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Objective: Nebulized ciprofloxacin-dexamethasone represents an adjuvant medication utilized following airway surgery. However, minimal objective information exists on this treatment, especially over more extended periods. This study measured the safety, tolerability, and adherence to nebulized ciprofloxacin-dexamethasone utilized in the outpatient setting after endoscopic airway surgery for adult patients.

Study design: Retrospective cohort study.

Setting: Single-institution academic center.

Methods: All patients with laryngotracheal stenosis managed by a single surgeon from 2021 to 2024 who underwent endoscopic airway surgery were included. Patient demographics, stenosis etiology, comorbidities, and ciprofloxacin-dexamethasone prescriptions were documented. Ciprofloxacin-dexamethasone dose, duration of treatment, adherence, tolerability, and side effects were collected. Potential side effects evaluated included allergic reactions, postoperative infections and pneumonia, and Cushingoid symptoms.

Results: Sixty-nine adult patients underwent endoscopic airway surgery to treat laryngotracheal stenosis, and fifty-nine were prescribed nebulized ciprofloxacin-dexamethasone postoperatively. Fifty-two patients (88.1%) filled their prescription and utilized this treatment regimen. Importantly, over 90% (47/52) of this cohort completed the prescribed four-week regimen. Four patients (7.7%) experienced temporary side effects, which dissipated after discontinuation: two altered taste/smell, one nausea/chills, and one blurry vision. No significant complications were reported.

Conclusion: Nebulized ciprofloxacin-dexamethasone is a safe and tolerable treatment for adult patients after endoscopic airway surgery. The majority of patients were able to obtain, adhere to, and successfully utilize this medication in the outpatient setting. This study represents an important step in understanding the tolerability of this adjuvant treatment regimen.

Objective: This study aims to characterize the relationship of esophageal dysmotility on modified barium swallow (MBS) and esophagram studies with high-resolution manometry (HRM), the gold standard of esophageal dysmotility diagnosis, in head and neck cancer (HNC) survivors with dysphagia.

Study design: Retrospective diagnostic accuracy study.

Setting: Specialty dysphagia clinic at a tertiary care center.

Methods: A retrospective analysis of 30 patients treated for dysphagia between 2020 and 2023 was conducted. Inclusion criteria required HNC survivors aged 18 years or older who were diagnosed with dysphagia, treated in a HNC dysphagia clinic, and completed at least one HRM study. Data were collected on patient demographics, cancer history, MBS, esophagram, and HRM studies. MBS and esophagram results were reviewed for evidence of esophageal dysmotility. HRM studies were assessed with the Chicago Classification Version 4.0. Data were summarized and analyzed using t test for continuous variables and a chi-square test for categorical variables. McNemar's test and diagnostic odds ratios were calculated to compare diagnostic test results.

Results: Of the 30 patients reviewed, 20 (67%) showed dysmotility on HRM, 15 (50.0%) completed MBS only, 2 (6.7%) completed esophagram only, and 13 (43.3%) completed both MBS and esophagram. MBS and esophagram accurately identified dysmotility in 66.7% and 76.9% of patients with confirmed dysmotility on HRM, respectively.

Conclusion: Esophageal dysmotility is an understudied comorbidity of dysphagia in the HNC survivor population. Our study suggests that MBS and esophagram have limited predictive value in the assessment of dysmotility in HNC survivors with dysphagia. Thus, future studies should aim to better understand the relationship between other aspects of post-HNC dysphagia and esophageal dysmotility.

Objective: Laryngeal clear cell carcinoma (LCCC) is an exceedingly rare tumor. Current literature on LCCC is limited to case reports with little comprehensive data available. This systematic review aims to analyze existing literature to better characterize LCCC and to identify trends in presentation, treatment, and survival.

Data sources: A literature search of PubMed, MedLine, and Embase was conducted.

Review methods: A systematic review of LCCC cases from 1976 to 2024 was performed. Data extraction followed PRISMA guidelines. Included studies were those describing adult or pediatric patients pathologically diagnosed with LCCC. Excluded studies were those describing nonclear cell pathology, nonlaryngeal location, or nonprimary clear cell carcinoma.

Results: In total, 7 studies (n = 9 patients) were included in the analysis. Males (77.7%) were more commonly affected, with an average patient age of 56.5 years. The supraglottis was the most frequently involved subsite (66.6%). Most patients presented with advanced locoregional disease. Surgery alone was the most common treatment (66.6%), followed by chemoradiation (22.2%) and surgery with adjuvant chemoradiation (11.1%). Disease recurrence occurred in 55.5% of cases. Four patients (44.4%) died due to the disease, with an average survival of 9.3 months.

Conclusion: LCCC is a rare tumor often presenting as a supraglottic mass with cervical metastasis. Patients underwent various treatments with surgery, chemoradiation, or a combination of both. Reported survival was generally poor, emphasizing the aggressive nature of this disease.

Objective: Traumatic brain injury affects 1.5 million people per year in the United States, with the majority classified as mild (mTBI). While many immediate symptoms are limited to the short-term, some patients experience long-term daily impairments in function and quality of life. The objective of this study was to assess the relationship between mTBI post-concussive symptoms and hearing, tinnitus, and dizziness symptoms.

Study design: Cross-sectional study.

Setting: Level I public trauma center.

