Journal of Otolaryngology - Head & Neck Surgery最新文献

IntroductionOtolaryngologists were among the physicians with the highest risk of exposure to SARS-CoV-2, and more than half of them reported anxiety and distress during the pandemic. Consequences of this experience on retirement plans among otolaryngologists are unknown. This study aimed to describe the effect of the pandemic on retirement plans among otolaryngologists.MethodsA cross-sectional survey assessed retirement plans of physicians in the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) between May and June 2023. Participants were recruited through CSOHNS membership lists. Respondents shared demographic information and rated 4 pandemic-related factors and 13 independent factors on a 5-point Likert scale from least important to most important in influencing retirement.ResultsEighty-two members responded, of which 20 (24.4%) were females. All female participants were 65 or younger, whereas 25 (40.3%) males were 65 or older. Half of the participants were in academic practice; 39% reported no change to their anticipated retirement date prior to the pandemic, whereas 25% reported either earlier or later dates. A greater proportion of female otolaryngologists reported earlier dates of retirement than originally planned compared with males (40% vs 19.3%). The factors most commonly rated as "important" were the desire for time with loved ones (mean: 3.82, SD: 1.179), the desire to improve their quality of life (mean: 3.65, SD: 1.344), and increased workload (mean: 3.26, SD: 1.210). Significant differences were observed between genders and age groups (≤55 years vs >55 years) regarding increased workload, desire for improved quality of life, personal and loved ones' health concerns, pandemic-related concerns, psychological/emotional issues, and burnout (P < .05).ConclusionsPandemic-related factors play a limited role in retirement decisions made by otolaryngologists. More females reported earlier retirement dates after the pandemic, which may further exacerbate preexisting gender inequalities in the otolaryngology workforce.

ImportanceIn different types of carcinoma, sex has a strong impact on risk factors, diagnosis, treatment, and outcomes. Previous studies have reported that female patients with head and neck carcinoma (HNC) have better survival.ObjectiveThis study aimed to analyze sex differences in tumor regression and survival, as well as host- and disease-related factors.DesignA retrospective cohort study.SettingTertiary Care, University Hospital.Participants1115 patients registered in the Head and Neck Tumor Registry of the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck were included.Main Outcome MeasuresSeveral host- and disease-related factors were analyzed to determine possible sex differences.ResultsThis study included 1115 patients with HNC, of whom 78.6% (n = 876) were men and 21.4% (n = 239) were women. There were no differences in tumor regression or incident cases per year in our department between male and female patients with HNC. Statistically significant sex differences were found for tumor site (P < .001), Union for International Cancer Control (UICC) stage (P = .04), treatment modality (P = .027), alcohol consumption (P = .005), and alcohol cessation (P < .001).Conclusions and RelevanceThis study revealed significant sex differences in patients with HNC. Female patients with HNC were characterized by a higher percentage of oral carcinoma, lower UICC tumor stage, single treatment modality, and less alcohol consumption than men.

ObjectiveTo study whether the ability to detect frequency changes or temporal gaps at the early phase postactivation can predict speech perception performance at the late phase postactivation in postlingually deafened cochlear implant (CI) users.MethodPsychophysical tests and event-related potential (ERP) tests were conducted at the third-month postactivation (early phase postactivation, T1) and after 1-year postactivation (late phase postactivation, T2) in 27 postlingually deafened CI users. CI hearing thresholds and speech perception performance were measured at T1 and T2. The frequency change detection threshold (FCDT) and gap detection threshold (GDT) were obtained through psychophysical tests. The evoked threshold, amplitude, and latency of auditory change complex response, evoked by frequency change or temporal gap stimuli, were investigated using ERP tests.ResultsCompared with T1, speech perception performance was significantly better at T2, but there was no significant difference in the psychophysical or ERP test results. Speech perception performance at T2 could be predicted by GDT at T1, but not by FCDT or ERP indicators at T1. Receiver-operating characteristic curve analysis suggested that the GDT at T1 may be moderately accurate in discriminating between good and poor speech perception groups at T2.ConclusionCompared to early phase postactivation, CI users' ability to detect frequency changes or temporal gaps did not change significantly at the late phase postactivation, but speech perception performance improved significantly. The early GDT can predict later speech perception performance of CI users.Level of EvidenceIII.

ImportanceUnlike other head and neck cancers, head and neck soft tissue sarcoma (HN-STS) is staged similarly to sarcomas in the trunk and extremities. The current American Joint Committee on Cancer (AJCC) staging system has limitations that hinder accurate prognosis prediction for HN-STS.ObjectiveWe aimed to develop a novel location-grading-node-metastasis (LGNM) staging system based on the primary tumor location to more accurately stratify prognosis for HN-STS.DesignA retrospective case series from 1990 to 2021.Setting/ParticipantsThis study included 471 patients diagnosed with HN-STS at Sun Yat-sen University Cancer Center between 1990 and 2021.Main outcome measuresIn the primary analysis, we obtained the overall survival (OS) rate. Secondary measures included area under the receiver operating characteristic curve, Harrell's C, Somers' D, Gönen and Heller's K, O'Quigley's ρ2k, Royston's R², the Bayesian information criterion for concordance, and variation in patient outcomes.ResultsThe eighth edition of AJCC T classification for tumor size inadequately conveys prognosis information. In contrast, the primary tumor location and local invasion are prognostic factors for HN-STS and categorized into 4 stages: L1 (low risk: scalp, face, supraclavicular, ear), L2 (intermediate risk: neck, paravertebral, pharynx, tonsil, eye, orbit), L3 (high risk: cavity, lip, palate, buccal mucosa, salivary gland, maxilla, mandible), and L4 (any location with local invasion). The new LGNM staging system effectively distributed patients into stages I to IV, with statistically-significant survival differences among these stages. Five-year OS rates were 96.9% for stage I, 78.4% for stage II, 37.1% for stage III, and 7.1% for stage IV (P < .001). Additionally, the LGNM staging system demonstrated superior predictive ability and concordance compared with the seventh and eighth editions of AJCC staging systems.Conclusions/RelevanceThe LGNM staging system shows better homogeneity and discriminatory power than the AJCC system, improving risk stratification and prognosis prediction in HN-STS.

