Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceePrescriptions are associated with increased patient satisfaction, decreased provider burden, decreased administrative costs, and a positive impact on planetary health. However, ePrescription uptake by physicians is historically low and acts as a barrier to reaping the benefits therein.ObjectiveWe aimed to attain 20% overall usage of ePrescriptions in the Department of Otolaryngology-Head and Neck Surgery (OHNS) at the London Health Sciences Centre (LHSC) by December 2023 through systematic implementation of change ideas.DesignPre-post intervention design.SettingAmbulatory clinics in OHNS at LHSC, an academic hospital.ParticipantsFourteen staff and 15 resident physicians in OHNS; 38 patients in pediatric otolaryngology clinic.Intervention or ExposureA root-cause analysis identified potential obstacles to ePrescribing. Change ideas, including educational seminars, surveys, quarterly reporting of ePrescription usage, and public encouragement of top ePrescribers in the department, were implemented and tested using Plan-Do-Study-Act cycles.Main Outcome MeasuresPercent ePrescription usage and carbon footprint savings associated with ePrescriptions were measured. Provider and patient satisfaction surveys were conducted as balancing measures to assess for the perception of increased burden on providers.ResultsDuring the pre-intervention and post-intervention phases, a total of 400 and 1000 ePrescriptions were prescribed by the department, respectively. There was a statistically-significant increase in the mean proportion of ePrescriptions used before (mean: 9.7%; sd = 7.6) and after (mean: 40.7%; sd = 6.4) the intervention (p < 0.001), which exceeded the goal. SPC charting suggested special cause variation, signifying a statistically-significant improvement. Additionally, a reduction of 125.9 lbs of CO₂ equivalents was associated with ePrescription use. 66.7% of providers rated overall satisfaction with ePrescriptions at 7/10 or higher, and 76.9% indicated that patients either sometimes, usually, or always opted for ePrescriptions when given the choice.Conclusion and RelevantOur change ideas increased ePrescription usage in an academic OHNS department and were associated with increased planetary health savings and provider satisfaction.

ImportanceChronic refractory cough (CRC) has a negative impact on the quality of life of sufferers and is difficult to treat. Although previous studies have documented various treatment methods for CRC, no treatment method has proven fully effective.ObjectiveThis study investigated the treatment efficacy and adverse effects of neuromodulators (NM), Amitriptyline and Gabapentin, in the treatment of CRC, and the factors that predicted outcomes.DesignProspective data review.SettingPrivate otolaryngology clinic.ParticipantsThis study included 103 successive patients (72 female, 31 male) during the period between 2013 and 2023. Mean age of patients was 56.6 years (standard deviation: 13.5; range: 21 to 83).InterventionAll patients received treatment using NM, including Amitriptyline and Gabapentin.Main Outcome MeasuresCough Severity Index (CSI) and the Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ). The minimal important difference (MID) in CSI was calculated and used as the threshold to determine response to NM treatment.ResultsA MID of 7 or more in CSI was regarded as a response to NM χ₍₁₎² = 4.813; P = .028. Using this criterion, 55.6% responded to NM therapy. Chemical triggers significantly predicted responses to NM [χ₍₁₎² = 4.813; P = .028] while thermal, mechanical, and abnormal throat sensation triggers were not significant predictors of response. Pretreatment CSI was a significant predictor of response to NM [χ₍₁₎² = 5.603; P = .018]. Pretreatment NLHQ, citric acid cough threshold result, and response to superior laryngeal nerve blocks did not predict response to NM. Seventy percent of patients undergoing NM therapy experienced at least one adverse effect.Conclusion and RelevanceThe findings appeared to imply the therapeutic effects of neuromodulators on CRC, especially in patients presenting with chemical triggers. However, the adverse effect was a factor that may impact on application of this treatment method.Level of Evidence: 3.

