Journal of Otolaryngology - Head & Neck Surgery最新文献

Objective: Impacted esophageal foreign bodies (EFBs) are a common but preventable presentation in children, requiring prompt removal in the operating room by esophagoscopy. Our objective was to describe the overall cost of impacted pediatric EFBs and determine factors that increase resource burden.

Methods: A cost analysis of pediatric patients undergoing esophagoscopy for EFB removal from 2010 to 2021 was performed. Characteristics of each EFB, patient transfer, and hospital course were collected. Direct and indirect healthcare costs were calculated using hospital-specific costs and provincial fees. Amounts were calculated in Canadian dollars.

Results: Six hundred and eighty patients were included. The total amount spent on pediatric EFBs from 2010 to 2021 was $2,673,288. The mean total cost per child with an EFB was $3469. An extra hour of delay before Otolaryngology-Head and Neck Surgery (OHNS) consultation at a tertiary hospital corresponded to an $816 cost [95% confidence interval (CI; 244.7-1287.4)]. On average, children requiring transfer to a tertiary care center cost $1965 more than those initially presenting to a tertiary care center (P = .001). Higher-risk EFBs (n = 165, 24%) were associated with a longer hospital stay and greater complication rate and resulted in a $4095 increase in overall cost compared to lower-risk EFBs [$6829 (standard deviation (SD) $11,347) vs $2734 (SD $10,451), P = .02]. Button battery ingestions cost 8.8 times more than non-dangerous EFBs, such as coins. Longer distance for transfer was associated with a higher likelihood of having complications [odds ratios (OR) 1.5, 95% CI (1.1-1.8)].

Conclusion: EFBs pose a significant economic burden to the healthcare system, driven by transfer to a tertiary care center, delays in transfer to the operating room, and high-risk EFBs. It is critical to identify areas for improved efficiency such as increased parental education for primary prevention, early involvement of the OHNS team and improving the capacity of community hospitals to manage EFB to limit transfers when possible.

ImportanceQuality indicators are used to evaluate the quality of healthcare delivery and as a speciality, otolaryngology-head and neck surgery (OHNS) is beginning to transition toward this empirical understanding of healthcare quality and delivery.ObjectiveTo describe the number and quality of studies that have developed novel quality indicators for any subdiscipline in OHNS.DesignWe performed a database search of MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Cochrane Database of Systematic Reviews. We did not employ language or study-type restrictions and included studies published from database inception to October 2024.Study SelectionFollowing abstract screening, 184 articles underwent full-text screen. Eligible studies developed quality indicators in any subdiscipline within OHNS. Article screening and full-text review was performed in duplicate.Data Extraction and SynthesisWe extracted study-specific and methodological data in duplicate. Quality appraisal was assessed using the Appraisal of Indicators through Research and Evaluation instrument.ResultsWe identified 10,592 studies, of which 25 studies developed new quality indicators. Quality indicator development studies primarily focused on otology/neurotology, pediatric OHNS, and head and neck surgery. Few studies investigated facial plastics, rhinology and skull base surgery, and laryngology. Most studies employed Delphi consensus methods and patient engagement was rare. Consensus methodology reporting was poor and indicators were often not validated. Outcome indicators were often measured with fewer studies investigation structure or process indicators.ConclusionsQuality indicators may help standardize and improve patient care in OHNS. Future research should focus on structure and process indicators, while improving reporting, optimizing panel composition, and validating quality indicators.

ImportanceLingual thyroglossal duct cysts (LTGDCs) are rare congenital anomalies that necessitate proactive surgical intervention due to their potential for life-threatening airway obstruction. The challenging anatomical location of LTGDCs complicates their surgical management, and there are currently no standardized surgical modalities in place.ObjectiveTo analyze the clinical features of LTGDCs and evaluate the feasibility, safety, and efficacy of coblation-assisted transoral endoscopic excision of LTGDCs.DesignRetrospective case series (2009-2022) analyzing preoperative, intraoperative, and postoperative data.SettingTertiary academic center.ParticipantsTwenty-nine patients (20 males, 9 females; ages 3-70, with a median age of 34 years) were diagnosed with LTGDCs, including 7 (24.1%) with recurrent LTGDCs following prior surgeries at other institutions.InterventionCoblation-assisted transoral endoscopic excision of LTGDC using FK retractors and a 30° Hopkins telescope for optimal visualization and manipulation.Main Outcome MeasuresComplete cyst excision, postoperative recovery, recurrence rates, complications, and surgical feasibility.ResultsAll LTGDCs were completely excised. During the procedure, it was found that the LTGDCs abutted but did not adhere to the hyoid bone, which allowed for their dissection from the periosteum of the hyoid bone using coblation. Postoperative recovery was uneventful, with an average postoperative stay of 3.1 days (range 1-5 days). No complications, such as bleeding, infection, or airway obstruction, occurred. The mean follow-up period was 5.3 years (range 6 months to 12.4 years), with no recurrences observed during this time.ConclusionsCoblation-assisted transoral endoscopic excision is a reliable, effective, and minimally invasive approach for managing LTGDCs. It ensures complete removal with low recurrence and complication rates, aided by superior visualization and manipulation space provided by FK retractors and a 30° Hopkins telescope.RelevanceThis technique offers a safe alternative to traditional surgeries, reducing trauma and enhancing recovery. Future studies should explore comparisons with other surgical modalities to validate their broader applicability.

