OTO Open最新文献

Objective: We sought to determine the incidence and outcomes of head and neck cancer (HNC) among patients with schizophrenia.

Study design: Cohort study utilizing TriNetX, a database containing millions of deidentified clinical records.

Setting: Multicenter study utilizing records from 68 healthcare organizations.

Methods: A cohort of patients with schizophrenia was analyzed for the annual incidence of HNC diagnosis between 2011 and 2021. TriNetX was queried for adult patients with HNC with and without schizophrenia (or long-term antipsychotic use, as a surrogate). Cohorts were 1:1 propensity-matched based on sociodemographic variables to produce matched cohorts of 25,077 patients each. Outcomes included mortality, recurrence in lymph nodes and lung, systemic treatment, failure to thrive, and hospice enrollment. Outcomes are reported as hazard ratio (HR; Cox proportional hazards model) and odds ratio (OR) with 95% CI.

Results: Incidence of HNC in patients with schizophrenia peaked at 0.061% in 2012. HNC patients with schizophrenia have a significantly increased risk of mortality (HR 1.37, 95% CI 1.10-1.72), locoregional recurrence (OR 1.36, 95% CI 1.30-1.43), distant metastases to the lung (OR 1.72, 95% CI 1.59-1.87), chemotherapy (OR 4.26, 95% CI 3.88-4.69), radiation (OR 2.47, 95% CI 2.19-2.78), failure to thrive (OR 2.41, 95% CI 2.32-2.73), and hospice enrollment (OR 3.17, 95% CI 2.66-3.76) compared to HNC patients without schizophrenia.

Conclusion: HNC patients with schizophrenia have a significant increase in risk of mortality, recurrence, and poor outcomes compared to those without schizophrenia. These findings support a renewed focus on ensuring safety nets for this vulnerable population to ensure appropriate cancer screening and care.

Objective: Cochlear implants (CI) are surgical devices used for rehabilitation of sensorineural hearing loss. More individuals are receiving CIs as technology and surgical techniques improve and candidacy guidelines expand. Despite growing public awareness, CI utilization remains low. Understanding sentiment regarding these devices is important. Reddit is a text-based website wherein posters interact on specialized forums, "subreddits." R/Cochlearimplants allows for unique CI sentiment analysis.

Study design: A search was done from October 2024 to November 2024 on r/Cochlearimplants.

Setting: Internet.

Methods: Posts were sorted by highest engagement. Metadata regarding date, comments, and upvotes were collected. Sentiment was analyzed using TextBlob and VADER, Python library Natural Language Processing tools.

Results: Four hundred and twenty unique posters made 1068 total entries. Entries spanned 2019 to 2024, the majority in 2024 (51%, n = 543). VADER found the majority of entries positive (n = 562, 52.9%) while TextBlob found the majority neutral (n = 928, 87%). Sentiment distribution over time was significantly different (P < .001), with more negative sentiment in 2024 than 2019 to 2023. Negative VADER entries had significantly higher word counts (P < .001). Positive VADER entries had higher upvotes (P < .001).

Conclusion: Sentiment regarding CI remains more nuanced than can be gleaned from this analysis, including cultural and ethical issues. This study demonstrates that sentiment on r/Cochlearimplants is generally neutral or positive, trending relatively more negative over time. This could suggest negativity towards CIs is growing with increased utilization. Awareness of online sentiment may help providers understand patient perspectives and dispel misinformation.

Objective: Remote access techniques in thyroid surgery have been developed to improve cosmetic outcomes, based on the presumed impact of surgical scars on patients' quality of life (QoL). This systematic review aimed to evaluate the impact of surgical scars on the overall QoL of patients who have undergone thyroidectomy for low-risk thyroid carcinoma. The review focuses on the rank of scar-related QoL issues relative to other aspects assessed by validated QoL instruments.

Data sources: MEDLINE, EMBASE, CENTRAL, LILACS, Google Scholar (no language or time restrictions).

Review methods: A systematic review was conducted for original articles using validated QoL instruments with scar-related domains in thyroid cancer patients who had undergone OT. Study quality was assessed using the JBI critical appraisal tool for cross-sectional studies. Data were analyzed from 14 patient groups across 9 studies, representing 3658 patients.

Results: In 12 of 14 samples, scar-related issues ranked lower than sixth place in QoL assessments, with 7 samples placing scar-related items at the lowest position. The Thyca-Qol questionnaire was the most commonly used tool, though most studies had limitations, including selection and recall biases. However, across geographically and culturally diverse populations, scar-related concerns consistently ranked lower in importance compared to other QoL factors.

