Otolaryngology- Head and Neck Surgery最新文献

Objective: This study aims to describe and evaluate clinical and polysomnographic outcomes of the preservation palatopharyngoplasty procedure, which preserves pharyngeal mucosa and muscles, in patients with obstructive sleep apnea with high modified Mallampati scores (3 or 4).

Study design: A retrospective chart review.

Setting: A tertiary medical center.

Methods: A total of 23 patients who underwent preservation palatopharyngoplasty between November 2022 and May 2024 were included. Outcomes measured were apnea-hypopnea index (AHI), oxygen desaturation index (ODI), Epworth Sleepiness Scale (ESS) scores, and Nasal Obstruction Symptom Evaluation (NOSE) Scale scores pre- and postsurgery. Data were analyzed using unpaired or paired t-tests, and statistical significance was set at P < .05.

Results: The mean age of included patients was 51.74 years. Postoperative results showed a significant 25.48% (standard deviation [SD] = 32.59) decrease in AHI (P = .0011) and 35.25% (SD = 11.00) mean decrease in ODI (P = .0030). REM sleep percentage increased from 12.96% to 21.35% (P = .0106), and REM AHI decreased from 55.49 to 40.02 events/h (P = .0255). Significant improvements were also seen in ESS (P = .0123) and NOSE scores (P = .0134). Among the included patients, 12 out of 23 patients achieved surgical success per Sher's criteria.

Conclusion: The preservation palatopharyngoplasty significantly improved subjective and objective measures in OSA patients with higher Mallampati scores by enhancing upper airway patency and reducing OSA severity.

Objective: This study aimed to investigate the relationship between the dietary inflammatory index (DII) and middle ear disease (MED) in adults using data from the National Health and Nutrition Examination Survey (NHANES) 2015 to 2020.

Study design: A cross-sectional analysis was conducted on a sample of American adults to explore the association between DII and MED.

Setting: The study utilized data from 3 NHANES cycles (2015-2020), assessing the health and nutritional status of adults and children in the United States.

Methods: We analyzed data from 3743 participants aged 20 and older, with MED defined by abnormal tympanogram results. DII was calculated based on dietary intake data recorded during the 24 hours before the interview. Logistic regression models were used to examine the association between DII and MED, adjusted for various demographic and health-related factors.

Results: The results revealed a significant positive association between higher DII scores and the likelihood of MED, particularly in individuals under 60 years of age. A nonlinear relationship was identified, with a threshold effect at a DII value of 2.74, below which higher DII was associated with increased risk of MED, while the association weakened above this threshold.

Conclusion: This study suggests that inflammatory dietary patterns are associated with an increased risk of MED, especially in younger adults. The findings underscore the importance of dietary interventions in preventing and managing MED and warrant further prospective studies to confirm these results and understand the mechanisms by which diet affects middle ear health.

Objective: This study aims to investigate the characteristics of hearing loss associated with MYO15A mutations and to analyze the longitudinal prognosis over a 4-year period using different treatment modalities, including cochlear implants (CIs), hearing aids (HAs), and conservative management.

Study design: A retrospective case review.

Setting: A tertiary referral center.

Methods: Sequencing was performed to recruit patients with potentially pathogenic MYO15A mutation-induced hearing loss. Audiological data, radiological imaging, and assessment of hearing and speech performance before and after different treatments were analyzed in combination with patients' genotypes.

Results: Sixteen patients with MYO15A mutation-induced deafness from 14 unrelated pedigrees were enrolled, carrying 5 previously unreported mutations: c.3660_3666delinsAA (p.Glu1221fs), c.4635delG (p.Val1545fs), c.6664A>G (p.Met2222Val), c.8215delG (p.Ala2739fs), and c.8897delG (p.Gly2966fs). Inner ear malformations were observed in 3 patients. CI recipients exhibited significant improvements in hearing and speech abilities 1-year post-implantation, while individuals using HAs showed a gradual improvement trend over a 4-year period. Notably, even those with bilateral cochlear aperture atresia achieved satisfactory hearing and speech outcomes following early CIs.

Conclusion: Patients with MYO15A mutations who underwent CIs generally demonstrated earlier improvements in hearing and speech development compared to those using HAs. Early genetic detection and timely implementation of assistive acoustic stimulation are recommended for optimal outcomes.

Objective: To analyze the utilization patterns of outpatient laryngoscopic excision procedures for laryngeal cancer in the United States, examining procedural costs and patient demographics to identify disparities in healthcare access.

Study design: Retrospective cohort study.

Setting: National Ambulatory Surgery Sample database of major ambulatory surgeries in the United States, 2016-2021.

Methods: Encounters for endoscopic resection of laryngeal cancers were identified focusing on patient demographics and procedural costs. Analysis was performed regarding trends over time.