Importance: Perineural invasion (PNI) is an established prognostic factor in oral squamous cell carcinoma (OSCC), but the impact of its subcategories on survival is not fully understood. This study quantifies the number and diameter of PNI foci to assess their prognostic relevance in OSCC.

Objective: To evaluate the prognostic significance of PNI subcategories, specifically the number and diameter of PNI foci, as predictors of overall survival (OS) and disease-free survival (DFS) in OSCC patients.

Design: Retrospective cohort study, adhering to STROBE guidelines.

Setting: Single-center study at MacKay Memorial Hospital, Taiwan, including patients diagnosed with OSCC from 2005 to 2018.

Participants: Nine hundred twenty-six patients with biopsy-proven OSCC, excluding those with perioperative mortality or incomplete follow-up.

Exposure: Histological evaluation of PNI, including quantifying the number and diameter of invaded nerves, along with clinicopathological features such as tumor stage and lymphovascular invasion (LVI).

Main outcome measures: OS and DFS, assessed via Cox proportional hazards models, Kaplan-Meier survival analysis, and receiver operating characteristic curve analysis for PNI foci subcategories.

Results: PNI was present in 138 (14.9%) patients and was significantly associated with adverse histologic features, advanced tumor stage, nodal involvement, metastasis, and LVI. Multivariate analysis revealed that both the number of PNI foci greater than 4 and nerve diameters exceeding 0.21 mm were significantly associated with poorer OS and DFS (P < .05). After adjusting for clinical variables, PNI remained an independent predictor of worse OS [hazard ratio (HR): 1.37] and DFS (HR: 1.46).

Conclusions and relevance: PNI is a significant independent prognostic factor in OSCC. Patients with more than 4 PNI foci or nerve involvement greater than 0.21 mm in diameter experienced significantly worse survival outcomes. These findings suggest that detailed assessment of PNI subcategories should be incorporated into OSCC management, guiding treatment decisions and potentially informing the need for adjuvant therapies.

Objective: Surgical training programs have a high prevalence of trainee stress and burnout. Formal mentorship programs (FMP) have been shown to alleviate these factors and improve quality of life (QOL) in short-term follow-up. This study aims to determine the long-term effects of an FMP on the well-being of a single-center cohort of surgical trainees.

Methods: A voluntary FMP was established at a surgical training program comprised 8 resident physicians. To quantitatively measure stress and burnout, the Perceived Stress Survey (PSS) and Maslach Burnout Inventory (MBI) were administered at baseline, 3, 6, 9, 12, 18, and 24 months. The World Health Quality of Life-Bref Questionnaire (WH-QOL) was administered at baseline, 12 and 24 months.

Results: Baseline levels of stress and burnout were high among all residents with an average PSS of 18.5 and MBI of 47.6, 50.6, and 16.5 for the emotional, depersonalization, and personal achievement domains respectively. After FMP implementation, PSS was reduced to 7.9 at 12 months (P = .001). These scores were sustained at 24 months (6.8, P = 1). MBI scores improved in emotional exhaustion (14.9, P < .0001), depersonalization (20.1, P < .0001), and personal achievement (40.1, P < .0001) at 12 months. All these benefits were sustained at 24 months. Baseline overall WH-QOL scores reflected low QOL (71.9). These significantly improved at 12 months (37.5, P = .002) with further improvement by 24 months (17.2, P = .03).

Conclusion: Long-term follow-up of a previously successful academic surgical FMP showed lasting improvements in stress, burnout, and overall QOL, despite new life challenges.

ImportanceLong wait times for medical care have been exacerbated following the pandemic in many health systems. Single-entry models (SEMs) have been proposed as a strategy to manage growing surgical backlogs and increase timeliness and quality of care by creating a single queue and centralizing the referral triage process.ObjectiveThe primary objective was to evaluate the perceptions of SEMs among community otolaryngologists for managing surgical backlogs. The secondary objectives were to better understand their experiences with the current system and to investigate their recommendations for implementing an SEM.DesignInterpretive Description.SettingOntario, Canada.ParticipantsNine community-based otolaryngologists.Intervention/ExposuresNot available.MethodsVirtual semi-structured interviews were conducted with study participants. Data were independently analyzed using inductive and deductive methods by multiple team members. Results were triangulated, and a final coding framework was developed collaboratively from which themes were identified.Main Outcome MeasuresPerceptions of SEMs as well as recommendations for design and implementation.ResultsThree thematic domains and 9 subdomains were identified from our interview data: (1) factors affecting the utility of SEMs; (2) opinions and buy-in of physicians; and (3) opportunities to improve equity.Conclusions and RelevanceWe identified a number of factors that should be considered in supporting community-based otolaryngologists to adopt SEMs as a strategy for ensuring timely and equitable access to care. Clinical leaders and specialty organizations play a pivotal role for such changes to succeed. Implementing SEMs may be an important step toward increasing equity, quality, efficiency, and cost-effectiveness in otolaryngology.

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).

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.