patients emphasized the importance of trusting relationships with referring physicians and surgeons, which could be an enabling factor for implementing an SEM.ConclusionLong surgical wait times in otolaryngology are negatively impacting patients. A SEM could offer a way to improve patient experiences and outcomes.