OTO Open最新文献

Objective: Recurrent acute rhinosinusitis (RARS) significantly decreases quality of life. Transplant recipients (TR) are particularly vulnerable to rhinologic conditions. There is a lack of guidelines for managing RARS in this population. Our study aims to determine the prevalence of and risk factors for RARS among TR and assess the need for sinus surgery within this group.

Study design: Retrospective cohort.

Setting: Mayo Clinic between 2017 and 2022.

Methods: A total of 1116 patients met the inclusion criteria and were divided based on the presence or absence of a new incident RARS diagnosis during the posttransplant period and frequency of sinus surgery. Logistic regression (LR) analysis was performed to identify the odds ratio.

Results: In total, 111/1116 (9.95%) had RARS. Patients with RARS had an increased history of asthma, viral infection, and rheumatoid arthritis (RA) (P = .003) in the pretransplant period. According to the LR analysis, patients with neutropenia, RA, and mantle cell lymphoma were 1.91, 2.71, and 4.02 times more likely to develop RARS (95% CI: 1.19-3.05, P = .01), (95% CI: 0.90-8.14, P = .07), and (95% CI: 1.16-13.89, P = .02) during the posttransplant period, respectively. In those that developed RARS, only 5.5% failed medical therapy and required surgery.

Conclusion: This is the first cohort to investigate the incidence of RARS in TR and the predictive factors associated with its development posttransplant. We found that patients with pretransplant comorbidities such as RA, viral infections, hematologic deficiencies, and malignancies were at an increased risk for developing RARS, though this is not linked to an increased necessity for sinus surgery.

Objective: To identify clinical and polysomnographic factors predicting poor long-term positive airway pressure (PAP) compliance in patients with obstructive sleep apnea (OSA) in a Southeast Asian population and to develop a simple risk model applicable in routine practice.

Study design: Retrospective cohort study.

Setting: Songklanagarind Hospital, Thailand, from January 2012 to December 2022.

Methods: Adult OSA patients aged 18 to 65 years prescribed PAP therapy were included. Adherence was objectively recorded from device downloads. Good adherence was defined as ≥4 hours per night on ≥70% of nights at 12 months. Logistic regression identified predictors of poor long-term adherence.

Results: A total of 343 patients were enrolled; 253 had follow-up data at 12 months. Good adherence was observed in 47.8% of patients. In multivariate analysis, age < 50 years (odds ratio [OR] 1.92; 95% CI 1.01-3.67; P = .046) and poor short-term adherence (OR 4.47; 95% CI 2.33-8.72; P < .001) independently predicted poor long-term adherence. The resulting "AP" model (Age and Poor early adherence) achieved an area under the curve of 0.73 (95% CI 0.66-0.79), with a high specificity of 94%.

Conclusion: Although predictors of PAP adherence have been described in Western populations, this study provides the first large data set from Thailand. The AP model, while simple, is pragmatic and easily applied in resource-limited settings. Prospective, multicenter validation across Southeast Asia is warranted to enhance its generalizability and incorporate modifiable predictors.

Objective: Glucagon-like peptide 1 receptor agonists (GLP-1RA) have shown remarkable results in glycemic control for patients with type 2 diabetes (T2DM). While no association has been made, there is a concern for thyroid cancer (TC) from GLP-1RA. We aimed to study the 5-year risk of TC in T2DM patients taking GLP-1RA.

Study design: Retrospective cohort.

Setting: TriNetX database.

Methods: TriNetX was queried to identify T2DM patients between 2017 and 2019. The 5-year risk of TC in patients using GLP-1RA was compared to patients taking sodium-glucose cotransporter 2 inhibitors (SGLT-2I), metformin, and dipeptidyl peptidase 4 inhibitors (DPP-4I) after propensity score matching by demographics and comorbidities.

Results: On analysis of T2DM patients taking GLP-1RA compared to SGLT-2I, 7736 patients were in each cohort after matching. The 5-year rate of TC in patients taking GLP-1RA was 0.30% compared to 0.48% in those taking SGLT-2I (RR 0.62 (95% CI 0.37-1.05); P = .07). Analysis of GLP-1RA versus metformin yielded 5158 patients in each cohort. Patients taking GLP-1RA had similar rates of TC compared to those taking metformin (0.25% vs 0.39%; RR 0.65 (95% CI 0.32-1.31); P = .22). A comparison of GLP-1RA versus DPP-4I yielded 12,570 patients in each cohort. The rate of TC was not increased in those taking GLP-1RA compared to those taking DPP-4I (0.33% vs 0.37%; RR 0.91 (0.60-1.39); P = .67).

