OTO Open最新文献

Objective: Unilateral hypoglossal nerve stimulation (HGNS) to treat obstructive sleep apnea involves implantation of a pulse generator, a respiratory sensing lead, and a stimulation lead. Complications may arise related to all components. Previous studies have presented the overall incidence of reported adverse events. The objective of this study was to provide an updated report of complications from the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database, with a focus on the respiratory sensing lead, and propose a care algorithm with two cases of sensing lead migration.

Study design: Retrospective cross-sectional study, case report.

Setting: Tertiary care center.

Methods: The MAUDE database was queried for events related to the HGNS respiratory sensing lead from January 1, 2000, to December 1, 2022. Primary outcomes were respiratory lead migration resulting in pneumothorax or need for revision surgery/explantation.

Results: In total, 151 out of 765 HGNS adverse events were related to the respiratory sensing lead, and of those, 75 were related to lead migration. There were seven events related to migration of the sensing lead into the pleural space, of which six cases underwent revision surgery (<1% of adverse events reported related to HGNS). Two cases noted pneumothorax due to sensing lead migration. We report two cases of sensing lead migration at our institution. Migration was demonstrated with serial imaging. These cases highlight the potential need for preoperative or intraoperative chest tube placement, based on the extent of migration, complications, and complexity.

Conclusion: Migration of the respiratory sensing lead is a rare event with multidisciplinary surgical planning considerations.

Objective: To investigate the prevalence of depression and anxiety in patients with vestibular disorders using a large patient database.

Study design: Retrospective cohort.

Setting: The TriNetX database.

Methods: TriNetX, a deidentified database, was retrospectively queried to identify adults with vestibular disorders. The rates of anxiety and depression in patients with vestibular disorders were compared to patients without vestibular disorders within 5 years of the index event, which was set at the time of diagnosis of vestibular dysfunction.

Results: On analysis of patients with and without vestibular disorders, after propensity score matching for demographics and common comorbidities, 64,153 patients were identified in each cohort. Patients with vestibular disorders were more likely to have depression (relative risk [RR] 1.37 [95% CI 1.35-1.40]) and anxiety (RR 1.51 [95% CI 1.45-1.57]) compared to the general population. Similarly, a higher rate of antidepressant use was seen in patients with vestibular disorders (RR 1.41 [95% CI 1.39-1.43]).

Conclusion: Patients with vestibular disorders have higher rates of depression and anxiety compared to the general population.

Objective: This study investigates the roles of allergy, serum IgE, serum eosinophils, and tissue eosinophils in chronic rhinosinusitis (CRS) patients undergoing functional endoscopic sinus surgery (FESS). The study aims to evaluate these biomarkers in predicting disease severity and postoperative outcomes.

Study design: A retrospective cohort study.

Setting: A single academic institution.

Methods: This retrospective study enrolled patients from 2017 to 2023. Preoperative evaluations included blood tests, sinus computed tomography, nasal endoscopy, questionnaires, olfactory tests, acoustic rhinometry, saccharine transit test, and nasal bacterial culture. The number of eosinophils was counted in the surgical specimens. Postoperative evaluations were performed 3 months after surgery. The severity and outcomes of CRS were compared between allergy-positive and -negative groups, IgE-positive and -negative groups, serum eosinophil-positive and -negative groups, and eosinophilic and noneosinophilic CRS groups.

Results: Ninety-six CRS patients who underwent bilateral primary FESS were enrolled. Allergy and serum IgE showed limited predictive value for CRS outcomes. In contrast, serum eosinophils and tissue eosinophils were significantly associated with worse preoperative CRS severity, especially in olfactory dysfunction. Both biomarkers demonstrated greater postoperative improvements, with serum eosinophils showing predictive potential for ECRS (sensitivity 73.5%, specificity 78.7%).