ImportanceThe retrograde cricopharyngeus dysfunction (R-CPD) is an emerging topic in otolaryngology, gastroenterology, and primary care.ObjectiveTo review the current literature about the etiology, clinical presentation, and management of retrograde cricopharyngeus dysfunction (R-CPD).DesignSystematic review.SettingThree investigators conducted the PubMED, Scopus, and Cochrane Library review of the literature related to the etiologies and management of patients with R-CPD through the PRISMA statements.ParticipantsStudies that incorporated R-CPD patients.InterventionsIn-office, or operating room botulinum toxin injection, or no treatment.Main outcome measuresEtiology, clinical presentation, and therapeutic outcomes.ResultsSeventeen studies met the inclusion criteria (826 patients). A family history was reported in 28.0% of cases with most patients developing R-CDP symptoms in childhood (55.5%). In addition to the cardinal symptom of the inability to belch, associated complaints of bloating and chest pain, gurgling noises, and excessive flatulence were found in 95.7%, 86%, and 80.2% of cases, respectively.The diagnosis was recognized by patients themselves in 78.9% of cases. The immediate success rate of botulinum toxin injection into the cricopharyngeal sphincter in facilitating burping was 92.5%. Recurrence occurred in the first month of follow-up in 9.5% of cases, whereas 12.6% and 27.9% of patients had recurrence during the 1-5 months and more than 6 months posttreatment, respectively. Transient dysphagia is the most prevalent complication after botulinum toxin injection (31.1%). The heterogeneity was high across studies, limiting the establishment of further combined analyses.Conclusion and relevanceR-CPD is a recently-recognized and likely-underdiagnosed condition associated with severe symptoms affecting the quality of life of patients. Future studies are needed to elucidate the etiology of this condition, develop adequate patient-reported outcome questionnaires for the baseline and follow-up evaluations of symptoms, and propose therapeutic consensus.

ImportanceNeck dissection is a common surgical treatment for patients with oral squamous cell carcinoma (OSCC). Due to the low incidence of level IIb metastases and the risk of injury to the spinal accessory nerve during level IIb dissection, the need for preventive neck dissection of this area has been discussed.ObjectiveThis study aimed to verify the incidence of level IIb metastases in patients with cN0 OSCC and to discuss the need for excision.DesignRetrospective cohort study.SettingThis study was conducted at 3 centers: the Department of Oral and Maxillofacial Surgical Oncology at the Institute of Science Tokyo Hospital, the Department of Oral and Maxillofacial Surgery at Kobe University Graduate School of Medicine, and the Department of Clinical Oral Oncology, Hokkaido Cancer Center.ParticipantsIn total, 222 patients with cN0 OSCC underwent supraomohyoid neck dissection (SOHND) between 2013 and 2021.Main Outcome MeasuresIncidence of level IIb metastases in patients with cN0 OSCC.ResultsLymph node metastasis was confirmed in 57 patients (25.7%). Two patients (0.9%) had level IIb metastasis. The primary site in these cases was the tongue in 1 case and the lower gingiva in the other, both with advanced cT4 primary tumors. Isolated level IIb metastasis was observed in tongue OSCC samples. Both patients with level IIb metastases experienced primary recurrence. The 5 year overall survival rates for pN(-) and pN(+) patients were 80.6% and 74.3%, respectively (P = .229). The 5 year disease-specific survival rates for the pN(-) and pN(+) patients were 89.6% and 77.2%, respectively (P = .057).Conclusions and RelevanceLevel IIb lymph node involvement in clinical N0 neck cancers is rare. Thus, SOHND may be adequate for most patients with OSCC. Therefore, level IIb dissection may be omitted in patients with cN0 in early-stage OSCC.

