OTO Open最新文献

Objective: To evaluate the analgesic role of ropivacaine local infiltration in patients undergoing thyroidectomy.

Data sources: PubMed, Google Scholar, CENTRAL, Scopus, and Web of Science.

Review methods: A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs). Our specific endpoints include pain severity, total opioid analgesia consumption, patient satisfaction, length of hospital stay, postanesthesia care unit (PACU) length of stay, surgery duration, and the incidence of postoperative nausea and vomiting (PONV). Using Stata, we pooled dichotomous outcomes and continuous outcomes using risk ratio (RR) and standardized mean difference (SMD) or mean difference (MD), respectively, with a 95% confidence interval (CI).

Results: Eight RCTs and 633 patients were included. Ropivacaine significantly decreased pain after 1 to 2 hours postoperatively (SMD: -1.40, 95% CI [-2.30, -0.51]). However, there was no difference between both groups after 4 hours (P = .11), 6 to 8 hours (P = .05), 16 to 18 hours (P = .10), and 24 hours (P = .37). Also, ropivacaine significantly decreased analgesia consumption (SMD: -0.75, 95% CI [-1.30, -0.20]), with no effect on surgery duration (P = .59), length of hospital stays (P = .32), patient satisfaction score (P = .25), and PACU length of stay (P = .25). Finally, there was no difference between both groups regarding the incidence of PONV (RR: 1.01, 95% CI [0.70, 1.45]).

Conclusion: Ropivacaine local infiltration after thyroidectomy significantly decreased pain for up to 1 to 2 hours and analgesia consumption compared to control, but with uncertain evidence. However, ropivacaine had no effect on pain from 4 to 24 hours, surgery duration, length of PACU stay, length of hospital stay, and patient satisfaction.

Objective: To develop and evaluate the effectiveness of domain-specific customization in large language models (LLMs) by assessing the performance of the ENT GPT Assistant (E-GPT-A), a model specifically tailored for otolaryngology.

Study design: Comparative analysis using multiple-choice questions (MCQs) from established otolaryngology resources.

Setting: Tertiary care academic hospital.

Methods: Two hundred forty clinical-vignette style MCQs were sourced from BoardVitals Otolaryngology and OTOQuest, covering a range of otolaryngology subspecialties (n = 40 for each). The E-GPT-A was developed using targeted instructions and customized to otolaryngology. The performance of E-GPT-A was compared against top-performing and widely used artificial intelligence (AI) LLMs, including GPT-3.5, GPT-4, Claude 2.0, and Claude 2.1. Accuracy was assessed across subspecialties, varying question difficulty tiers, and in diagnostics and management.

Results: E-GPT-A achieved an overall accuracy of 74.6%, outperforming GPT-3.5 (60.4%), Claude 2.0 (61.7%), Claude 2.1 (60.8%), and GPT-4 (68.3%). The model performed best in allergy and rhinology (85.0%) and laryngology (82.5%), whereas showing lower accuracy in pediatrics (62.5%) and facial plastics/reconstructive surgery (67.5%). Accuracy also declined as question difficulty increased. The average correct response percentage among otolaryngologists and otolaryngology trainees was 71.1% in the question set.

Conclusion: This pilot study using the E-GPT-A demonstrates the potential benefits of domain-specific customizations of language models for otolaryngology. However, further development, continuous updates, and continued real-world validation are needed to fully assess the capabilities of LLMs in otolaryngology.

Objective: The fibula free flap (FFF) remains the workhorse flap for head and neck defects necessitating osteocutaneous reconstruction. Although lower extremity angiography, ultrasound (US), and other vascular studies are routinely used for fibula assessment and patient selection, predictors of donor-site morbidity following harvest remain poorly understood. We sought to investigate the factors associated with FFF donor-site complications.

Study design: Retrospective analysis of patients at a tertiary care center.

Setting: Tertiary care center.

Methods: In total, 119 patients undergoing FFF reconstruction during the years 2012 to 2022 were included. Multivariable logistic regression was used to identify independent predictors of soft-tissue donor-site wound complications.

Results: A total of 48 (40.3%) patients developed a donor-site wound complication with an average time to diagnosis of 24 days (±16) following surgery. In multivariable regression, history of alcohol use disorder (P = .0083) and method of donor-site closure (P = .0368) were independent predictors of donor-site wound complications. Split-thickness skin graft closure was associated with a 146% increased odds of wound complications (odds ratio [OR] = 2.46, 1.11-5.43, 95% confidence interval). Patient age, body mass index, Charlson comorbidity index, skin paddle size, and Doppler US characteristics were not predictive of postoperative donor-site morbidity.

Conclusion: Predictors of FFF donor-site wound complications included history of alcohol abuse and method of donor-site closure. This study highlights unique lower extremity Doppler US findings in patients undergoing FFF reconstruction in addition to modifiable risk factors associated with fibula donor-site morbidity and soft-tissue complications. Our findings underscore the need to critically evaluate wound closure techniques in this population.

Objective: To compare patient demographics, comorbidities, anesthesia type, and trends in nasal valve implantation (NVI) and nasal radiofrequency remodeling (NRR) techniques versus traditional nasal valve repair (NVR).

