Otolaryngology- Head and Neck Surgery最新文献

Objective: To validate the feasibility of an innovative nasal lining-framework complex (NLFC) for reconstructing total nasal defects.

Study design: Retrospective cohort study.

Methods: This NLFC is composed of forearm flap and support framework. Twenty-four patients were followed up for a minimum of 17 months in 5 centers. Patients' medical history data were retrospectively analyzed. Visual Analog Scale (VAS) of surgeons and patients was used to evaluate the aesthetic effects and self-satisfaction. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and Rhinoplasty Outcome Evaluation (ROE) questionnaire were used for functional assessment.

Results: Reconstruction surgeries were all successfully completed. The flaps healed well in all patients, and there were no signs of ischemic necrosis. The healing time of the wound was 10 to 14 days, except for 1 case with infection. The nasal lining was reconstructed and no significant contracture was observed. The average VAS of surgeons was 4.29 ± 0.69 (range 3-5). The mean VAS score of patients was 3.75 ± 0.79 (range 2-5). There was a significant positive correlation between patients' and surgeons' VAS scores (P = .007, r = .5355). The results of the NOSE questionnaire showed that all patients had no obvious ventilation restriction, and only 3 patients mildly felt that the nasal inspirations were slightly insufficient during exercise or exertion. The mean ROE of the patients was 21 ± 1.96 (range 18-25).

Conclusion: This NLFC is suitable for total nasal reconstruction, which can provide effective support to prevent flap collapse and retraction and ensure good nasal ventilation.

Level of evidence: Level IV, therapeutic study.

Objective: Patients with refractory chronic cough (RCC) are being seen in increasing numbers within otolaryngology clinics. Identifying the next steps in the evaluation and management of cough in patients who have had first-line treatment for gastroesophageal reflux, sinonasal disease, pulmonary disease, and angiotensin-converting enzyme inhibitor-related cough is paramount. This state-of-the-art review focuses on emerging treatments for RCC from an otolaryngology perspective.

Data sources: Pubmed.

Review methods: The available literature on chronic cough, with a focus on RCC, emerging paradigms concerning pathophysiology, and evolving treatment approaches was reviewed and summarized.

Conclusions: Guided by a more detailed understanding of refractory cough physiology, a myriad of new treatment options have been developed to treat RCC. These are primarily aimed at disrupting what is thought to be a hypersensitive cough reflex, whether by a dampening of its sensory inputs or an alteration in motor activity, and are inclusive of neuromodulator treatments, superior laryngeal nerve blockade, vocal fold augmentation, botulinum toxin injection, topical capsaicin, and potentially the eventual use of P2X3 antagonists. Improved laryngopharyngeal reflux diagnosis and management, as well as the potential benefit of behavioral cough suppression therapy, are also discussed.

Implications for practice: The literature supporting each of these strategies is growing-and as more patients with RCC seek otolaryngology care, knowledge of these various approaches may improve the overall treatment of this condition.

Objective: Toxic shock syndrome (TSS) is a rare but serious complication after sinonasal surgery and a commonly cited consideration for prescribing antibiotics when nasal packing or stents are placed. Most reports are limited to case reports or small series. The aim of this systematic review was to describe the incidence, risk factors, and clinical course of patients who developed TSS as a complication of endoscopic sinus surgery (ESS) and/or septoplasty.

Data sources: A systematic review was conducted using MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library databases.

Review methods: Eligibility criteria were patients of any age who developed TSS as a complication of ESS and/or septoplasty.

Results: Twenty-five studies were included in the final review. Seventy cases were identified over 38 years (1982-2020). The pooled incidence of TSS after sinonasal surgery was 0.0003 (0.0002-0.0004, 95% confidence interval, CI) or 30 per 100,000 persons. Among 33 patients with single-subject data, mean age was 33.8 years (29.73-37.87, 95% CI). Seventeen (51.5%) patients had nasal packing, 3 (9.1%) had stents, 5 (15.2%) had both, 7 (21.2%) had none. Fourteen (42.4%) patients had nonabsorbable packing and 5 (15.2%) had absorbable packing. Sixteen (48%) patients received peri-operative antibiotics. Thirty-two (97%) patients had full recovery.

Conclusion: The incidence of TSS after sinonasal surgery is very rare. TSS can occur with and without nasal packing and prophylactic antibiotics were not protective. Outcomes were favorable with appropriate recognition and management. Further study is needed to determine which patients are most at risk for TSS.

Objective: To calculate the minimal clinically important difference (MCID) for the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI).

Study design: Prospective cohort study.

Setting: A single tertiary care balance and falls center.

Methods: Fifty-three subjects meeting Barany Society criteria for vestibular migraine (VM) or probable VM were included and divided into 3 treatment groups. Treatment was not standardized, instead, management was decided individually between each patient and their provider. All subjects completed VM-PATHI before and after intervention. A Global Rating of Change (GRoC) questionnaire was also completed following intervention. Anchor-based methods, using a GRoC questionnaire, were utilized to estimate the MCID that produced the highest sensitivity and specificity on a receiver operating characteristic (ROC) curve.