Conclusion: T2DM patients taking GLP-1RA may not have an increased 5-year risk of TC compared to those taking metformin, SGLT-2I, or DPP-4I. Conclusions of long-term use are limited as most GLP-1RA were approved within the last decade.

Objective: Signaling was introduced to the otolaryngology match in 2021, with 5 signals allotted to applicants in 2021, 4 in 2022, 7 in 2023, and 25 in 2024. This study investigated the modifying effect of signaling volume on the relationship between away rotations and matching in otolaryngology from 2018 to 2024.

Study design: Cross-sectional.

Setting: National survey of US medical students.

Methods: We used the Texas Seeking Transparency in Application to Residency (STAR) survey responses of otolaryngology applicants from 2018 to 2024. Using multivariate logistic regression, we determined the odds of matching where away rotations were performed and how these odds varied across the pre-volume (2018-2020), low-volume (2021-2023), and high-volume (2024) signaling eras.

Results: In total, 28.3% (n = 855) of otolaryngology applicants from 2018 to 2024 completed the Texas STAR survey. Using multivariate logistic regression, adjusting for applicant characteristics, and including an interaction term between performing away rotations and signaling time period, applicants in the high-volume signaling era were found to be significantly less likely to match at programs where away rotations were performed (odds ratio [OR]: 0.56, 95% CI: 0.33-0.95; P < .05) compared to the pre-signaling era. The same trend was seen in the low-volume signaling era, though not statistically significant (OR: 0.76, 95% CI: 0.47-1.22, P = .24). The most impactful factor on matching across all study years was performing an away rotation (OR: 12.1, 95% CI: 9.0-16.5, P < .001).

Conclusion: The introduction of signaling and the recent increase in signal number are associated with decreased likelihood of matching at a program where an away rotation was performed compared to the pre-signaling era.

Level of evidence: V.

Objective: To analyze the temporal trends and turning points of thyroid cancer burden in China from 1990 to 2021 and project future incidence and mortality to 2035.

Study design: Cross-sectional study.

Setting: Data were sourced from the Global Burden of Disease 2021 database.

Methods: Temporal trends were evaluated using Joinpoint regression, and associations between cancer burden and sociodemographic indices were explored through frontier analysis. A Bayesian Age-Period-Cohort model was applied to project future disease burden through 2035.

Results: In 2021, China reported 48,104 new thyroid cancer cases and 7692 deaths. From 1990 to 2021, the age-standardized incidence rate (ASIR) and prevalence rate (ASPR) increased markedly (average annual percentage change [AAPC]: 2.98% and 2.25%, respectively), whereas the age-standardized mortality rate (ASMR) and disability-adjusted life year rate (ASDR) declined (AAPC: -0.65% and -0.56%). A pivotal shift occurred around 2005: while ASMR and ASDR continued to decrease in both China and globally, China's ASIR and ASPR accelerated further, contrasting with a global deceleration. Projections indicate that China's ASIR for thyroid cancer is expected to increase more rapidly than the global average over the next 15 years.

Conclusion: The thyroid cancer burden in China is characterized by rapidly rising incidence and stagnating mortality decline, a pattern distinct from global trends and likely driven by intensified detection. This escalating burden necessitates public health strategies focused on optimizing screening practices and managing overdiagnosis.

Objective: While the etiology of Meniere's disease (MD) is likely multifactorial, genetics are thought to play a role. Several previous studies have yielded inconclusive results, potentially due to phenotypic uncertainty and variable diagnostic criteria. To explore potential genetic bases in a more rigorous context, we assessed the clinical predictors and diagnostic yield of current hearing loss panels in a highly curated cohort of patients with bilateral and/or early-onset MD.

Study design: Retrospective cohort study.

Setting: Multidisciplinary tertiary care hearing loss genetics clinic.

Methods: Data from clinical notes, audiograms, and genetic reports of adult patients diagnosed with bilateral and/or early-onset (<40 years) MD from October 2019 to June 2025 were analyzed with logistic regression and summary statistics to determine predictive factors and diagnostic yields of existing genetic panels.

Results: Of the 37 patients analyzed (mean age 47.7 + 14.5 years, 54% male), 24 (64.8%) had early-onset MD, 22 (59.5%) had bilateral MD, and 9 (24.3%) had both. Moderately severe to profound hearing loss prior to 65 was significantly associated with pathogenic or likely pathogenic variants (PLPV) (OR 8.98 [1.17, 101]; P = .046). No significant predictors were found for definitive diagnosis, plausible diagnosis, or negative panels. Eight (22%) patients had a PLPV detected on their hearing loss panel, with 0 definitive diagnoses, 3 (8.1%) plausible diagnoses (MYO15A, SLC17A8, P2RX2), and 6 (16%) completely negative panels.