Results: Of 11,371 encounters in 2016-2021, patients were mostly male (82.6%), White (75.3%), and living in metropolitan areas with greater than 1 million residents (54.1%), with an even distribution between income quartiles. Predictors of utilization at urban teaching hospitals progressively decreased in patients residing in smaller metropolitan areas (250-999,000 residents (odds ratio [OR] = 0.451, P ≤ .0001) and 50-249,000 residents (OR = 0.193, P ≤ .0001). Higher utilization was found in non-White patients (Black [OR = 1.673, P = .0075], Hispanic [OR = 1.752, P = .0118]), and those with patients with higher income (2nd quartile [OR = 1.411, P = .0058], 3rd quartile [OR = 2.017, P ≤ .0001], and 4th quartile [OR = 4.422, P < .0001]). These findings were consistent on multivariate analysis, however belonging to a racial minority lost significance (Black patients [P = .0508], Hispanic [P = .3008]).

Conclusion: There are existing disparities in endoscopic resection of laryngeal cancers. Our findings add to the literature underscoring the importance of expanding access to minimally invasive laryngeal preserving surgical treatment.

Objective: Cochlear implant (CI) electrode array tip fold-overs occur at an increased rate with perimodiolar electrode arrays, necessitating removal and re-insertion. The degree to which an intra-operative correction of tip fold-over affects CI performance and hearing preservation has not been previously reported.

Study design: Retrospective chart review of CI recipients receiving a slim perimodiolar electrode array from 2016 to 2023.

Setting: Tertiary referral center.

Methods: Low-frequency pure tone average (LFPTA) was defined as the average of thresholds at 125, 250, and 500 Hz. We defined hearing preservation candidacy as LFPTA < 60 dB HL preoperatively, and successful hearing preservation was defined as LFPTA < 80 dB HL at activation. Consonant-nucleus-consonant (CNC) word recognition and AzBio scores in quiet and in +10 dB signal-to-noise ratio (SNR) were collected preoperatively, and at 3- and 6-months postoperatively.

Results: From 663 implants, 35 (5.3%) experienced tip fold-over that was identified and corrected intra-operatively. There was no significant difference in 3-month CNC scores between those with fold-overs (44.9%, SD 20.9%) and those without (46.2%, SD 21.0%; P = .98). Similarly, there was no difference in AzBio in quiet (53.1%, SD 21.7% vs 60.8%, SD 28.0%; P = .26) or in AzBio +10 dB SNR (19.1%, SD 23.7% vs 31.5%, SD 27.2%; P = .60). Of 19 hearing preservation candidates that experienced tip fold-over, 6 (31.6%) had preserved hearing at activation compared to 31 of 59 candidates (52.5%; P = .11) without fold-over.

Conclusion: While tip fold-over remains a clinical concern, speech performance does not appear to be negatively affected if the fold-over is identified and corrected.

Objectives: To investigate the influence of race and insurance type on speech delay rates and hearing rehabilitation access in children with bilateral hearing loss (HL).

Study design: Retrospective cross-sectional study of pediatric patients with bilateral HL who received cochlear implants (CIs) or hearing aids (HAs).

Setting: This study used the national Pediatric Health Information System (PHIS) database to identify patients with HL across 52 tertiary care pediatric hospitals in the United States.

Methods: Data collected included demographics, CI/HA use, speech delay/disorders, and type of insurance coverage.

Results: This study identified 18,422 patients with bilateral HL (40.1% female, 66.3% white, 66.3% on public insurance), with an average age of 5.21 ± 4.37 years. Patients with private insurance were more likely to be white than non-white (48.9% vs 27.5%, P < .001), more likely to receive CI (18.0% vs 14.7%, P < .001), more likely to receive HA (21.3% vs 17.9%, P <.001), and less likely to have speech delay diagnoses (74.9% vs 81.0%, P < .001) compared to patients with public insurance. Compared to non-white patients, white patients were more likely to have CI (16.8% vs 14.7%, P < .001), more likely to have HA (20.6% vs 17.0%, P < .001), and less likely to have speech delay diagnoses (81.1% vs 77.2%, P < .001). When adjusting for other variables, these associations with insurance type and race were still observed.

Conclusion: Disparities seen amongst different races and income groups can be observed at the population level and highlight an opportunity for policy interventions to secure equitable access for children with pediatric HL.

Objective: This study aims to compare the intraoperative ergonomics of tonsillectomies and adenoidectomies performed in seated versus standing positions for pediatric otolaryngology residents and attending physicians.

Study design: A randomized controlled trial.

Setting: A tertiary care center.

Methods: Intraoperative data were collected for 2 attending physicians and 13 residents as they performed adenoidectomies and tonsillectomies. Each tonsillectomy was randomized to either first tonsil sitting/second tonsil standing or vice versa. Adenoidectomies performed during the same anesthesia were performed in the second of the 2 positions, and thus also randomized. Isolated adenoidectomies were randomized to either the sitting or standing position. The rapid upper limb assessment (RULA) was used to quantify ergonomic risk for each operation on a 0 to 7 scale.

Results: Univariate analysis demonstrated a significant difference between sitting and standing positions (P < .001), with the sitting position exhibiting lower mean total RULA scores (mean = 3.26, median = 3.00) compared to standing (mean = 3.76, median = 4.00). This was confirmed using a multi-variable analysis adjusting for demographic variables. Univariate analysis showed that PGY1 residents had the lowest total RULA scores, whereas attending physicians had the highest total RULA scores. However, this was not confirmed by multi-variable analysis. Upper arm, lower arm, and trunk body region scores were higher in the sitting position, while wrist and neck scores were higher in the standing position. These conclusions were drawn from both univariate and multi-variable analysis.