Study design: Retrospective case-control.

Setting: In total, 58 health care organizations (HCOs) across the United States.

Methods: The TriNetX Research Network was queried from 2021 through 2023, forming three cohorts of patients who underwent (1) NVR, (2) NVI, or (3) NRR. Demographics, comorbidities, and anesthesia type were compared across groups at the time of intervention.

Results: A total of 10,568 NVR, 764 NVI, and 485 NRR cases were identified. Patients undergoing NVI or NRR compared to NVR were more likely to be older and exhibit a higher prevalence of medical comorbidities, including sleep apnea, hyperlipidemia, type 2 diabetes, gastroesophageal reflux disease, liver disease, hypertension, ischemic heart disease, other heart diseases, cerebrovascular disease, hearing loss, and kidney disease (all P < .05). Of all cases, 82.4% of NVR, 84.8% of NVI, and 55.2% of NRR were performed under general anesthesia. Patients who underwent NRR had the highest comorbidity burden of all cohorts and were most likely to receive local anesthesia. However, when analyzing anesthesia type by specific procedure (NVR, NVI, and NRR), most comorbidities were not significantly more common in those who underwent local anesthesia compared to general anesthesia.

Conclusion: NVI and NRR have provided surgeons with alternative treatment options for nasal valve collapse, especially for patients who are older and with a higher burden of medical comorbidities.

Objective: To illustrate improved posttonsillectomy hemorrhage rates with a novel cost-effective monopolar intracapsular tonsillectomy (ICT) technique.

Study design: Retrospective cohort.

Setting: Single physician's experience at a Midwest private practice.

Methods: A single surgeon's chart review of 576 pediatric patients who underwent a tonsillectomy in the last 20 years was completed. In total, 331 cases were treated with ICT performed with a novel monopolar bovie electrocautery technique, as opposed to the more widely used microdebrider or coblator techniques. In total, 246 were treated with the traditional extracapsular tonsillectomy (ECT) technique using monopolar electrocautery.

Results: Of the 331 ICTs performed, one postoperative hemorrhage requiring intervention was identified, resulting in an ICT postoperative bleed rate of 0.3%. Of the 246 ECTs performed, 9 postoperative bleeds requiring intervention were identified, resulting in an ECT postoperative bleed rate of 3.7%. In this cohort, the relative risk of developing a bleed with ECT was 12 times higher than the bleed risk with ICT (P = .018). Every 30 cases of ICT prevented one tonsil bleed (number needed to treat [NNT] = 29.8). Potential savings of ICT with monopolar cautery is $1.5 to $1.6 million for every 10,000 cases that transition to ICT with electrocautery from a microdebrider or coblator technique.

Conclusion: ICT with monopolar electrocautery resulted in a significantly decreased bleed rate compared to the ECT technique in this single surgeon experience and at a much lower cost compared to the more widely used microdebrider or coblator techniques.

Objective: This umbrella review aims to evaluate the clinical outcomes of robotic-assisted thyroid surgery compared to traditional endoscopic and open surgical approaches.

Data sources: We conducted a systematic search of PubMed, EMBASE, and Cochrane Database through August 2024.

Review methods: We conducted a comprehensive analysis of systematic reviews and meta-analyses that compare robotic-assisted thyroid surgery with endoscopic or open methods. The primary outcomes assessed include surgical efficiency indicators, general postoperative complications, specific complications (nerve and endocrine), postoperative recovery and patient experience, and recurrence and long-term prognosis. The methodological quality of the included reviews was assessed using the AMSTAR2 tool.

Results: Of the 1987 articles retrieved, 21 were eligible. Robotic surgery, though associated with longer operative times, offers distinct advantages in terms of precision. Although robotic surgery shows some variation in central lymph node dissection and an increase in postoperative drainage, its safety is comparable to both open and endoscopic techniques. Additionally, robotic surgery demonstrates superior cosmetic outcomes and shorter hospital stays from multiple approaches, though its high costs remain a significant factor. In terms of recurrence and survival rates, no significant differences were observed between robotic and open surgery.

Conclusion: Robotic surgery choices should balance benefits, costs, and patient needs. As technology and skills improve, efficiency and cost-effectiveness may increase, expanding its clinical role.

Objective: Macroglossia is a risk factor for obstructive sleep apnea (OSA) and has been linked to an elevated apnea-hypopnea index (AHI). Obesity may contribute to macroglossia, but its exact relationship is unknown and likely multifactorial, and the degree to which increased adiposity of the tongue affects the development of OSA is not understood. The primary objective of this study was to evaluate how tongue fat and volume relate to the presence and severity of OSA.

Data sources: Studies reporting the impact of tongue fat or volume were identified using predefined inclusion criteria from September 2002 to 2022.

Review methods: All studies underwent a 2-stage blinded screening, extraction, and evaluation process. Primary outcomes were the effect of tongue fat and volume on OSA severity and evaluation of study quality. Secondary outcomes included the impact of obesity on tongue fat distribution and OSA severity.

