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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.

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.