Conclusion: Our results show that allergy testing and serum IgE levels were not reliable tools for CRS severity or outcomes, while elevated serum and tissue eosinophils were associated with worse preoperative CRS severity, particularly in olfactory dysfunction. FESS provided effective improvements in olfactory outcomes in eosinophilic CRS patients. Serum eosinophils could serve as a reliable noninvasive biomarker for predicting disease severity and surgical outcomes in ECRS patients.

Level of evidence: 3.

Objective: To describe and assess the usefulness of delayed postcontrast three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences on 3-Tesla (3 T) magnetic resonance imaging (MRI) in patients presenting with acute inner ear complications after stapes surgery.

Study design: Case series.

Setting: French tertiary referral center.

Methods: The clinical records and imaging of patients who underwent delayed postcontrast 3D-FLAIR MRI sequences for labyrinthine complications after stapes surgery, performed between January 2019 and April 2023, were retrospectively reviewed.

Results: A total of 712 patients underwent stapes surgery between January 2019 and December 2023. Eight patients (1.12%) were included in the study, with a median age of 52 years (interquartile range 40-54). After the surgery, seven patients presented with vertigo and sensorineural hearing loss (SNHL), and one patient presented with only vertigo with complete areflexia on caloric testing. Computed tomography (CT) of the temporal bone showed a slightly excessive penetration of the prosthesis (>1 mm) into the vestibule in one patient and a periprosthetic granuloma in another patient. CT was normal for six patients. Delayed postcontrast 3D-FLAIR MRI sequences showed blood-labyrinth barrier (BLB) impairment in the cochlea, the vestibule, and the semicircular canals in seven patients. No endolymphatic hydrops were found, but one patient presented with utricular collapse, and the saccule was not visible in three other patients.

Conclusion: Delayed postcontrast MRI sequences may reveal BLB impairment and help analyzing the endolymphatic compartment in cases of SNHL or vestibular disorders after stapes surgery. Those sequences could help uncovering the causes of such events.

Objective: Hearing phenotype of the congenital cytomegalovirus (cCMV)-infected children with isolated sensorineural hearing loss (SNHL) may be distinct from other types of SNHL and may provide an alternative approach for diagnosis.

Study design: A retrospective cohort study.

Setting: Hearing test results of SNHL patients between 2006 and 2022 at Primary Children's Hospital and patients with the following conditions were included: cCMV with isolated SNHL, connexin 26 mutation, enlarged vestibular aqueduct (EVA), and idiopathic.

Methods: Using 1-way analysis of variance (ANOVA) tests, we compared each patient's first reliable hearing threshold from 250 to 4000 Hz. The area under the receiver-operating characteristic (AUROC) curves was calculated for hearing measures in the cCMV and idiopathic groups. The Youden index was then obtained to determine a prediction model for cCMV infection. Finally, plots of various parameters over time were evaluated to compare the cCMV and idiopathic groups.

Results: A total of 72 patients were evaluated (cCMV: 19; connexin 26: 13; EVA: 24; and idiopathic: 16). The ANOVA test indicated the cCMV group tended to display greater hearing threshold asymmetry (P < .001 vs EVA and connexin, P < .06 vs idiopathic). The ROC curve demonstrated high specificity (0.94) for cCMV infection if the threshold difference between the two ears was greater than 58.6 dB. Comparisons of plots over time suggest no statistically significant difference between the cCMV and idiopathic groups.

Conclusion: cCMV-infected children with isolated SNHL can present differently from the other causes of SNHL. The AUROC analysis suggests that a PTA difference greater than 58.6 dB may provide a prediction model to distinguish cCMV from other types of SNHL.

Objective: To determine the prevalence of borderline personality disorder among patients who undergo facial plastic surgery and identify associated demographics, clinical characteristics, and outcomes.

Study design: Retrospective cohort.

Setting: More than 80 health care organizations across the United States.

Methods: This retrospective cohort study queried the TriNetX Research Network to identify patients who underwent facial plastic surgeries during 2012 to 2023. Demographics, clinical characteristics, and outcomes were compared between patients with and without a diagnosis of borderline personality disorder.

