Journal of Otolaryngology - Head & Neck Surgery最新文献

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.

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.