ImportanceSudden sensorineural hearing loss (SSNHL) is associated with metabolic syndrome, central obesity, and albumin level. Malnutrition may adversely affect recovery in older patients with SSNHL, yet its clinical relevance remains underexplored.ObjectiveThis study investigated the associations of the geriatric nutritional risk index (GNRI) with clinical outcomes in older patients (age >65 years) with SSNHL.DesignObservational retrospective study.SettingTertiary academic medical center.ParticipantsA total of 328 patients aged over 65 years who were diagnosed with SSNHL were retrospectively enrolled. Patients were included if they had complete clinical, audiometric, and laboratory data, including serum albumin levels and anthropometrics for GNRI calculation.Intervention/ExposuresThe primary exposure was the GNRI, calculated using body weight, height, and serum albumin. All patients received steroid treatment for SSNHL.Main Outcome MeasuresThe primary outcome was hearing recovery, categorized as favorable or unfavorable based on clinical audiometric improvement.ResultsAmong older patients with SSNHL, 107 (32.62%) and 221 (67.38%) had favorable and unfavorable outcomes, respectively. Vertigo, worse initial level of hearing loss, and low GNRI were mainly associated with unfavorable hearing outcomes in older patients with SSNHL. Furthermore, low GNRI (<99) was linked to unfavorable clinical outcomes (odds ratio [OR] = 1.91, P = .0151). Multivariate logistic regression revealed that vertigo (aOR = 3.45, P = .0002), worse initial level of hearing loss (per 1 unit increase in hearing loss elevates the risk of poor hearing recovery by 2%, P = .0015), and low GNRI (aOR = 1.79, P = .0435) were associated with unfavorable clinical outcomes.ConclusionIn summary, evaluation of nutritional status plays a crucial role in improving clinical outcomes in SSNHL. Moreover, GNRI can predict clinical outcomes in older patients with SSNHL treated with steroids. Older patients with SSNHL who have vertigo, a worse initial level of hearing loss, and low GNRI exhibit unfavorable outcomes.RelevanceGNRI is a simple, accessible marker that can help identify older SSNHL patients at higher risk of poor recovery. Future prospective studies should validate its use as a prognostic tool and explore whether nutritional interventions can improve hearing outcomes.

ImportanceSalivary gland tumors (SGTs) are rare and heterogeneous, necessitating improved prognostic tools to optimize patient management.ObjectiveTo evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in distinguishing between benign and malignant SGTs, identifying tumor stage, and predicting survival and adverse events.DesignSystematic review conducted according to PRISMA guidelines.SettingPublished clinical studies from tertiary care centers and academic hospitals globally, retrieved from electronic databases (PubMed/MEDLINE, Embase, and Cochrane Library).ParticipantsIncluded studies focused on adult and pediatric patients with histologically-confirmed SGTs. Eligibility criteria encompassed all original research articles reporting NLR values related to diagnosis or prognosis of SGTs.ExposureThe exposure of interest was the NLR, evaluated pretreatment in relation to tumor type (benign vs malignant), tumor stage, survival, and adverse treatment outcomes.Main Outcome MeasuresPrimary outcome: prognostic performance of NLR regarding overall survival and disease stage.ResultsSeventeen original studies were included, with a median cohort size of 123 patients (range: 20-1989). The mean NLR was 2.86 for distinguishing benign versus malignant SGTs, 2.23 for early-stage versus late-stage malignancy, and 3.62 across different malignant histologic subtypes. An NLR below the cutoff value of 2.51 was significantly associated with improved overall survival (P < .05). A higher cutoff of 3.95 correlated with the presence or absence of grade ≥3 adverse events (P < .05).ConclusionsNLR shows promise as a cost-effective, noninvasive biomarker to stratify malignancy risk, assess tumor stage, and predict prognosis and treatment-related toxicity in both adult and pediatric SGT populations.RelevanceThese findings support the integration of NLR into routine pretreatment evaluation protocols for SGTs. Future prospective, multicenter studies are necessary to validate standardized cutoff values for clinical use and to further investigate its role in personalized treatment strategies.

ImportanceThe necessity of adjuvant radiotherapy in patients with pT1-2N1-2b oropharyngeal squamous cell carcinoma (OPSCC) remains unclear.ObjectiveTo examine the prognostic role of adjuvant radiotherapy in patients with either p16-positive or p16-negative pT1-2N1-2b OPSCC.DesignRetrospective study.SettingSurveillance, Epidemiology, and End Results database.ParticipantsPatients diagnosed between 2010 and 2015 with either p16-positive or p16-negative T1-2N1-2bM0 OPSCC who received primary surgery with neck dissection with or without adjuvant radiotherapy were screened for inclusion.InterventionPrimary surgery with neck dissection with or without adjuvant radiotherapy.Main Outcomes and MeasuresOverall survival (OS) and disease-specific survival (DSS) were main outcomes. The overlap propensity score weighting method was applied to account for known confounding. Cox regression analysis and weighted cox regression analysis were used to calculate the hazard ratio (HR) and 95% confidence interval (CI).ResultsA total of 247 patients with p16-negative OPSCC (median follow-up duration: 39 months; 3-year OS: 84.9%; 3-year DSS: 89.5%) and 1175 patients with p16-positive OPSCC (median follow-up duration: 35 months; 3-year OS: 95.3%; 3-year DSS: 96.7%) were included. Adjuvant radiotherapy was associated with improved OS [weighted HR (95% CI): 0.37 (0.17-0.79)] and DSS [weighted HR (95% CI): 0.34 (0.13-0.88)] in pT1-2N1-2b p16-negative OPSCC. No prognostic role of adjuvant radiotherapy was observed in pN1 subgroup of p16-negative OPSCC [weighted HR (95% CI) for OS: 0.89 (0.20-4.06); weighted HR (95% CI) for DSS: 1.12 (0.19-6.71)]. Adjuvant radiotherapy was associated with improved OS [weighted HR (95% CI): 0.34 (0.18-0.62)] and DSS [weighted HR (95% CI): 0.30 (0.14-0.64)] in pT1-2N1-2b p16-positive OPSCC. Subgroup analyses of p16-positive OPSCC, including pN1, pN2a-2b, and positive lymph nodes ≤4 subgroups, supported that adjuvant radiotherapy had positive prognostic role.Conclusions and RelevanceConsistent with the National Comprehensive Cancer Network guidelines, patients with pT1-2N2a-2b OPSCC should receive adjuvant radiotherapy (regardless of p16 status), while patients with pT1-2N1 p16-negative OPSCC could consider omitting adjuvant radiotherapy. Patients with pT1-2N1 p16-positive OPSCC may benefit from adjuvant radiotherapy.