Results: Among 60,792 patients, there were 309 (0.51%) with a diagnosis of borderline personality disorder (mean age 45.0; 77% female, 22% male) and 60,453 controls (mean age 54.7; 63.4% female, 34.5% male). Patients with borderline personality disorder were younger (P < .001) and more likely to be female (P < .001). They were more likely to undergo rhinoplasty (P < .001), but less likely to have blepharoplasty (P < .001) or facelift (P = .01). They also had higher rates of psychiatric and substance use disorders (P < .001). Patients with borderline personality disorder were at greater risk of postoperative emergency department visits (15.9% vs 4.8%) and hospitalization (12.0% vs 6.6%) compared to controls in the first 3 months postoperatively (P < .001). However, these rates did not represent a significant increase relative to their own baseline levels (15.9% for emergency visits and 3.9% for inpatient admissions over a comparable 3-month period, P = 1.0 and .44, respectively).

Conclusion: Patients with borderline personality disorder are more likely to be younger, female, undergo rhinoplasty, have additional psychiatric comorbidities, and present to the hospital at baseline and during the recovery period.

Objective: To evaluate the feasibility of a temporal bone dissection laboratory in Tanzania to support otologic surgical training for otolaryngologists in the region.

Study design: This prospective cohort study evaluates six temporal bone laboratory training sessions over the course of 11 months. Pretraining and posttraining surveys were distributed during the first year of implementation in 2023. Postsurveys were distributed both immediately and 6 months posttraining.

Setting: Single tertiary care academic medical center in Dar es Salaam, Tanzania.

Methods: Participant data for 47 attendees including country/region of practice, otologic procedures completed, and number of trainees/audiologists in their clinical practice were collected in the pretraining survey. A 5-point Likert scale was used to assess pretraining and posttraining comfort with completing common otologic procedures. Study outcomes included comfort level, barriers to implementing acquired knowledge, and overall training quality.

Results: The results highlight that participants did not have pretraining comfort with, exposure to, and training with many otologic surgeries. These limitations were largely attributed to barriers identified by participants including limited access to training, learning opportunities, and equipment for otologic procedures. Findings also indicate statistically significant increases in comfort level for the majority of common otologic procedures evaluated.

Conclusion: This study highlights that the training has been both feasible for and desired by participants, and has addressed critical needs in continued surgical training. Temporal bone dissection labs are a feasible and highly desired model to increase the otologic capacity of practicing otolaryngologists regionally and offer a promising approach for addressing the lack of training opportunities in the region.

Objective: Postoperative hypocalcemia after total thyroidectomy (TT) affects pediatric patients at higher rates than adult patients, yet its rate remains poorly defined. This study aims to determine the rates of transient, permanent, and any hypocalcemia after TT in pediatric patients and analyze potential risk factors.

Data sources: PubMed, EMBASE, Scopus, and Cochrane.

Review methods: A database search was conducted through March 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data concerning postoperative hypocalcemia, risk factors, and clinical context were collected and analyzed. Transient hypocalcemia was defined as lasting less than 6 months and permanent as lasting greater than 6 months after surgery.

Results: In total, 67 studies with 7331 pediatric patients met the inclusion criteria. Surgical indications for TT in this cohort included malignant conditions (54.75%), benign conditions (19.70%), Graves' disease (18.59%), genetic syndromes (MEN2A/2B, RET mutation) (6.04%), and Hashimoto's thyroiditis (0.92%). The pooled incidence rates were 25.2% (95% CI 0.20-0.31) for transient, 7.4% (95% CI 0.05-0.10) for permanent, and 32.1% (95% CI 0.26-0.39) for any hypocalcemia. Fifteen of the included studies also examined risk factors for postoperative hypocalcemia. Patients undergoing TT for malignancy (odds ratio [OR] 2.82, 95% CI [1.18-6.73]; P = .02) or Graves' disease (OR 6.12, 95% CI [3.10-12.01]; P < .0001), as well as those undergoing any lymph node dissection (OR 3.71, 95% CI [1.95-7.06]; P < .0001) were at higher risk for postoperative hypocalcemia.