Conclusions: Current hearing loss panels show limited diagnostic utility for MD. Future research should prioritize whole genome sequencing to identify novel MD-associated loci and provide guidance to patients.

Objective: When medical management fails to solve skin flap complications following cochlear implantation (CI), same-sided reimplantation may be attempted using revision flaps that provide viable, vascularized tissue. This systematic review assesses long-term outcomes and complications of the most prevalent skin flaps in revision CI.

Data sources: PubMed, Web of Science, and Embase.

Review methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, each database was queried from inception to December 15, 2024 for articles describing revision CI after skin flap failure. A qualitative synthesis of postoperative complications and long-term outcomes was employed for selected studies.

Results: Of an initial 1878 abstracts screened, 12 studies met the inclusion criteria, amounting to 69 flap revisions following CI. Thirty-four revisions were performed after wound breakdown or skin necrosis at the implant site. Among the 7 studies that reported initial incision shape for their cohort, 5 used C-shaped, 1 used inverted U, and 1 used lazy S. Of the 11 articles that described their revision flap technique, 8 used a rotational flap. Three of these studies also used temporoparietal fascia flaps (TPFF). There were 9 revision flap failures (13.4%). Successful techniques included the rotational flap with either TPFF or free flap supplementation when required for coverage.

Conclusion: The current data shows that skin flap revision for CI reimplantation is a feasible option following original flap failure; however, surgeons should take care to plan appropriately for each patient's unique anatomy and available viable tissue.

Objective: Early and integrated palliative care (PC) interventions are recommended for advanced-stage cancers. The rate with which patients with stage IV oral cavity squamous cell carcinoma (OCSCC) receive PC as part of their oncologic care is unknown. We sought to understand the utilization of PC for patients with stage IV OCSCC in Medicaid expanded versus non-expanded states.

Study design: Retrospective cohort.

Setting: National Cancer Database was queried for patients with stage IV OCSCC from 2004 to 2017.

Methods: Patients in Medicaid expanded (EXP) states were categorized as pre-expansion (pre-EXP) or post-expansion (post-EXP). Patients in nonexpanded states (NEXP) were categorized as diagnosed before 2014 (pre-NEXP) or during/after 2014 (post-NEXP). Multivariable logistic regressions were used to compare receipt of PC among pre-EXP and post-EXP patients, and separately among post-EXP and post-NEXP cases.

Results: Among 15,356 patients who met inclusion criteria, 629 (4.10%) received PC. There was a trend towards increased receipt of PC in post-EXP compared to pre-EXP cases, but this did not reach statistical significance. Among pre-EXP and post-EXP cases, patients were more likely to receive PC with the lowest income quartile, tongue cancer as the oral cavity subsite, and no insurance.

Conclusion: There was no significant difference of PC receipt for patients with stage IV OCSCC in Medicaid expanded versus non-expanded states. Results among patients in pre-EXP and post-EXP states suggest increased PC use among more disadvantaged patient groups. Further analysis on receipt of PC in vulnerable patient populations with advanced-stage cancer is warranted.

Objective: To determine whether exposure to monopolar electrosurgery during subsequent surgeries following Bonebridge implantation has negative impact on the implant.

Study design: Retrospective study.

Setting: Tertiary medical center.

Methods: Fifty-six patients who received Bonebridge implantation between December 2014 and June 2024 were reviewed. Twelve patients with exposure to monopolar electrosurgery during subsequent operation were included. Bonebridge-aided sound field thresholds, as well as subjective outcomes based on patient experience were analyzed to determine if there are any adverse effects on the implant after monopolar electrosurgery exposure.

Results: The mean age at receiving Bonebridge implantation and subsequent operation were 15.1 ± 6.8 (range, 7.7-29.9) years and 16.5 ± 6.5 (range, 10.2-30.1) years, respectively. Each of the included patients experienced one episode of monopolar electrosurgery exposure after Bonebridge implantation. All monopolar electrosurgery exposures were in the head-and-neck region, but none of them involved the ipsilateral temporoparietal area. The mean pre-monopolar electrosurgery and post-monopolar electrosurgery Bonebridge aided sound field thresholds pure tone average were 31.8 ± 3.3 decibel hearing level and 29.5 ± 3.9 decibel hearing level, respectively (Wilcoxon signed-rank test, P = .203). No adverse events associated with implant malfunction occurred after monopolar electrosurgery exposure.

Conclusion: No adverse events or hearing impairment were observed in this series of Bonebridge-implanted patients who underwent operations involving monopolar electrosurgery. Notably, the exposures were of relatively brief duration and limited to areas outside the ipsilateral temporoparietal region. Further multicenter, prospective studies with larger cohorts and comprehensive adverse event analysis are warranted to better corroborate these findings.