ImportanceNasal septal deviation (NSD) and rhinosinusitis (RS) are common conditions with overlapping symptoms, yet they require distinct treatment approaches. Clarifying their relationship is essential to guide preventative management strategies.ObjectiveTo examine the association between NSD and RS.DesignSystematic review following the PRISMA guidelines. Embase, MEDLINE, and Web of Science were searched from inception to January 2025.ParticipantsStudies were included if participants were adults (≥18 years); studies conducted exclusively in pediatric populations were excluded.Main Outcome MeasuresAssociation between NSD and RS based on prevalence, NSD severity, and mean nasal septal angle (NSA), as well as overall study quality and risk of bias.ResultsA total of 34 studies were included, of which 26 reported NSD and 8 reported RS as their primary outcome. Among the studies reporting on NSD, 17 assessed prevalence, of which 7 (41.2%) demonstrated an association with RS; 5 assessed severity, of which 2 (40.0%) demonstrated an association between moderate/severe NSD and RS; and 10 assessed mean NSA, of which 3 (30.0%) demonstrated an association with RS. All studies reporting on RS assessed prevalence, of which 4 (50.0%) demonstrated an association with NSD. Overall, 16/40 (40.0%) individual outcome measures indicated an association between NSD and RS. A risk of bias analysis identified 12/34 (35.3%) studies as low risk. Of these, 5/17 (29.4%) individual outcomes measures demonstrated an association between NSD and RS.ConclusionThe current body of evidence reveals an inconclusive relationship between NSD and RS. Variability in definitions, diagnostic criteria, and outcome measures, combined with insufficient control for bias, limit the ability to draw definitive conclusions.Relevance:We propose standardized reporting guidelines to ensure consistency across studies and enable more meaningful comparisons. Implementing this framework may ultimately support the development of preventative strategies to optimize patient outcomes.PROSPERO registration numberCRD42024514049.

ImportanceMost French Olfactory Questionnaires are time consuming, which may affect the patient participation.ObjectiveTo validate a short French version of the Olfactory Disorders Questionnaire (Fr-ODQ).DesignProspective controlled study.SettingMulticenter study.ParticipantsPatients with long-lasting olfactory dysfunction (OD) treated with platelet-rich plasma into the olfactory clefts and asymptomatic subjects.InterventionDevelopment and validation of a short ODQ.Main OutcomesIndividuals completed the full Fr-ODQ. The Threshold, Discrimination, and Identification (TDI) test was performed in OD patients. A combined statistical analysis was performed to determine the most informative items of the Fr-ODQ to develop a shorter version. The internal consistency was determined with Cronbach's alpha. The reliability and external validity were evaluated through a test-retest approach and by correlating with the Fr-ODQ. Both the minimal clinically important difference (MCID) and the threshold of the short ODQ version were determined.ResultsA total of 263 patients (173 [65.8%] females) and 129 controls (92 [71.3%] females) completed the evaluations. The mean age of patients was 51.2 ± 15.3 years. The mean duration of OD was 42.4 ± 54.3 months. The biostatistical models selected 10 essential items composing the Fr-ODQ-10. The baseline Fr-ODQ-10 was significantly correlated with the TDI (r_s = 0.228; P = .001) and the Fr-ODQ (r_s = 0.875; P = .001), demonstrating high external validity. Fr-ODQ-10 was significantly lower in controls compared to OD patients (P = .001), highlighting high internal validity. The internal consistency was good (α = .796). The external consistency was adequate, with significant correlations between the test-retest Fr-ODQ-10. The Fr-ODQ-10 significantly decreased from baseline to 4 months post-treatment. A Fr-ODQ-10 score >7.5 was considered abnormal (sensitivity: 84.8%, specificity: 84.2%). The MCID of Fr-ODQ-10 was established at >3.Conclusion and RelevanceThe Fr-ODQ-10 is a valid and reliable clinical instrument, demonstrating correlation with the psychophysical olfactory assessment.

