Otolaryngology- Head and Neck Surgery最新文献

Objective: Stigma is a human construct that guides community standards and opinions, often characterized by negative beliefs about a particular circumstance, quality, or person. This study reviews the literature for stigma related to hearing loss and hearing device use.

Data sources: PubMed, Scopus, and Embase.

Review methods: Databases were searched from inception to April 28, 2024. Two independent researchers screened articles and performed full-text reviews. Grounded theory was used to identify and analyze positive and negative themes across disparate qualitative data.

Results: After screening 1096 abstracts, 45 full-texts and 4 conference abstracts were included including 17 studies in pediatric populations, 19 studies in adults of working age, and 14 studies in older adult populations. In pediatric populations, stigma is primarily tied to bullying and poor classmate perceptions, with school-based supports offering mixed results in minimizing perceived stigma. Among working and older age adults, common positive themes included improved quality of life and self-empowerment among hearing aid (HA) users. All working age studies refer to the role of HAs in creating a visible disability. The pervasive theme among older adults was being perceived as old or senile. Although studies were largely equal in gender representation, differential gender effects of stigma and HA decisions were identified.

Conclusion: Hearing loss stigma appears to be pervasive across age and gender with distinctions that have implications for intervention development. Future studies are needed to parse further nuances related to the stigma of hearing loss.

Objective: Hypoglossal nerve stimulation (HNS) is an increasingly used therapy. However, not all patients undergoing HNS implantation benefit from the treatment, making an improved patient selection a priority. This study investigates whether backscattered ultrasonographic imaging (BUI) can predict the response to HNS therapy.

Study design: Cross-sectional study.

Setting: Secondary and tertiary hospital.

Methods: In this multicenter cross-sectional study, we recruited patients who had undergone HNS implantation during their scheduled follow-up consultation. HNS therapy parameters were collected. Standardized submental ultrasonographic examination and home sleep apnea testing were performed. The primary outcome was assessing the response to HNS therapy using ultrasonographic features and preoperative patient characteristics.

Results: In total, 62 participants, 49 male, with a median (interquartile range [IQR]) age of 62 (55-67) and a median (IQR) body mass index of 27.6 (25.2-29.7). The follow-up was a median (IQR) of 19.5 (4.8-41.4) months after implantation. The apnea-hypopnea index (AHI) was preoperatively 40.5 (29.8-58.0) and reduced at follow-up to 21.0 (11.0-35.3). In total, 42% were responders to HNS. Preoperative AHI (34.8/hour vs 49.3/hour, r = 0.44) was significantly higher in nonresponders than in responders. The average prediction accuracy of HNS therapy based on baseline AHI alone was 71%. A lower backscatter signal, indicating less fat deposition in the tissue, was observed in the responder group. When the baseline AHI and backscatter signal were combined, the prediction accuracy of response to the HNS reached 78%.

Conclusion: The combination of tissue composition analyzed using the backscattered signal and the preoperative AHI is highly predictive for determining the HNS treatment response.

Trial registration: ClinicalTrials.gov identifier NCT06154577.

Objective: Although previous studies suggest an increased stroke risk in head and neck cancer (HNC) survivors, the risk with various treatment modalities, including radiotherapy, is less certain. This study investigates stroke incidence and risk in HNC patients, including how different treatments influence stroke risk.

Data sources: A literature search of PubMed, Scopus, and Embase was conducted.

Review methods: We included all primary studies assessing stroke as an outcome in HNC patients aged 18 and older, regardless of cancer subtype or treatment modality. Incidence rates were pooled by reconstructing individual patient time-to-event data from survival curves. Random-effects meta-analyses were employed to compare stroke risk between HNC patients, healthy controls, and treatment groups.

Results: In total, 15 studies (N = 2,295,447 patients) were included in the analyses. Among surviving HNC patients, stroke occurred at a rate of 1% per year (10% at 10 years and 15% at 15 years cumulatively). Meta-analyses showed that HNC patients had a significantly higher stroke risk compared to healthy controls (hazard ratio [HR] = 1.45; 95% CI: 1.27-1.65; I²: 20%). Among HNC patients, radiotherapy alone increased stroke risk compared to surgery alone (HR = 1.66; 95% CI: 1.35-2.03; I²: 0%). Patients who received any form of radiotherapy had higher stroke risk compared to those without (HR = 1.47; 95% CI: 1.29-1.68; I²: 60%). Patients with definitive chemoradiotherapy had heightened stroke risk compared to patients who received definitive surgery (HR = 1.28; 95% CI: 1.09-1.49; I²: 86%).

Conclusion: Patients with HNC face an elevated stroke incidence and risk, especially those treated with radiotherapy. This underscores the need for surveillance and tailored preventive strategies to reduce stroke risk in this vulnerable population.

Objective: NCCN guidelines recommend a neck dissection addressing at least levels II-IV for high-grade mucoepidermoid carcinoma (MEC) and close observation of the lymphatic basins for low-grade MEC. However, no guidelines exist for intermediate-grade MEC with clinically and radiologically uninvolved cervical lymph nodes.

Study design: Retrospective analysis.

