Journal of Otolaryngology - Head & Neck Surgery最新文献

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.

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.

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.

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.