Otolaryngology- Head and Neck Surgery最新文献

Objectives: Oropharyngeal fat volume is associated with obstructive sleep apnea (OSA) severity. Selective adipose cryolysis may produce cold-induced adipose cell death while sparing surrounding tissues. This study explored (1) similarities in tongue fat between porcine and human models and (2) the feasibility and potential reduction of lingual fat using selective adipose cryolysis.

Study design: Porcine model.

Setting: Preclinical research laboratory under IACUC-approved protocols.

Methods: Anatomical, histological, and biochemical characterizations of tongue tissue from 6 porcine and 4 human cadaver specimens were conducted to establish comparative frameworks. Comparison of fat distribution and composition was conducted via image analysis of histological sections as well as gas chromatography analysis of fatty acid composition. Safety and efficacy of selective adipose cryolysis were evaluated in an additional 16 porcine animals using a prototype cooling system. Histological analysis examined tissue response at 3, 6, 30, and 45 d posttreatment.

Results: Comparative analysis revealed similar fat distribution and composition between human and porcine tongues. Selective adipose cryolysis induced progressive reduction in treated area tongue fat content at all timepoints, from 42% at baseline to 32% (t = 3 d) and 14% (t = 30 d), accompanied by macrophage infiltration, crown-like structure formation, and tissue remodeling.

Conclusion: Selective adipose cryolysis holds promise as a targeted therapeutic approach for reducing lingual fat in humans. The porcine model may provide valuable insight into treatment mechanisms and support initial translational work. Further research is warranted to elucidate long-term treatment outcomes and optimize clinical implementation strategies, with the goal of improving management of OSA in humans.

Tracheoesophageal puncture (TEP) is the gold standard for voice rehabilitation after total laryngectomy (TL). Retrospective analysis was performed of TEP outcomes in patients between 2013 and 2020 at a single tertiary hospital. TEP was performed primarily in 79%, secondarily in 6%, and not placed in 15% of 226 patients. Within the study population, 53.4% utilized their TEP, including 52% of primary and 71.4% of secondary TEPs. TEP-related complication occurred in 50.8%, including 50.8% of primary and 50% of secondary TEPs. Secondary TEP was less likely in Black versus White patients, and more likely in patients undergoing pharyngectomy. Older patients and those with TEP complications were less likely to utilize TEP. Our study, performed in a TL population of predominantly lower socioeconomic status, showed high complication rates and low rates of utilization overall. Our findings suggest secondary TEP may be favorable to allow increased pre-operatively counseling and patient healing prior to procedure.

Objective: To investigate vestibular loss and compensation in Ramsay-Hunt syndrome with dizziness (RHS-D) and vestibular neuritis (VN).

Study design: Retrospective cohort study from 2019 to 2023.

Setting: Tertiary care neurotology practice.

Methods: Patients with RHS-D or VN who underwent videonystagmography, including cervical vestibular evoked myogenic potential (cVEMP), caloric stimulation, rotary chair, and oculomotor testing, were reviewed and stratified by vertigo etiology. The main outcome measures were rates and severity of vestibular loss, as measured by cVEMP and caloric stimulation, and of vestibular compensation, as measured by rotary chair and oculomotor testing.

Results: Ten patients were found to have RHS-D and 22 with VN. Caloric and cVEMP abnormalities were noted in 100 and 70% of RHS-D patients compared to 60 and 20% with VN (P = .029 and P = .034, respectively). RHS-D patients were significantly more likely to present with concurrent caloric and cVEMP abnormalities compared to VN (70 and 13%, respectively; P = .009). Vestibular loss appeared more severe in RHS-D compared to VN suggested by significantly lower mean bithermal slow phase velocity sum (3.8 and 21 degrees per second, respectively), greater canal paresis (78.7 and 40.2%, respectively), and greater cVEMP amplitude asymmetry (64 and 31%, respectively) (P = .014, P < .001, and P = .053, respectively). Regarding vestibular compensation, abnormal gain asymmetry was present in 88% of RHS-D patients with a mean asymmetry of 31.2 compared to 11% in VN with a mean of 14.0 (P = .019 and P = .003, respectively).

Conclusion: Compared to VN, RHS-D patients appear to suffer from a more profound vestibular loss and a worsened ability to compensate for such deficits.

Objective: This study aims to develop an interpretable machine learning (ML) predictive model to assess its efficacy in predicting postoperative recurrence in pediatric chronic rhinosinusitis (CRS).

Study design: A decision analysis was performed with retrospective clinical data.

Setting: Recurrent group and nonrecurrent group.

Methods: This retrospective study included 148 pediatric CRS treated with functional endoscopic sinus surgery from January 2015 to January 2022. We collected demographic characteristics and peripheral blood inflammatory indices, and calculated inflammation indices. Models were trained with 3 ML algorithms and compared their predictive performance using the area under the receiver operating characteristic (AUC) curve. Shapley Additive Explanations and Ceteris Paribus profiles were used for model interpretation. The final model was transformed into a web for interactive visualization.

Results: Among the 3 ML models, the Random Forest (RF) model demonstrated the best discriminative ability (AUC = 0.728). After reducing features based on importance and tuning parameters, the final RF model, including 4 features (systemic immune inflammation index (SII), pan-immune-inflammation value (PIV) and percentage of eosinophils (E%) and lymphocytes (L%)), showed good predictive performance in internal validation (AUC = 0.779). Global interpretation of the model suggested that L% and E% substantially contribute to the overall model. Local interpretation revealed a nonlinear relationship between the included features and model predictions. To enhance its clinical utility, the model was converted into a web (https://juice153.shinyapps.io/CRSRecurrencePrediction/).