Setting: Patients with intermediate-grade MEC with a clinically N0 neck from our tertiary academic institution from 2015 to 2023.

Methods: Evaluation for histologic lymphatic metastases was performed when surgeons elected to perform neck dissection. For patients who did not receive a neck dissection, review of medical records to document the results of clinical observation, and specifically regional lymphatic recurrence, on long-term follow-up.

Results: Thirty-five patients with N0 intermediate grade MEC were included, composed of 26 patients who underwent primary tumor resection and neck dissection and 9 patients who received resection of the primary tumor without neck dissection. One out of 26 patients receiving neck dissection was found to have lymphatic metastasis. Watchful waiting of 9 patients demonstrated no recurrence at a mean follow up of 40 months. Thus, 1 out of 35 patients (2.9% [95% confidence interval: 2.7%-3.1%]) had documented metastatic disease in the lymphatics.

Conclusions: For patients presenting with intermediate-grade MEC, there was a low chance (2.9%) of positive histologic or clinical lymphatic metastases in the neck. Given this low risk, we believe the potential benefit of neck dissection may be outweighed by the potential morbidity. Careful consideration of the clinical behavior of the lesion could be considered along with a more selective approach toward elective lymphadenectomy in intermediate-grade MEC.

Objective: To examine associations with changes in quality-of-life (QOL) outcomes following treatment of vestibular schwannoma (VS) using stereotactic radiosurgery (SRS).

Study design: Prospective longitudinal study.

Setting: Tertiary academic center.

Methods: Patients who were treated for sporadic VS using SRS from 2015 to 2022 were included. QOL outcomes were measured using the disease-specific Penn Acoustic Neuroma QOL (PANQOL) scale.

Results: Seventy-nine patients with pre-SRS and at least one post-SRS PANQOL assessments were available for analysis. The mean change in total PANQOL scores was -2 (SD 13) on a 100-point scale. The mean duration between assessments was 4.6 years (SD 2.0). Age at SRS, sex, and SRS treatment doses were not significantly associated with changes in total PANQOL scores. Total PANQOL scores improved a mean of 4 points for patients with tumors confined to the internal auditory canal but declined a mean of 5 points for patients with tumors extending into the cerebellopontine angle (P = .01); however, these changes did not exceed the minimum clinically significant threshold of 11 points. The correlation coefficient between treated tumor volume at SRS and change in total PANQOL scores was -0.30 (P = .007). Changes in PANQOL total (P = .5) and hearing domain (P = .3) scores for patients who maintained serviceable hearing or progressed to nonserviceable hearing did not significantly differ.

Conclusion: Tumor extent and treated volume at SRS had a statistically significant but likely not clinically important impact on total PANQOL scores. Progression to nonserviceable hearing did not have a significant impact on PANQOL total or hearing domain scores.

Objective: Compared with those of English language preference (ELP), patients of non-English language preference (NELP) are at increased risk of postoperative complications and health care utilization. A series of interventions were initiated to reduce utilization and improve post-tonsillectomy outcomes for NELP patients.

Methods: This quality improvement (QI) study was performed at a tertiary pediatric hospital. Data collection began in 2019 and interventions, including improving translated postoperative education materials, pain medication tracking charts, direct access to interpreters, consistent tonsillectomy technique, and routine postoperative nurse phone call for education, were initiated by December 2020. Postintervention data were collected through July 2024. The primary outcome measured was return to the emergency department (ED) or urgent care (UC) with same-day discharge within 30 days post-tonsillectomy. Additional data collected included demographics, language spoken, reason for surgery, and reason for return.

Results: Between January 2019 and July 2024, a total of 14,007 patients underwent tonsillectomy: 12,830 (91.6%) ELP and 1177 (8.4%) NELP. After interventions, there was a 70.2% reduction (7.73% in 2019 to 2.30% in 2024) in NELP patients who were seen and discharged same day. In 2019, NELP patients were seen significantly more often (P = .016). In 2023, there was not a statistically significant difference between the two groups (ELP = 1.28%; NELP = 2.30%, P = .55).

Discussion: In our patient population, a set of thoughtful interventions for NELP patients/caregivers reduced minor, potentially unnecessary, nonoperative returns to the ED/UC.

Implications for practice: Implementation may reduce complications, improve the postoperative experience for NELP patients, and reduce overall health care costs.

Objective: Prior studies have been contradictory on the role of human papillomavirus (HPV) infection in sinonasal inverted papilloma (SNIP) recurrence. This systematic review and meta-analysis was performed to further evaluate this potential association.

Data sources: PubMed, Embase, and Scopus electronic databases.

Review methods: Case-control studies reporting SNIP recurrence data and HPV status identified by polymerase chain reaction (PCR) and in-situ hybridization (ISH). Meta-analysis was performed to determine pooled odds ratios (ORs) and 95% confidence intervals (CI).

