OTO Open最新文献

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.

Objective: Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignancy and survival rates vary throughout literature. The primary objectives are to study overall survival (OS), disease-specific survival (DSS), locoregional recurrence-free survival (LRFS), and secondarily margin status.

Study design: Multi-institutional retrospective cohort study.

Setting: Queen Elizabeth II Health Sciences Center (QEII HSC) from 2006 to 2023 and the University of Michigan (UM) from 2017 to 2023.

Methods: An institutional pathology database (QEII HSC) and parotidectomy database (UM) were used to identify 37 patients with CXPA who underwent surgical resection.

Results: Most cases were locoregionally advanced with 51% being ≥T3 and 32% being cervical node positive. All cases were treated with surgery, 78% received adjuvant radiation. Overall, 2-year survival was 82% and 5-year survival was 61.7%. In univariate analysis, tumor size >4 cm, pathologic nodal stage ≥1, pathologic overall stage 4 disease, lymphovascular invasion, extranodal extension, and positive margins were associated with increased risk of death. In adjusted multivariable analysis, only pathologic nodal stage ≥1 (hazard ratio [HR] 9.474, confidence interval [CI] 1.19-75.41, P = .034) remained statistically significant. The 2-year LRFS was 80% and the 5-year LRFS was 75%. Of the 7 patients with locoregional recurrence, 6 had prior adjuvant radiation, and 4 recurred locally. Multivariable cox models for LRFS were not significant.

Conclusion: Patients with CXPA that metastasize to the neck have a worse prognosis. LRFS after surgery is 75% with high rates of adjuvant radiation. Further research on prognostic factors of LRFS and adjuvant radiation outcomes is required.

N,N-Diethyl-meta-toluamide (DEET) and permethrin are pesticides commonly used in combination due to their synergistic insecticidal and repellent properties. This study investigates whether simultaneous exposure to these compounds elicits synergistic cytotoxicity in sinonasal epithelial cells (SNECs). Ethmoid sinus mucosal specimens were procured from eight patients during endoscopic sinus surgery. SNECs were expanded on culture plates and exposed to various concentrations of DEET and permethrin (0-5 mM), individually and concurrently, for up to 156 hours. Experiments were replicated in triplets, and cell viability was recorded every 2 hours using Incucyte real-time cell imaging system. Synergy score was calculated on the basis of the Loewe additivity synergy model. DEET and permethrin exhibited synergistic cytotoxicity across all eight tissues, albeit with variations in onset and magnitude. In conclusion, the concurrent exposure of DEET and permethrin can lead to synergistic cytotoxicity in sinonasal epithelia.

Objective: The effectiveness of various palatopharyngeal surgeries is currently poorly understood. This study compares various palatopharyngeal surgery techniques without tonsillectomy for reducing the apnea-hypopnea index (AHI).

Data sources: Embase, MEDLINE, Web of Science, ClinicalTrials, CINAHL, the Cochrane Library, and International Clinical Trials Registry Platform.

Review methods: We included studies of palatopharyngeal surgery in adults reporting AHI outcomes, excluding those with tonsillectomy or combined surgeries. A random-effects model was used to pool effect sizes. Surgical techniques were categorized into cold steel, muscle relocation, suture, radiofrequency, laser, powered instruments, and implants. The primary outcome was the reduction in AHI. Secondary outcomes were the AHI responder rate, AHI reduction over the follow-up duration, and the outcomes by publication year.

Results: From 3793 screened records, 45 studies with 1501 patients were included. Overall, palatopharyngeal surgery reduced AHI by 5.2/h (95% CI, 2.7-7.7; P < .0001). Powered instruments showed the greatest AHI reduction (26.3/h; 95% CI, 18.9-33.7), followed by muscle relocation (20.2/h; 95% CI, 3.7-36.7) and suture techniques (15.3/h; 95% CI, 9.6-21.0). Palatal implants (2.6/h; 95% CI, 0.4-4.7) and laser techniques (4.5/h; 95% CI, 1.3-7.8) showed modest effects, whereas radiofrequency (0.4/h; 95% CI, -2.0 to 2.8) and cold steel (6.6/h; 95% CI, -0.2 to 13.5) had no significant impact. The overall responder rate was 51% (95% CI, 41-60), with powered instruments, relocation, and suture techniques demonstrating the highest rates.

Conclusion: Palatopharyngeal surgery techniques significantly differ in reducing AHI. Powered instruments, muscle relocation, and suture techniques are most effective.

Trial registration: PROSPERO identifier: CRD42024559063.