Conclusions: The impact of surgical scars on QoL in thyroid cancer survivors is low, with scar-related items ranking among the least significant issues. Remote access techniques designed primarily for cosmetic outcomes should demonstrate additional benefits to justify their use.

Objective: To evaluate the analgesic efficacy and safety of local anesthetic infiltration in the tonsillar fossa using ropivacaine compared to bupivacaine in pediatric patients undergoing tonsillectomy.

Data sources: CENTRAL, PubMed, Web of Science, Scopus, and Google Scholar.

Review methods: Eligible randomized controlled trials (RCTs) were evaluated for risk of bias using Cochrane's Risk of Bias Tool (RoB-2). The primary outcome was postoperative pain within the first 24 hours following tonsillectomy. Secondary outcomes included the time to first analgesic requirement and complication rates (ie, bleeding, airway obstruction, local anesthetic toxicity, and nausea). Data were synthesized using the standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes, both reported with 95% confidence intervals (CI).

Results: Seven RCTs with a total of 375 patients were analyzed. Regarding posttonsillectomy pain scores, there was no significant difference between ropivacaine and bupivacaine at 1 hour (SMD = -0.01, 95% confidence interval [CI] [-0.36, 0.34]), 2 hours (SMD = 0.03, 95% CI [-0.45, 0.51]), 4 hours (SMD = -0.17, 95% CI [-0.39, 0.06]), 6-8 hours (SMD = 0.04, 95% CI [-0.38, 0.46]), and 12 hours (SMD = -0.23, 95% CI [-0.62, 0.15]). However, at 24 hours, ropivacaine demonstrated a superior effect compared to bupivacaine (SMD = -0.23, 95% CI [-0.43, -0.03]). There was no significant difference between ropivacaine and bupivacaine in terms of time to first analgesia and complication rates (P > .05).

Conclusion: This meta-analysis demonstrated that ropivacaine and bupivacaine offer comparable clinical analgesic efficacy and safety profiles in pediatric patients undergoing tonsillectomy.

Objective: Evaluate the utility of high-resolution esophageal manometry (HREM) in patients with symptoms of oropharyngeal dysphagia (OD) but unremarkable Modified Barium Swallow Studies (MBSS).

Study design: Retrospective cohort study.

Setting: Tertiary academic center.

Methods: A retrospective review was conducted on patients with symptoms of oropharyngeal dysphagia from January 2021 to December 2024. Demographics, symptoms, and Charlson Comorbidity Index scores were recorded. Patients with unremarkable MBSS then underwent HREM. HREM data based on the Chicago Classification V 3.0 were analyzed, including mean residual upper esophageal sphincter (UES) pressure, median lower esophageal sphincter (LES) pressure, and ineffective swallow rates, using T-tests, and Chi-Squared tests.

Results: Among 29 patients (mean age 53.2 years, 48.7% female), HREM findings showed mean residual UES pressure of -0.5 mmHg, median residual LES pressure of 13.9 mmHg, and 22.9% ineffective swallows. Esophageal pathologies (ineffective esophageal motility or esophagogastric junction outflow obstruction) were identified in 58.6% of cases. Symptom-specific differences in esophageal motility disorders were not statistically significant.

Conclusion: HREM identified esophageal pathologies in 58.6% of patients with OD symptoms and normal MBSS, highlighting its value in the diagnostic workup of oropharyngeal dysphagia. The overlap of symptoms between oropharyngeal and esophageal motility disorders supports integrating HREM for comprehensive evaluation.

Level of evidence: 4.

Objective: To evaluate the clarity of retraction notices in otolaryngology journals and examine the relationship between retraction notice clarity and improper post-retraction citations.

Study design: A retrospective analysis of retracted articles in otolaryngology journals from journal inception to August 1, 2024.

Setting: Articles were selected from leading otolaryngology journals with citation data retrieved from major academic databases.

Methods: Retracted articles were identified using the Retraction Watch Database. Citation patterns were analyzed through Google Scholar and Scopus. Retraction notices were evaluated for adherence to Committee on Publication Ethics (COPE) guidelines. The study included 80 retracted articles, with 1398 citations in Google Scholar and 714 in Scopus. Primary outcomes included the proportion of retraction notices meeting COPE guidelines and the rate of improper post-retraction citations.

