OTO Open最新文献

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.

Objective: To analyze public perceptions of over-the-counter (OTC) hearing aids through sentiment and thematic analysis of online consumer reviews and their changes over time.

Study design: Sentiment and thematic analysis.

Setting: Online reviews from third-party and product websites.

Methods: All English online consumer reviews posted between 2016 and 2024 for OTC hearing aids (83 models) were recorded (n = 21,727). Sentiment analysis was performed using Valence Aware Dictionary and Sentiment Reasoner (VADER), a rule-based sentiment analysis tool incorporating natural language processing. VADER provides scores for each review ranging from -1 (most negative), 0 (neutral), to 1 (most positive). Additional thematic analysis was performed for the top 100 most positive, neutral, and negative reviews (n = 300).

Results: Overall, mean (SD) VADER sentiment score of online reviews was generally positive at 0.587 (0.411). Multivariable regression analysis showed that higher VADER scores were associated with higher-priced and behind-the-ear (BTE) type hearing aids. Although there was a significant increase in a number of reviews after the Food and Drug Administration's new establishment of the OTC hearing aid category in 2022, the mean sentiment scores slightly decreased (β =-.10, [95%CI: -0.12 to -0.09]). Thematic analysis revealed that positive sentiments highlighted the affordability and time-saving benefits of OTC hearing aids as alternatives to prescription models. Negative sentiments centered on sound quality, challenges with customer service, and inadequate amplification for those with severe hearing loss.

Conclusion: Customers generally viewed OTC hearing aids positively, while mixed experiences were present. When used as indicated for adults with mild to moderate hearing loss, OTC hearing aids may offer a viable alternative to prescription devices, improving accessibility and affordability.

Objective: This study aimed to assess the effectiveness of intraoperative parathyroid hormone (PTH) measurements from bilateral internal jugular veins (BIJVs) in determining parathyroid gland laterality during surgery for primary hyperparathyroidism (PHPT).

Study design: Prospective cohort study.

Setting: Single tertiary care center, February 2021 to February 2023.

Methods: All patients underwent intraoperative BIJV PTH measurements during parathyroidectomy. Preoperative localization of abnormal parathyroid glands was performed using cervical ultrasound (USG) and sestamibi scans (MIBI). Receiver operating characteristic (ROC) analysis was performed to determine the best performance (sensitivity and specificity) for predicting parathyroid gland laterality.

Results: A total of 124 patients underwent surgery during the study. PTH measurements from BIJV successfully confirmed the laterality of parathyroid adenomas in 102 cases (82.3%, P = .001). Intraoperative BIJV PTH measurements proved to be the most effective method for determining parathyroid gland laterality, with an accuracy of 82.3%. ROC curve analysis identified an optimal cutoff point of 16.7% for the percentage difference between right and left BIJV PTH values. The area under the curve (AUC) was 0.882, indicating high diagnostic accuracy. This cutoff yielded a sensitivity of 76.5% and a specificity of 95.5%. Additionally, no patients experienced complications related to the internal jugular vein (IJV) procedure.

Conclusion: Intraoperative BIJV PTH measurement is a valuable adjunct in parathyroidectomy, improving localization and enhancing surgical outcomes in PHPT patients.

Objective: Previous studies have demonstrated the impact of sociodemographic factors on disease development, management, and outcomes in adult and pediatric populations. Given that postoperative management is key in reducing complications following a tracheotomy, we assessed the impact of sociodemographic factors on a patient's discharge disposition.

Study design: Cross-sectional study.

Setting: Health Care Utilization Project's (HCUP) National Inpatient Survey (NIS).

Methods: The HCUP NIS was queried for all patients undergoing tracheotomy between 2017 and 2021. All analyses were performed using R Version 4.3.1 survey procedures to account for strata and cluster effects.

Results: We identified 81,069 admissions during which a tracheotomy was performed and, after appropriate weighting for the HCUP NIS survey design, found that 15.1% of admissions resulted in routine discharge, 4.5% transferred to a short-term hospital, 52.3% transferred to a skilled nursing facility (SNF)/intermediate care facility (ICF)/other facility, 16.9% discharged with home health care. Admissions routinely discharged had the lowest median (interquartile range) age (48 [23, 61] years), whereas admissions resulting in death or transfer to a SNF/ICF/other facility type had the greatest age (63 [53, 70] years). On both univariable and multivariable analyses, age, race, sex, insurance type, geographic region, and hospital size were associated with discharge disposition.

Conclusion: Our study highlights that disparities exist among patient populations and were found in both unadjusted and adjusted analyses. Further attention and resource allocation for the care of patients with a tracheostomy may work toward identifying sources of disparity, which may be modified to improve patient care.

Objective: Traditional transcutaneous approaches for pilomatricoma excision in the face and neck are effective but often leave conspicuous scars that compromise cosmetic outcomes. We aimed to evaluate a refined endoscope-assisted hairline approach that uses a concealed scalp incision and enhanced endoscopic visualization to improve esthetic results while maintaining surgical efficacy.

Study design: Prospective observational study.

Setting: Dankook University School of Medicine, Korea.

Methods: Fifty patients with benign pilomatricomas of the face and neck were prospectively enrolled and allocated into two groups. Group A (n = 25) underwent the refined endoscope-assisted hairline approach, whereas Group B (n = 25) received the conventional transcutaneous approach. Clinical data including operative time and postoperative complications were recorded. Cosmetic outcomes were objectively evaluated using standardized photographic documentation and patient satisfaction scores collected at 3 and 12 months postoperatively.

Results: The mean operative time was significantly longer in Group A compared to Group B (P < .001), reflecting the technical intricacies of the hairline approach. No significant differences were observed between the two groups in hospital stay or overall complication rates. Importantly, cosmetic satisfaction scores were significantly higher in Group A (P < .001), with objective assessments consistently demonstrating reduced scar visibility and superior preservation of skin integrity.

Conclusion: The refined endoscope-assisted hairline approach is a safe and highly effective technique for pilomatricoma excision in cosmetically sensitive facial and neck regions. This innovative method offers significant improvements in esthetic outcomes without compromising safety, representing a distinct advance over conventional methods.