ImportanceNontechnical skills are crucial in delivering critical and urgent patient care. Through our simulation module, we gear residents and interprofessional personnel with the knowledge and skills necessary to tackle complex airway emergencies and limit human error.ObjectiveDevelop, implement, adapt, and evaluate a novel interdisciplinary and interprofessional crisis resource management (CRM) simulation module for the management of complex airways.DesignSimulation-Based Quality Improvement Project.SettingMcGill University's Arnold and Blema Steinberg Medical Simulation Center and a variety of hospital environments at the McGill University Health Centre in Montreal, Quebec, Canada.Participants138 residents (otolaryngology, anesthesia, pediatric emergency medicine) and allied healthcare professionals (nurses and respiratory therapists) participated in 20 unique scenarios.Intervention or ExposuresFrom 2012 to 2022, modules occurred from 4 to 6 half days per year, structured as 3 to 4 simulation scenarios, each followed by debriefing sessions.Main Outcome MeasuresParticipants completed self-assessment forms evaluating module satisfaction, CRM skill development, and narrative commentary. Quantitative and qualitative data were obtained and analyzed.ResultsParticipants reported a significant perceived increase (P < .05) in all nontechnical CRM skills. Participants without previous CRM training reached comparable levels in CRM skills to those with such training. Increasing involvement of allied healthcare professionals, formal debriefing focused on role clarity, and increasing complexity of scenarios are identified as key elements for stressing CRM skills and consolidating lessons learned.ConclusionsThis module is among the first of its kind in otolaryngology given its interprofessional, longitudinal, and evolving nature, while providing an opportunity for residents to develop nontechnical skills through simulation. Its interdisciplinary and interprofessional nature is a key element to its success.RelevanceThis module aims to translate into positive results in patient safety and patient outcomes in challenging airway management scenarios. Implementing modules as continued medical education may help maintain proficiency overtime.

ImportanceClinicians face great challenges in diagnosing dizziness/vertigo disease due to its subjectivity. Currently, there is an absence of machine learning model that could make full use of the information gained from both medical history and physical signs.ObjectiveTo develop and validate a machine learning model based on medical history and physical signs for dizziness/vertigo disease diagnosis, relieving the burden of diagnosis for clinicians.DesignA retrospective cohort study.SettingTertiary referral center.ParticipantsThis study included 1003 patients conformed to the inclusion criteria at the neuro-otologists' clinics.ExposuresThirty-one medical history items, and 9 bedside examination signs recorded by routinely performing a detailed ocular motor examination using video goggles.Main Outcome MeasuresThe accuracy, precision, recall, F1 scores, and Matthews' correlation coefficient of disease diagnosis.ResultsOn the collected dataset of 16 categories of dizziness/vertigo diseases, the proposed model achieved an accuracy of 98.11% and an F1 score of 95.43%. The model demonstrated its optimal robustness when tested with datasets containing added noise. Additionally, an analysis of the correlation between medical history and signs was conducted, along with several case studies.ConclusionsA machine learning-based model was proposed for the diagnosis of dizziness/vertigo, which effectively combined patients' medical history and signs. In terms of diagnostic accuracy, it outperforms models that rely solely on either medical history or signs for diagnosis.RelevanceThe proposed method can effectively combine the patient's medical history and physical sign information to make the diagnosis of dizziness/vertigo disease, which has the potential to relieve the burden of diagnosis for clinicians to a certain extent.

ImportanceChatGPT has emerged as a medical resource through advanced language processing. Patients with thyroid nodules classified under The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) may use it to complement discussions with physicians.ObjectiveWe aimed to determine whether ChatGPT's recommendations on managing thyroid nodules classified by TBSRTC align with those of experienced thyroid specialists.Setting/ParticipantsA multidisciplinary panel of 5 thyroid cancer specialists, including otolaryngologists and endocrinologists, from 3 university-affiliated teaching hospitals in Montreal, Canada, evaluated the responses.Intervention/ExposureChatGPT-3.5 was prompted with 4 questions for each of the 6 Bethesda categories regarding the meaning and management of thyroid nodules, generating 24 responses for evaluation.Main Outcome/MeasuresWe assessed ChatGPT's accuracy against the latest American Thyroid Association (ATA) guidelines using a 4-point Likert scale (<50%, 50-74%, 75-89%, >90%). Additionally, specialists rated their comfort or reluctance in recommending ChatGPT as a complementary tool for patient discussions.ResultsOf the 24 ChatGPT-generated responses, 19 (79.2%) demonstrated moderate to good consistency with the ATA guidelines. The mean consistency score was 3.38/4 and median was 3.5. Consensus (IQR ≤ 1) was achieved in 23 out of 24 responses (95.8%), reflecting strong inter-rater reliability. Consistency scores were highest in Bethesda I-III and declined progressively in higher-risk categories, with the lowest mean score observed in Bethesda VI. Similarly, an upward trend in clinician reluctance was observed from Bethesda I through VI, indicating greater caution in recommending ChatGPT responses for patients suspicious for or diagnosed with malignancy (Bethesda V-VI).Conclusion and RelevanceWhile ChatGPT's responses generally align with specialist recommendations, they are not fully reliable. ChatGPT lacks the ability to serve as an independent or accurate source of medical advice for thyroid nodule management. It remains a useful complement for patient discussions, especially in low-risk scenarios, but further improvements are necessary to make it a safe, reliable component of patient care in complex cases.