Results: Retraction notices adhered to COPE guidelines in 52.5% of cases (N = 42). Among 80 retracted articles, only 42.5% were labeled as retracted across all platforms. Alarmingly, 98.2% of citations that occurred after articles were retracted did not acknowledge their retracted status. Clearer retraction notices correlated with fewer improper citations. Proper labeling across all platforms led to a 52.89% reduction in citation rates, whereas any missing labels resulted in only a 28.72% reduction.

Conclusion: Clarity in retraction notices significantly impacts improper citation rates. Standardized, prominently displayed retraction notices adhering to ethical guidelines can reduce misinformation. Strengthening retraction practices and improving database integration are recommended to enhance the effectiveness of retractions and maintain scientific integrity.

This article presents an innovative approach to adenoidectomy training through the development of a 3-dimensional (3D) printing model, termed e-A.L.Ex (endoscopic-adenoidectomy learning experience). Adenoidectomy, a common procedure in otolaryngology, has evolved with the integration of endoscopic techniques, necessitating precise training methodologies. The model, created from computed tomography scans and utilizing 3D printing technology, accurately replicates anatomical structures crucial for adenoidectomy. Surgical simulation with bovine thymus mimics adenoid tissue, providing a realistic training experience. Collaboration with a 3D printing company ensured the model's development, emphasizing ethical considerations, and obtaining institutional approval. The discussion highlights the model's significance in enhancing surgical education and addressing the learning curve associated with endoscopic procedures. Overall, the e-A.L.Ex model represents a pivotal tool in advancing endoscopic adenoidectomy training, with implications for improving surgical outcomes.

Objective: Literature describing disparities in chronic rhinosinusitis (CRS) often analyzes race, gender, or socioeconomic status (SES) in isolation. Analyses encompassing a comprehensive range of disparities remain lacking. We conducted a systematic review to provide a detailed characterization of the CRS disparity landscape.

Data sources: A systematic review was conducted in Covidence adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search of PubMed/MEDLINE, CINAHL, Scopus, etc. was performed for literature published through September 2024.

Review methods: A total of 690 publications were identified and screened by two authors independently. In total, 26 ultimately met the inclusion criteria. Studies were classified by pertaining health disparity (race, gender, SES, age, and geographic region) and reported outcomes (incidence, severity, and treatment choice).

Results: In total, 26 studies on CRS disparities were published from 2012 to 2024. 16 focused on SES, describing that lower SES was associated with reduced treatment adherence, resulting in poorer endoscopic findings and quality of life. 14 studies examined racial/ethnic disparities. Hispanic patients were more symptomatic than non-Hispanic patients, whereas black patients had fewer health visits, leading to worse outcomes. Other studies discussed the impact of gender, age, and/or geographic region (n = 9, 4, 4, respectively). Findings included higher symptom burden among female patients and higher CRS incidence in regions of air pollution. Only three studies proposed solutions to disparities.

Conclusion: Most literature on CRS disparities describes the influence of SES and race on disease presentation and progression. Other disparities related to gender, age, and geographic region were identified. Further research should uncover root causes and propose detailed solutions to advance equitable care in CRS.

Objective: Sinus headache is a common complaint that can be due to chronic rhinosinusitis (CRS) or non-rhinogenic facial pain/pressure (NRFP). The purpose of this study is to characterize over-the-counter (OTC) medications used for sinus headache.

Study design: Cross-sectional study.

Setting: Tertiary care academic center.

Methods: Patients presenting with midfacial pain or pressure to a rhinology clinic were surveyed on how often they utilized common OTC medications, with choices ranging from "always" to "never." Patients were categorized into CRS or NRFP groups based on endoscopy and imaging.

Results: The study included 251 patients, with 69.3% female and a mean (standard deviation) age of 49.9 (15.7) years. Patients with CRS (n = 114) reported symptom relief "sometimes" to "always" when using pain relievers (38.6%), intranasal steroids (37.7%), and oral antihistamines (36%). Patients with NRFP (n = 137) responded "sometimes" to "always" with the use of intranasal steroids (49.6%), decongestants (48.9%), and pain relievers (45.3%). A greater proportion of NRFP patients responded "sometimes" to "always" for decongestants to relieve symptoms compared to CRS patients (P = .011). There was no significant difference in other OTC medications between groups.

Conclusion: Patients with midfacial pain or pressure reported using a variety of OTC medications for symptomatic relief. Decongestants were more frequently associated with symptom improvement in patients with NRFP. This finding indicates that symptomatic relief with decongestants may suggest a diagnosis of NRFP.