Methods: Adult patients presenting with mTBI ≥6 months prior to study enrollment were asked to complete the Neurobehavioral Symptom Inventory (NSI), Revised Hearing Handicap Inventory (RHHI), Tinnitus Functional Index (TFI), and Dizziness Handicap Inventory (DHI) survey instruments. The NSI is a validated, self-reported measure of post-concussive symptoms. Linear regression analyses were performed.

Results: A total of 38 subjects were recruited, with mean age of 52 (range 24-78), 74% male, 61% self-identifying as White, and 87% self-identifying as Non-Hispanic/Latinx. Median time since injury was 32.5 months (IQR 30-35). Mean NSI score was 22.32 (range 0-70), mean RHHI was 16.05 (0-68), mean TFI was 16.00 (0-85.2), and mean DHI was 18.86 (0-100). On linear regression, NSI score was positively correlated with RHHI, TFI, and DHI scores (P < .01).

Conclusion: The postconcussive symptoms of mTBI are associated with impairments in hearing, tinnitus, and dizziness. Based on this work, structural causal models may be developed to dissect associations to inform management and treatment of mTBI patients with audiovestibular symptoms.

Objective: Nebulized ciprofloxacin-dexamethasone (CPD) is an adjuvant, off-label treatment used to optimize healing after airway surgery, but there is limited data regarding its accessibility. This study examined socioeconomic factors influencing CPD utilization and assessed its cost.

Study design: Retrospective chart review.

Setting: Single institution tertiary care center.

Methods: All patients prescribed nebulized CPD after endoscopic airway surgery from 2021 to 24 by a single surgeon were analyzed for associations between CPD access and socioeconomic factors including insurance type and Area Deprivation Index (ADI). The typical regimen was 2 mL CPD ophthalmic solution nebulized twice daily for 4 weeks. A model to estimate CPD cost combined retail pricing from GoodRx with cost-sharing calculations from Medicare plans including Aetna, Blue Cross Blue Shield (BCBS), and Cigna, incorporating co-pays, coinsurance, and deductibles.

Results: Out of 59 patients prescribed CPD postoperatively, 52 (88.1%) filled their prescription. Patients with Medicaid and Medicare were less likely to access CPD than those with commercial insurance (P = .037). There was no association between ADI and CPD utilization (P = .514). CPD otic and ophthalmic solutions cost $420 and $255, respectively, utilizing GoodRx without insurance. The estimated price of CPD otic solution for patients with Medicare Advantage PPO plans was $340 (Aetna), $1362 (BCBS), and $47 (Cigna), whereas the ophthalmic solution cost $53, $51, and $40, respectively.

Conclusion: Nebulized CPD was utilized by most patients regardless of ADI, but less accessible for those with Medicaid and Medicare. Prescribing the ophthalmic formulation instead of otic may significantly reduce cost and promote more equitable care postoperatively.

Objective: Analyze the relationship between surgical and non-surgical interventions for otitic barotrauma (OB), and identify underlying medical diagnosis, recurrence rates, and treatment outcomes.

Study design: Retrospective cohort analysis.

Setting: TriNetX US collaborative network.

Methods: The network was queried for patients diagnosed with OB within the past 20 years and a surgical intervention within 1 month. Patients receiving surgical intervention were assigned to the surgical cohort while those that did not receive operative care were assigned to the non-surgical cohort. Cohorts were 1:1 propensity score matched for age and gender.

Results: Patients that undergo operative treatment have significantly increased association with previous diagnoses of middle ear pathology, as well as most forms of sinonasal disease (P < .05). Surgical treatment was significantly associated with recurrence of OB, tympanic membrane (TM) perforation, otitis media, as well as mixed hearing loss (P < .05).

Conclusion: Our study indicates an association between previous sinonasal and otologic pathology and higher likelihood of undergoing operative treatment for OB. Our findings also indicate that operative treatment is significantly associated with recurrence of the condition. Increasing air travel and participation in recreational activities tied to OB underscore the need to better understand treatment options.

Objective: Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) offers a scarless alternative to conventional thyroidectomy. Most studies incorporate intraoperative neuromonitoring (IONM), which may be unavailable in resource-limited settings. We evaluated the learning curve, feasibility, and safety of TOETVA without IONM.

Study design: Retrospective.

Setting: A retrospective analysis of 103 patients undergoing hemithyroidectomy by TOETVA between February 2020 and January 2025 was conducted at a tertiary care center in central India.

Method: Learning curve assessment was performed using Cumulative Sum (CUSUM) analysis, and outcomes were compared between phase 1 (cases 1-50) and phase 2 (Cases 51-103). Statistical analyses included independent t tests for continuous variables and chi-square tests for categorical variables (P < .05).

Results: Mean operative time significantly decreased from 185 ± 24 minutes in phase 1 to 105 ± 12.95 minutes in phase 2 (P < .001), with proficiency achieved after 50 cases. Nodule size was larger in phase 2 (4.5 ± 2.3 cm vs 3.0 ± 1.0 cm, P = .003). The conversion rate was 4.9%, with no permanent recurrent laryngeal nerve palsy. Hoarseness of voice and seroma rates remained unchanged (P = 1.00), whereas hospital stay significantly decreased (P < .001).

Conclusion: TOETVA without IONM is feasible and safe, demonstrating a well-defined learning curve with low complication rates. These findings support its adoption in low-resource settings.