Conclusion: Our ML model demonstrated promising accuracy in predicting postoperative recurrence in pediatric CRS, revealing a complex nonlinear relationship between postoperative recurrence and the features SII, PIV, L%, and E%.

Peer review is an essential cornerstone of scientific advancement. This process involves understanding study design, data analytics, and interpretation of the evidence. For clinicians who are performing their initial peer reviews, and even for seasoned reviewers who assess complex manuscripts, it can be helpful to have a standard approach. We therefore provide a conceptual framework for peer review which builds upon experiences that are already familiar to trainees and practicing clinicians, by drawing parallels between patient encounters and peer review. This framework has been used in successive years as a didactic tool for our trainees who are being mentored toward excellence in peer review.

Objective: To determine the relationship between pretreatment neutrophil-to-lymphocyte ratio (NLR) and 6-month progression-free survival (PFS)/2-year overall survival (OS) among patients with recurrent or metastatic (R/M) oral cavity cancer on pembrolizumab.

Study design: This study was a retrospective, observational study performed at a tertiary care academic center.

Setting: Participants included patients with oral cavity squamous cell carcinoma (OCSCC) who began pembrolizumab treatment at the University of California, San Francisco between May 2016 and May 2022.

Methods: The primary outcome was a 6-month PFS. The secondary outcome was a 2-year OS. NLR was treated as a continuous variable. Disease progression was determined using radiographic criteria, adopted from the Response Evaluation Criteria in Solid Tumors.

Results: Fifty-two patients with OCSCC were included. Immune checkpoint inhibitor (ICI) indication was recurrence/metastasis for all patients. The median pretreatment NLR was 5.7 (interquartile range: 3.6-7.6). Twenty-seven (55%) patients received pembrolizumab alone. Of those receiving treatment for R/M prior to ICI, 9 (18%) received salvage surgery and adjuvant therapy, 2 (4%) received chemotherapy alone, 1 (2%) received chemoradiation, and 10 (20%) received salvage surgery. Nineteen (36.5%) patients had distant metastases at the start of ICI. Six-month PFS was 46%. Two-year OS was 44%. NLR was independently associated with 6-month PFS [hazard ratio, HR: 1.05 (95% confidence interval, CI: 1.01-1.11), P = .028] and 2-year OS [HR: 1.12 (95% CI: 1.05-1.20), P < .001].

Conclusion: Higher pretreatment NLR was associated with poorer 6-month PFS and 2-year OS in OCSCC patients treated with pembrolizumab.

Objective: Examine the management and outcomes of pediatric head and neck lymphatic malformations (HNLMs).

Study design: Retrospective case series.

Setting: Tertiary academic hospital.

Methods: Patients aged 18 years or younger treated for HNLMs at Johns Hopkins Hospital from 2000 to 2023 were identified. Demographics, clinical characteristics, and treatment courses were recorded from charts. Outcome measures included estimated clinical post-treatment size reduction and complications. Fisher's exact test was performed for comparisons between treatments.

Results: We identified 101 pediatric patients (50.5% female) with HNLMs. Fifty-two received unimodal treatment, 11 received multimodal treatment, and 38 underwent active observation or no treatment. Of those who received treatment, 44% had their first treatment before 2 years of age. 54.5% of all patients received sclerotherapy. Sclerotherapy caused nearly complete or complete resolution in 52.2% (n = 24) of low-stage (de Serres Stages 1-3) HNLMs and complete resolution in 26.1%. Most (71.4%) high-stage (de Serres Stages 4-5) malformations demonstrated limited size reduction response to all treatments. Surgery had a higher all-inclusive complication rate (25%) compared to sclerotherapy (17%). Multimodal treatment strategies were most often used to treat microcystic malformations of all stages, achieving a 42.9% nearly complete or complete resolution rate.

Conclusion: Low-stage and macrocystic pediatric HNLMs respond well to treatment. Sclerotherapy had the lowest complication rate. High-stage malformations had limited size reduction response to multimodal treatment. As new medical therapies continue to develop, opportunities for improved treatment algorithms will emerge.

Objectives: To compare the presurgical to postsurgical voice quality (VQ) outcomes of types I, II, III, and VI transoral laser cordectomies (TLC).

Study design: Prospective uncontrolled study.

Setting: Multicenter study.

Methods: Patients treated with TLC for a cT1 glottic squamous cell carcinoma were recruited from 2 European hospitals. The pre- to 3-, 6-, and 12-month post-TLC VQ was investigated with the voice handicap index (VHI), GRBAS, speech rate, maximal phonation time (MPT), and acoustic parameters. VQ was compared between types of TLC (types I, II, III, VI).

Results: Ninety-six patients completed the evaluations (16 females). The TLC consists of type I (N = 30), II (N = 27), III (N = 19), and VI (N = 20), respectively. The mean ages of groups ranged from 55.3 to 65.5 years. The VQ significantly improved from pre- to 3-, and 12-month post-TLC in types I, II, and III TLC groups. Only grade of dysphonia was significantly improved in type VI TLC after 6- and 12-month post-TLC. Type VI TLC reported higher values of F0, breathiness, and percent jitter than types I to III TLC 6- and 12-month after the surgery. Percent jitter, F0, and the breathiness were the voice outcomes that highlight the differences in VQ between TLC groups.

Conclusion: The pre- to 12-month post-TLC evolution of VQ is better in types I-II TLC compared to types III and VI. Type VI TLC reported the worse VQ at baseline and throughout the follow-up.