Conclusion: Hypocalcemia is a common postoperative complication of TT in pediatric patients. Risk factors include malignant surgical indication, Graves' disease, and any lymph node dissection.

Objective: To compare the costs of staged versus same-day surgery after drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea (OSA).

Study design: Retrospective cohort study.

Setting: Single tertiary-care center in the United States from 2017 to 2023.

Methods: Patients were grouped into two surgical pathways: (1) DISE with same-day OSA surgery and (2) DISE with staged OSA surgery. Nonparametric tests and log-normal models were used to compare insurance payments, out-of-pocket costs, and hospital costs between pathways and to evaluate predictors of hospital costs.

Results: A total of 57 pediatric OSA patients with a mean (standard deviation [SD]) age of 10.8 (4.0) years were included. The mean insurance payments, out-of-pocket costs, and hospital costs were $12,158 (SD 10,412), $340 (SD 1168), and $11,965 (SD 9615), respectively. Patients who underwent DISE with staged OSA surgery had significantly higher hospital costs than those who underwent DISE with same-day OSA surgery (mean difference $8995, 95% CI 3528-14462; P < .001), and this effect persisted in an adjusted log-normal model (coefficient 0.82, 95% CI 0.34-1.30; P = .001). There were no significant differences in insurance payments or out-of-pocket costs by surgical pathway.

Conclusion: DISE with staged OSA surgery conferred higher hospital costs than DISE with same-day OSA surgery but did not increase financial burden on patients or payers. This finding has important implications for resource utilization for a common pediatric condition.

Importance: Actinic cheilitis is a condition of the lower lip with the potential for malignant transformation. Although many topical treatment options exist, most involve prolonged application periods with expected adverse effects that limit compliance.

Objective: Trichloroacetic acid is a widely used chemical peel that has been used for the treatment of precancerous skin lesions. This study aims to study the efficacy of 35% trichloroacetic acid as a topical treatment for actinic cheilitis.

Study design: Prospective cohort study of patients with actinic cheilitis presenting to our institution between September 2020 and December 2023. After treatment completion, patients were followed twice yearly for a minimum of 2 years.

Setting: Tertiary care center.

Methods: All patients with actinic cheilitis presenting to an otolaryngologist-head and neck surgeon at our institution within the study time frame were eligible. Exclusion criteria include patients <18 years of age, patients who were pregnant, and patients with a biopsy-proven malignancy of the lip. A topical 35% trichloroacetic acid peel was applied to the lower lip in the minor procedure clinic following bilateral mental nerve blocks. Patients were brought back 1 month later for follow-up ± a repeat treatment. Photos were taken prior to treatment and 1 month following their final treatment. The severity of actinic cheilitis was graded using a proposed grading scale for actinic cheilitis, and the burden of the condition was assessed using Skindex-16 Surveys. Visual analog scales were used to study adverse events. Patients were monitored for remission and recurrence.

Results: A total of 11 patients were enrolled, with the majority requiring one treatment to achieve clinical remission. All patients who completed their full treatment course entered clinical remission following their trichloroacetic acid treatment, and there have been no cases of recurrence to date. The most common reported side effects were redness and swelling. Patients reported a significant improvement in their quality of life following treatment.

Conclusion: This study suggests that a 35% trichloroacetic acid peel is a safe, well-tolerated, and effective treatment option for patients presenting with actinic cheilitis. Further follow-up is indicated to study the longevity of the achieved results.

Trial registration: This study is registered on Clinicaltrials.gov (NCT04744103). https://clinicaltrials.gov/study/NCT04744103?locStr=Halifax,%20NS,%20Canada&country=Canada&state=Nova%20Scotia&city=Halifax&cond=actinic%20cheilitis&rank=1.