Conclusion: Sitting during adenotonsillectomy may mitigate ergonomic risk. Further research is needed to identify ways in which intraoperative ergonomics can be optimized. This study may also have implications for similar intraoral procedures.

Objective: Preserving residual hearing following cochlear implantation (CI) improves outcomes and allows patients to use electrical and acoustic stimulation. Hearing preservation and minimizing intracochlear trauma during implantation have become key areas of research and device development in recent years. This meta-analysis evaluated whether patient characteristics or surgical methodology impact hearing preservation postpediatric CI.

Data sources: A systematic search was performed in PubMed, Web of Science, Cochrane Library, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature.

Review methods: Per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the databases were searched for English studies published before August 2024. Search terms were "hearing preservation," "cochlear implant," "audiometry," and "pediatric" and their synonyms. The main outcome was the percentage of ears with hearing preservation after CI. Patient, audiological, device, and surgical technique characteristics were extracted. The impact of these factors on hearing preservation was evaluated.

Results: Twenty-four studies were included, with a total of 567 patients. Males comprised 50% of patients (95% confidence interval [CI]: 45%-55%). Mean patient age was 9.68 years (95% CI: 8.27-11.09 years). Mean pure tone averages (PTAs) before and after CI were 60.48 dB (95% CI: 48.81-72.14 dB) and 70.95 dB (95% CI: 56.75-85.15 dB), respectively. Hearing preservation was reported in 78% of ears (95% CI: 71%-85%), with high heterogeneity between studies (I² = 79.96%). Gender, surgical approach, electrode array, topical corticosteroids, and initial PTA were not significantly associated with hearing preservation.

Conclusions: Hearing preservation following pediatric CI occurred in 78% of ears. In this meta-analysis, no patient characteristic or surgical technique was significantly associated with hearing preservation.

Objective: To examine changes in trends of the incidence and characteristics of pediatric complicated rhinosinusitis with respect to the coronavirus disease 2019 (COVID-19) pandemic.

Study design: Retrospective cohort.

Setting: Single tertiary-care center.

Methods: A review of patients who presented to St. Louis Children's Hospital (SLCH) with complicated rhinosinusitis from 2017 to 2022 was performed. Clinical and follow-up data were analyzed in association with COVID-19.

Results: Eighty-three patients with complicated rhinosinusitis were identified and analyzed according to hospitalization before or after March 2020. No differences in demographic variables were found between the two groups. More patients had developmental comorbidities in the COVID-19 group (7 vs 1, P = .049). More patients with intracranial complications (55% vs 45%, P = .48) and Pott's puffy tumor (78% vs 22%, P = .13) were observed in the COVID-19 era group; however, this difference was not statistically significant. In the COVID-19 group, more patients were found to have Streptococcus anginosus growth in their surgical cultures (67% vs 33%, P = .03). The incidence of complicated sinusitis correlated with the incidence of all viral cases at SLCH, particularly in 2021 and 2022, and increased following COVID-19.

Conclusion: Trends in complicated sinusitis vary before and after the onset of the COVID-19 pandemic. There was an increase in complications of sinusitis due to S. anginosus species in the COVID-19 era and trends towards increased intracranial complications and Pott's puffy tumor. After an initial decrease, the incidence of complicated sinusitis per year increased following COVID-19.

Objective: Idiopathic vocal fold paralysis (IVFP) is an enigmatic disease that results in voice, breathing, and swallowing impairments. This systematic review provides a comprehensive discussion of the demographics, management, and outcomes of IVFP.

Data sources: PubMed and Embase databases.

Review methods: The PubMed and Embase databases were queried with the keywords "((vocal fold paralysis) OR (vocal cord paralysis)) AND (idiopathic)." Articles were selected if published between 1990 and 2023 and reported data related to patients aged ≥18 years with IVFP. Case studies and reviews were excluded. Participant demographics, presenting symptoms, and spontaneous recovery data were extracted.

Results: The database query identified 509 relevant abstracts, of which 29 studies met the inclusion criteria. A total of 1238 patients with IVFP were identified with a mean age of 55.8 years (range: 40.0-70.2). Patients experienced unilateral IVFP in 97.0% of cases with 67.5% affecting the left side. The most common presenting symptoms were dysphonia (n = 78), dysphagia (n = 41), sore throat (n = 16), and cough (n = 13). Five studies reported time to presentation with a mean of 114.5 days (range: 28-341). Eleven studies found a mean spontaneous recovery rate of 31.6% (range: 11.8%-87.5%) over a mean of 139.4 days (range: 68-180). Only 4.3% of patients were documented to have a viral upper respiratory infection (URI) before developing IVFP. No specific treatments were linked to spontaneous recovery.

Conclusion: There is a paucity of research describing the presentation and outcomes of patients with IVFP. Viral URI may be a potential contributing factor to IVFP development; however, more research is necessary.