ImportanceLimited evidence exists to guide the safe use of radiotherapy (RT) and concurrent disease-modifying antirheumatic drugs (DMARDs) in patients with collagen vascular disease (CVD).ObjectiveTo describe toxicity outcomes in patients with CVD receiving intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC) and to evaluate whether concurrent DMARD use is associated with increased toxicity.DesignRetrospective cohort study.SettingSingle academic tertiary care center in the United States, from 2005 to 2022.ParticipantsTwenty-three adult patients with CVD [eg, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), dermatomyositis (DM)] and biopsy-proven HNC treated with curative-intent IMRT. Eligibility required available treatment records and ≥90 days of follow-up post-RT.Intervention or ExposuresDefinitive or postoperative IMRT for HNC. Exposure of interest was concurrent use of DMARDs during RT.Main Outcome MeasuresRates of acute (≤90 days) and late (>90 days) grade ≥2 and ≥3 toxicities, as graded by CTCAE v5.0. Fisher exact tests were used to compare toxicity rates by DMARD use.ResultsMedian follow-up was 56 months (IQR 9-98). Most common CVDs were RA (39%), SLE (17%), and DM (17%). Median RT dose was 66 Gy (range 48-70 Gy); 39% received concurrent chemotherapy. Acute grade ≥3 toxicity occurred in 35% (n = 8) and late grade ≥3 in 13% (n = 3). No grade ≥4 toxicities were observed. DMARD use during RT was not associated with higher rates of acute or late grade ≥2 or ≥3 toxicity (P > .1 for all comparisons).ConclusionsIMRT was associated with moderate rates of severe toxicity in patients with CVD, but DMARD use during RT did not increase risk.RelevanceConcurrent DMARDs may be safely continued during IMRT for HNC in patients with CVD. Prospective studies are needed to confirm these findings and refine risk stratification by CVD subtype and treatment regimen.

ImportanceThere are many methods for pediatric voice assessment, but each has its own limitations. Currently, there are few studies that have compared the outcomes of subjective and objective evaluation methods in children with voice disorders.ObjectiveTo apply and compare the pediatric Voice Handicap Index (pVHI) with acoustic analysis in pediatric benign voice disorders.DesignCase-control study.SettingThis study was conducted at a single institution.ParticipantsPediatric participants with and without benign voice disorders were included from August 2021 to April 2023.Intervention or ExposuresThe questionnaire results for the pVHI were obtained, and acoustic analysis was conducted.Main Outcome MeasuresThe main outcomes included the pVHI scores, acoustic parameters, and the Pearson Correlation Coefficient.ResultsOut of the 338 participants, 160 children were diagnosed with voice disorders, whereas 178 did not exhibit such conditions. The total scores and those of each subscale were significantly higher in the patient group than in the control group (P < .05). Significant differences were also observed in the fundamental frequency (228.13 ± 66.78 vs 253.65 ± 47.21), jitter (2.08 ± 2.59 vs 2.42 ± 1.75), shimmer (8.52 ± 5.78 vs 9.44 ± 3.69), harmonic to noise ratio (HNR) (0.50 ± 0.68 vs 0.65 ± 0.19), s/z ratio (1.46 ± 1.89 vs 0.99 ± 0.44), and maximum phonation time (6.08 ± 3.38 vs 7.82 ± 2.50) (P < .05). When comparing the types of diseases, the physical dimension of the pVHI (17.43 ± 7.02 vs 15.29 ± 6.92 vs 13.32±7.71) and the HNR (0.39 ± 0.16 vs 0.41 ± 0.21 vs 0.75 ± 1.24) were most negatively affected in the vocal fold polyps group. Moderate to strong correlations were shown among the pVHI total and each subscale scores (P < .05), while the highest r score was shown between the physical and the total scores of the pVHI (r = 0.882).Conclusions and RelevancePediatric patients with voice disorders exhibit more severe voice handicaps in both pVHI scores and acoustic parameters. The total score of the pVHI is moderately to strongly correlated with each subscale, whereas no strong correlation was presented between different acoustic parameters or between acoustic parameters and pVHI scores. This indicates that the two evaluation methods are not interchangeable; thus, a comprehensive evaluation is essential in clinical practice to prevent bias.