OTO Open最新文献

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.

Objective: The aim of this pilot study is to compare the effectiveness of office-based blue laser therapy with coblation therapy in patients with inferior turbinate hypertrophy (ITH).

Study design: Retrospective chart review.

Setting: Tertiary referral center.

Methods: Patients presenting with nasal obstruction between November 2022 and November 2024, and underwent coblation or blue laser therapy for turbinate reduction were reviewed. Demographic data included age, gender, smoking, history of allergy, history of reflux disease, and history of prior nasal surgery. All patients had filled the nasal obstruction symptom evaluation (NOSE) questionnaire and the visual analog scale (VAS) before and on follow-up after treatment. Patient's level of comfort during the procedure was also rated using a 10-point Likert scale with a higher score indicating a greater level of comfort.

Results: A total of 10 patients underwent office-based blue laser therapy for turbinate reduction, and 10 patients underwent office-based coblation of the inferior turbinates. In the subgroup of patients who underwent office-based blue laser therapy, the mean NOSE score and VAS score decreased significantly (P = .005). In the subgroup of patients who underwent coblation, the mean NOSE score and VAS score decreased significantly (P = .005). When comparing the two subgroups, the difference in the drop of the NOSE score was not statistically significant (P = .198). Similarly, the difference in the drop of VAS score was not statistically significant (P = .280).

Conclusion: The results of this investigation indicate that both coblation therapy and blue laser therapy are effective office-based treatment modalities in patients with ITH with comparable results.

Objective: Otitis media with effusion (OME) affects 90% of children before school age, with current guidelines recommending tympanostomy tubes for persistent OME and hearing loss after 3 months of "Watchful Waiting," due to the risk of complications including long-term conductive hearing loss. Current nonsurgical treatment options are limited. This study evaluates the feasibility of at-home use of a novel prototype autoinflation device for children with OME or eustachian tube dysfunction.

Study design: Single-arm cohort study.

Setting: Pediatric otolaryngology private clinic.

Methods: Children aged 1 to 12 years with OME were recruited from a pediatric otolaryngology clinic and asked to use the device twice daily for 4 weeks. Baseline audiometry and tympanometry were performed at recruitment, with subsequent tympanometry testing after first use and at 2, 4, 8, and 12 weeks. Audiometry testing was repeated at week 4. Compliance was tracked using an App.

Results: Twenty-one patients were included (average age: 5.1 years, range: 2-12 years). After a single session, 86% of patients had middle ear pressure improvement in at least one ear, which maintained stable at 83% at week 4. Additionally, 86% of patients with hearing loss exhibited improvement at 4 weeks, where the average pure tone average in ears with baseline hearing loss improved from 26.8 to 18.9 dB HL.

Conclusion: These results demonstrate significant improvement in both tympanometry and audiometry after 4 weeks of device use. This indicates a strong potential benefit in regular ventilation of the middle ear for pediatric patients with OME undergoing "Watchful Waiting."