Results: 25 studies were identified including a total of 1116 benign SNIP tumors. A total of 267 SNIP were HPV+, 103 of which were recurrent, and 849 SNIP were HPV-, with 231 being recurrent. The pooled standard OR for recurrence in HPV+ tumors was 2.05 (95% CI: 1.31-3.19). Stratification by low-risk and high-risk HPV subtypes were not statistically significant. The standard OR for SNIP recurrence in low-risk and high-risk HPV+ subtypes were 1.57 (95% CI: 0.98-2.54) and 1.67 (95% CI: 0.98-2.80), respectively.

Conclusion: Infection with HPV may be associated with an increased risk of SNIP recurrence. This increased risk seems to be independent of HPV subtype based on low-risk or high-risk status. However, this correlation was variable among recently published studies requiring additional investigation.

Objective: To investigate the predictive value of tubomanometry (TMM) in predicting subjective outcome of Balloon Eustachian Tuboplasty (BET) in patients with long-lasting Eustachian tube dysfunction (ETD).

Study design: Retrospective case series.

Setting: Single tertiary referral center.

Methods: A total of 111 ETD patients undergoing 194 BET procedures were included. Demographics, TMM measurements, and tympanograms were registered before and 3 to 6 months after BET. The time ratio between the pressure increase in the nasopharynx and the outer ear canal was labelled R value.

Results: At follow-up, 58.8% of the patients were satisfied with BET outcomes. The prevalence of normal R values increased significantly at 30 mbar (12%, P = .024), 40 mbar (14%, P = .0082), and 50 mbar (13%, P = .011). The prevalence of R = 0 decreased at all three pressure levels (-20%, P = .0001; -15%, P = .0013, and -16%, P = .0005, respectively). Type A tympanograms increased from 37% to 56% (P = .0002), while type B tympanograms decreased from 44% to 25% (P = .0006). Stratifying TMM measurements (R ≤ 1, R > 1, and R = 0) showed that preoperative R values were not prognostic of subjective outcome. Preoperative type B tympanogram indicated a risk of poor subjective outcome.

Conclusion: BET appeared to improve Eustachian tube function with reduced prevalence of pathologic R values and tympanograms. Although preoperative R values were not prognostic, TMM remains promising for assessing Eustachian tube function. Further studies are needed to refine TMM's role in predicting BET efficacy.

Objective: This study aimed to attenuate cochlear inflammation following noise-induced hearing loss by targeting IL-1. We evaluated the effectiveness of IL-1 inhibition through auditory and histological assessments in an animal model.

Study design: Experimental animal study.

Setting: Gazi University Faculty of Medicine, Ankara, Turkey.

Methods: Twenty-four rats were randomly assigned into 3 groups: Anakinra, dexamethasone, and control groups. All animals were exposed to broadband noise (110 dB SPL, 8 hours), auditory brainstem response (ABR) tests were conducted before noise exposure, immediately after, and on Day 14. Anakinra, dexamethasone, and saline were administered intraperitoneally, cochlear tissues were harvested for histological and immunohistochemical evaluation.

Results: On Day 14, ABR thresholds in Anakinra group were better than the control group across all frequencies, with a significant difference observed at 8 kHz (P = .036). The mean number of OHC was significantly higher in Anakinra group compared to the control group (P < .05). The mean number of IHC in the Anakinra group was greater than in the dexamethasone group. IL-1β immunopositivity in the stria vascularis and spiral ganglia was significantly higher in Anakinra group compared to dexamethasone group (P = .022 and P = .013, respectively). TNF-α immunopositivity in the stria vascularis and spiral ganglia was significantly greater in control group than in Anakinra group (P = .037 and P = .01, respectively).

Conclusion: The comparable efficacy of Anakinra and dexamethasone in both histological and auditory assessments suggests that Anakinra may serve as a promising therapeutic option for noise-induced hearing loss.

Objective: Solid organ transplant (SOT) recipients carry a higher incidence of cutaneous squamous cell carcinoma (cSCC) with more aggressive features and worse outcomes compared to immunocompetent (IC) patients. The National Comprehensive Cancer Network advocates peripheral and deep en-face margin assessment such as Mohs micrographic surgery (MMS) for very-high-risk cSCC. We aim to assess the efficacy of MMS in the treatment of SOT immunosuppressed head and neck (HN) cSCC patients.

Study design: Cohort study with planned chart review enrolling HN cSCC patients (2004-2017).

Setting: Patients were enrolled from a tertiary care medical center registry.

Methods: Patients with cSCC were categorized on the independent variable of immune status. The incidence of MMS was compared between IC and SOT patients. Subgroup analysis of a matched cohort of patients treated with only MMS was performed for patient demographics, tumor characteristics, recurrence rates, and survival.

Results: A total Of 178 HN cSCC patients met the criteria. SOT patients were more likely to be treated with MMS, P < .001. In the subgroup analysis, 34 matched patients were treated with MMS alone. There was homogeneity between groups regarding patient demographics and tumor characteristics. One patient developed local recurrence in the SOT cohort (P = .310). Compared to IC cSCC patients, SOT patients treated with MMS did not experience worse disease-free or overall survival (OS) (P = .540).

Conclusion: This study suggests that narrow-margin MMS is an appropriate treatment option for SOT cSCC patients. SOT patients were more likely to be treated with MMS and did not compromise local recurrence, disease-free, or OS.