OTO Open最新文献

Objective: Otolaryngology (OTO) remains one of the most competitive surgical specialties, with limited residency positions. In 2021, a 25-program preference signaling system was introduced to enhance communication between applicants and programs. This study evaluates how signaling affects application metrics.

Study design: Retrospective database study.

Setting: Texas Seeking Transparency in Application to Residency (STAR) program, 2021 to 2024.

Methods: Statistical analysis in R (v4.3.3) included descriptive statistics, ANOVA for comparing continuous variables across match years, and T-tests to assess differences between matched and unmatched groups.

Results: From 2021 to 2024, there were 393 respondents, representing 26.77% of all OTO positions. Preference signaling use among matched applicants rose from under 25% in 2021 to 95.7% in 2024. Nonsignaling applicants had more publications (6.31 ± 3.74 vs 5.30 ± 3.78, P < .01) and volunteer experiences (7.82 ± 3.15 vs 6.00 ± 3.42, P < .001) than signaling applicants. Step 2 scores were similar between groups. Applications per applicant declined from 75.93 ± 31.79 in 2021 to 48.16 ± 23.55 in 2024.

Conclusion: Applicants with fewer traditional strengths, such as research and volunteering, were more likely to match using preference signaling. Strategic signaling may improve chances of matching into OTO. The decline in application numbers suggests growing trust in the signaling process from both applicants and programs.

Objective: To understand the content of patient calls after functional rhinoplasty and to evaluate artificial intelligence chatbots' ability to provide accurate, intelligible, and safe responses.

Study design: Retrospective review.

Setting: Tertiary-care institution.

Methods: A single-institution, retrospective review was conducted for patients who underwent functional rhinoplasty between 2017 to 2023. Postoperative calls and messages prior to first follow-up were analyzed, and 48 representative prompts were generated, including 6 "Red Flag Questions" indicating potential complications. Prompts were input into 4 chatbots (ChatGPT, Claude, Perplexity, and Gemini). Two independent, blinded experts graded responses using a Likert-style Global Quality Scale (GQS) and a binary Expert Opinion Question (EOQ; "Would you feel comfortable if your patient received this response rather than speaking with your staff?"). Flesch-Kincaid (FK) Grade Levels measured readability. Chi-square and Mann-Whitney U tests compared chatbot performance.

Results: Of 378 patients, 137 (36%) initiated contact, with 181 total calls. Common concerns included pain (19%) and medication questions (14%). Seventy-three percent (n = 132) received routine counseling, with no complications at first follow-up. ChatGPT produced "Good" or "Excellent" responses 98% of the time, significantly outperforming the next-best chatbot (Perplexity, 79%; P = .0039). Experts unanimously approved ChatGPT responses (mean EOQ = 1) 96% of the time, and 100% for Red Flag Questions. Perplexity was the most readable (median FK 13.2), and ChatGPT the least (16.8; P < .0001).

Conclusion: Patient calls are common after functional rhinoplasty. Most can be managed with reassurance. Chatbots, especially ChatGPT, provide reliable responses, which may improve satisfaction and reduce workload without compromising safety. Future development should focus on readability.

Objective: While one-fifth of eligible candidates use hearing aids (HAs), a smaller proportion of eligible candidates receive a cochlear implant (CI), partly due to cost and knowledge gaps. This study aims to quantify internet relative search volumes (RSVs) as a general awareness proxy for HAs and CIs around relevant events.

Study design: Retrospective infodemiologic study.

Setting: Google searches from 2004 to 2024.

Methods: Using Google Trends, we performed Welch's t-tests to compare average HA and CI RSVs (search volume relative to comparator search volume from 0%-100%) during event and non-event periods.

Results: From 2004 to 2024, HA RSV increased from 37% to 100% while CI RSV remained below 13%. Some federal announcements such as hybrid CI approval (Mar 2014; P < .045) and a new over-the-counter HA category (Oct 2021; P < .001) coincided with significantly increased CI and HA RSVs, respectively, while others like the Nov 2024 federal announcement stating when all cell phones must have wireless connectivity with HA (P = .099) and CI (P = .777) did not. Similarly, some public awareness campaigns like "Hearing 20/20" (P < .001 for HA and CI) and Feb 2024 International CI Day (P < .001) coincided with significantly increased RSVs, while others like the Feb 2009 (P = .093) and Feb 2023 International CI Days (P = .327) did not.

Conclusion: This study highlights that, unlike increasing search activity around HAs, CIs have not exhibited the same substantial changes in search volume, aside from brief spikes around certain campaigns. These findings underscore the need for more effective and sustained public outreach strategies to improve hearing device awareness.

Objective: Exposure to otolaryngology throughout medical school is variable, with the majority of students receiving their first exposure in clerkships. This shortens the match timeline for students who pursue otolaryngology and decreases learning opportunities for all students. The aim of the current study is to assess the impact of an otolaryngology curriculum for preclinical medical students.