Results: Out of 930 studies, 6 studies with 219 patients and 133 controls were included in meta-analysis. All 6 studies were case-control designs. Included studies showed low (4) and moderate (2) risks of bias. All studies compared tongue volume with an observed significant increase in tongue volume in OSA patients (P < .00001) with a weighted mean difference of 19.00 cm³ [15.53, 22.47]. Two studies compared tongue fat, and there was a significant increase in tongue fat in patients with OSA (P < .00001) with a weighted mean difference of 8.04 cm³ [4.25, 11.82].

Conclusion: This meta-analysis supports increased tongue volume and tongue adipose as important risk factors associated with OSA. Larger studies investigating tongue fat distribution and the effect of weight changes on tongue fat and volume and OSA severity are needed to characterize this relationship better.

Objective: To better understand the prevalence, risk factors, and management strategies of pregnancy-related rhinologic conditions.

Study design: Retrospective cohort study from January 2013 to January 2023.

Setting: Tertiary level Otolaryngology-Head and Neck Surgery clinic.

Methods: Pregnant patients with rhinologic concerns were included. Data were collected on various parameters including age during pregnancy, gestational age at evaluation for rhinologic complication, obstetric history, history of pregnancy loss, primigravida status, rhinologic condition, aspirin usage during pregnancy, and presence of advanced maternal age (AMA, ≥35 years old). Stata/SE 17.0 Software was used for statistical analysis. A P-value of <.05 was considered significant.

Results: Fifty-seven pregnant patients were included. Patients presented with epistaxis (N = 25, 43.9%), chronic rhinosinusitis exacerbations (N = 22, 38.6%), and rhinitis of pregnancy (N = 10, 17.5%). Mean age at presentation was 34.7 years (22-53). Multivariate analysis revealed associations between epistaxis and primigravida status (P = .008) and rhinitis of pregnancy with a history of pregnancy loss (P = .012). Gestational diabetes mellitus was significantly associated with epistaxis on univariate analysis (P = .011).

Conclusion: There is a need for increased awareness among health care providers, including otolaryngologists, regarding the diagnosis and management of rhinologic conditions of pregnancy.

Objective: With more than 1.57 billion people affected by hearing loss worldwide, this study investigates the association between ototoxic drug use and hearing loss, utilizing South Korean national health data. The goal is to inform clinical prevention and management guidelines by identifying ototoxic drugs and assessing their risks.

Study design: This study is a retrospective observational study using the Health Insurance Review and Assessment Service (HIRA) to analyze the association between suspected ototoxic drug use and hearing loss.

Setting: Data were obtained from the National Patient Samples (NPS) of HIRA in South Korea, covering 2009 to 2016. The study included all National Health Insurance (NHI) enrollees with at least one hospital visit.

Methods: Patients diagnosed with suspected ototoxicity hearing loss (SOHL) were identified, and ototoxic drugs were reviewed using national data. Of 491 reviewed ingredients, 151 were suspected ototoxic. Logistic regression and Cox proportional hazards models assessed associations between drug prescriptions and SOHL, analyzed with SAS 9.4.

Results: SOHL patients were older, with higher rates of underlying conditions and medication use compared to controls. The odds ratio (OR) for SOHL was significantly elevated in patients aged ≥65, increasing from 3.007 to 3.366. Proton pump inhibitors (PPIs) and antibiotics presented elevated risks, especially in older adults, with hazard ratios (HRs) for PPIs rising from 1.85 to 2.90. Notably, PPIs posed higher risks for patients <65.

Conclusion: The study confirms that factors like age, gender, underlying diseases, and specific medications increase SOHL risk, emphasizing the need for cautious medication use tailored to age.

Objective: Sialendoscopy is a diagnostic and interventional treatment for patients with salivary disease. Patients and physicians leverage website information to acquire knowledge about sialendoscopy; thus, understanding the quality of this information is essential. This study analyzes the quality and readability of online information on sialendoscopy.

Methods: "Sialendoscopy" was searched on Google, and the first 100 websites were evaluated. Each website was required to meet three criteria for inclusion: accessible when opened, content deemed relevant, and available in written format. Four validated readability and two validated reliability metrics were utilized. Additionally, a separate analysis was conducted for the top nine websites in the search engine, given most web traffic occurs on Google's first page.

Results: In assessing readability, the mean Flesch Reading Ease Score for included and the top nine websites was 36.2 and 39.5, respectively, with a P-value of .543. Both scores aligned with the "difficult to read" category. Other readability metrics aligned with high school reading levels. For reliability, the mean Discern score for the included and the top nine websites was 36.9 and 45.0, respectively, with a P-value of .030. These scores aligned with the "poor" and "fair" categories, respectively.

Discussion: The low readability and reliability scores implied that the online health information on sialendoscopy is not easily understandable at a reading level appropriate for the general public. Our findings showed that the most readable and highest quality websites were not the highest ranked in our search results. Factors such as search engine algorithms and complex medical terminology used in these informative websites contribute to the lack of readability and relability of online health education.

Implications for practice: As AI evolves, future studies should be conducted to assess its impact on readability and reliability of online health information. There is an opportunity to adjust search engine algorithms, collaborate with communications specialists, and utilize new technologies, such as artificial intelligence chatbots, for the benefit of health seekers.