Study design: Pre-post.

Setting: This study was conducted among preclinical students at the UNC SOM in fall 2022 and fall 2024.

Methods: Students participated in an otolaryngology education curriculum including a surgical simulation session, anatomy demonstrations, and career exploration lectures. Surveys before and after the simulation were used to assess understanding of concepts, procedures, and interest in otolaryngology, consisting of multiple-choice and Likert scale questions. Pre-survey and post-survey results were compared.

Results: A total of 39 students completed the pre-survey, and 37 completed the post-survey. Roughly half of these students (58%) had prior exposure to otolaryngology, most commonly research (34.6%) and shadowing (30.8%). Of those that completed both surveys, there was a statistically significant improvement in understanding of otolaryngology concepts and procedures (P < .05). Students reported that these sessions increased their interest in (4.25/5) and understanding of (4.38/5) otolaryngology, anatomy (3.88/5), and ear, nose, and throat (ENT) conditions (4.16/5).

Conclusion: Early, intentional exposure to otolaryngology not only fosters student interest in the specialty but also improves their understanding of otolaryngologic care. Medical educators should aim to provide focused, early exposure to medical students regardless of their specialty interest to enhance both specialty knowledge and general medical competence.

Level of evidence: 4.

Objective: Sterile water irrigation is anecdotally noted as a method to lyse pleomorphic adenoma (PA) cells in the surgical bed and reduce the rate of recurrence if the tumor is ruptured. Surgeons often presume that the hypotonicity of water lyses residual tumor cells in the surgical bed; however, its effect on the viability of tumor cells remains unclear. This study aims to determine if water causes increased tumor cell death compared to saline.

Study design: Prospective, laboratory-based study.

Setting: Tertiary academic center.

Methods: Surgically resected PA biospecimens were processed into a single-cell suspension and made into cell lines. Cells were exposed to sterile water or saline for 5, 10, or 15 minutes at room temperature (26°C), 37°C, or 44°C. After exposure, samples were analyzed for cell death by flow cytometry. Additional tumor cells were cultured after saline or water exposure to assess proliferation by tracking time to confluence. Three additional tumors were exposed to water or saline immediately after processing into cell suspensions, then cultured to determine time to confluence.

Results: Exposure of PA cells to water induced cell death and prevented cell proliferation in vitro. Higher water temperatures and longer exposure times further reduced cell viability in one cell line.

Conclusion: Study findings support the anecdotal claims that water irrigation can reduce the recurrence of PAs by increasing tumor cell lysis and suggest that the use of water irrigation might help to eliminate residual disease in the surgical bed. Further investigation is needed to confirm these results.

Objective: To evaluate the clinical and histopathological advantages of a modified technique-In Saline Coblation Adenoidectomy (ISCA)-over conventional coblation adenoidectomy (CCA) in pediatric patients, with respect to intraoperative efficiency, tissue preservation, and postoperative outcomes.

Study design: This study was designed as a prospective, randomized, single-blind trial. Patients were randomly assigned to two groups, Group A "CCA" and Group B "ISCA," each consisting of 25 children. Following the approval of the Medipol University Ethics Committee, patients who underwent adenoidectomy or adenotonsillectomy were included in the study.

Setting: In Group A, adenoid tissue was ablated using the coblator's built-in irrigation system. For Group B, the nasopharynx and, partially, the oral cavity were continuously filled with saline solution delivered via the nasal passage. Excess fluid was aspirated from the mouth using a dedicated suction tip. This ensured that the endoscope and coblator tip remained immersed in saline throughout the procedure.

Methods: A prospective, randomized, single-blind study was conducted involving 50 pediatric patients who underwent either conventional coblation (Group A, n = 25) or ISCA (Group B, n = 25). Operative time, intraoperative blood loss, postoperative pain scores, and wand-related issues were recorded. Histopathological analysis of adenoid specimens was performed to assess tissue integrity and thermal injury. Patients were followed for 6 to 18 months postoperatively for recurrence and complications.

Results: ISCA significantly reduced operative time compared to CCA (24 ± 5.8 minutes vs 33 ± 8.5 minutes; P < .05). Wand tip clogging and secondary wand use were observed only in Group A. Histopathological analysis revealed greater epithelial preservation and reduced carbonization in Group B (92% vs 0%; P < .001). Postoperative complications such as transient velopharyngeal insufficiency and localized infection occurred exclusively in Group A, whereas no statistically significant difference in recurrence or residual tissue was noted between the groups.

Conclusion: The ISCA technique offers clear clinical advantages over conventional coblation by improving procedural efficiency, minimizing collateral thermal injury, and eliminating wand-related delays. These findings support its wider adoption in high-volume pediatric otolaryngology settings.

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.