Results: Forty-three subjects were classified as responders and 10 were classified as nonresponders. The mean VM-PATHI pretreatment score minus the posttreatment score between the responders (mean = 14, SD 13) and nonresponders (mean = 4 SD = 12) was statistically significant (mean difference = 10, 95% confidence interval, CI [1, 20], P = .03). The VM-PATHI score change cutoff that best differentiated between responders and nonresponders was a VM-PATHI change of 6. Thus, the MCID was defined as a change of 6 points (sensitivity = 72%, specificity = 70%). The area under the ROC curve was 0.89, 95% CI [0.80, 0.98], which demonstrates an excellent ability for the VM-PATHI score change to discriminate between responders and nonresponders. The average change in VM-PATHI scores was 9 points (SD 11) for those with "a little better" rating on the GRoC, 14 points (SD 14) for those with a "moderately better" rating, and 20 points (SD 13) for those with a "very much better" rating.

Conclusion: Patients with VM are likely to demonstrate clinical improvement if their VM-PATHI score decreases by 6 or more.

Objective: Pain prevalence in long-term head and neck cancer (HNC) survivors is important but understudied to date. The present investigation examined pain prevalence, associated clinical characteristics, and disease-specific health-related quality of life (HRQOL) in a cohort of survivors 10 years postdiagnosis (N = 187).

Study design: Retrospective cohort study.

Setting: Single-institution tertiary care center.

Methods: Pain was assessed using a single-item numeric rating scale. Clinical characteristics were abstracted from the patient medical record and HNC-specific HRQOL scores were measured using the Head and Neck Cancer Inventory (HNCI) and are presented by the pain subgroup.

Results: At 10 years postdiagnosis, 56.7% reported no pain, 20.3% reported mild pain, 16.0% reported moderate pain, and 7.0% reported severe pain. Most patients with moderate or severe pain at the 10-year follow-up assessment also had advanced-stage disease at diagnosis. Multiple linear regression analyses indicated that advanced-stage disease at diagnosis was a significant predictor of pain at 10 years postdiagnosis controlling for age, sex, and comorbidity status (β = .184, t = 2.193, P = .030, sr² = 0.025). Across all HNC-specific HRQOL domains, those reporting moderate/severe pain at 10 years postdiagnosis failed to reach a score of 70 which is indicative of high functioning on the HNCI in the areas of aesthetics, eating, speech, and social disruption.

Conclusion: Pain is a significant issue in long-term HNC survivors up to 10 years postdiagnosis. More research is needed to understand the correlates and types of long-term pain exhibited after treatment, including the implementation of screening and intervention into clinical workflow to improve outcomes and optimize HNC survivorship care.

Objective: To develop and validate a patient-reported outcome measure (PROM) to evaluate the quality of life (QoL) among patients with obstructive sleep apnea (OSA).

Study design: A prospective cohort study.

Settings: Tertiary referral center.

Methods: We developed a 15-item English questionnaire that was administered to 176 adults with OSA and 22 adult controls without symptoms of OSA in a tertiary sleep surgery clinic between June 2021 and December 2021. The internal consistency and test-retest reliability were measured using the Cronbach's α and the intraclass correlation coefficient, respectively. The 2-sample Wilcoxon rank-sum (Mann-Whitney) test was applied to compare the 2 groups. Convergent validity of the test scores of the questionnaire was compared to previously validated outcome measures and objective sleep study outcomes using the Spearman correlation coefficient.

Results: Of the 198 respondents (176 cases and 22 controls); 71% were men and 29% were women. The internal consistency was excellent with the α of .92 (lower 95% confidence limit of 0.90). All the test-retest correlations were positive, significant, and strong ranging from 0.50 to 0.90. The differences between cases and controls were statistically significant for all the items and for the total score. The total score of the questionnaire with the Epworth Sleepiness Scale and objective OSA measures was moderate to strong.

Conclusions and relevance: The new tool provides a validated PROM to evaluate the QoL among OSA patients specifically, with excellent internal consistency, reasonable test-retest reliability, discriminant validity, and construct validity.

Level of evidence: Level 4.

Objective: Apply the Sustainability in Quality Improvement framework to virtual care for Otolaryngology-Head and Neck Surgery (OHNS) patients to understand the economic, environmental, and social impacts.

Methods: This project consisted of retrospective analysis of anonymized data from all appointments that took place in three academic ambulatory OHNS clinics (pediatrics, head and neck, and otology/neurotology) from fiscal years of 2021 to 2023. Data were obtained from our institution's Virtual Care Dashboard. The following metrics were calculated: travel costs avoided with virtual appointments (economic value), fuel and carbon emissions avoided with virtual appointments (environmental value), and differences in Ontario Marginalization (ON-Marg) Index scores between patients seen virtually versus in-person (social value).

Results: A total of 41,343 visits occurred over the 2-year period (18.1% virtual). Nearly all virtual visits were by telephone (99.6%). The average cost savings per virtual care visit was $87.50, and total cost savings across all 3 clinics was $640,300. Total environmental savings were 82,500 L of fuel and 246.6 metric tons of carbon emissions. There were no statistical differences in monthly average marginalization (ON-Marg) indices in patients seen virtually compared to in-person.

Discussion: Virtual care demonstrated financial and environmental savings for OHNS patients that can accumulate over multiple appointments. No difference in ON-Marg indices between patients assessed virtually versus in-person suggests that virtual care was accessible for patients regardless of social background.

Implications for practice: Our data suggests that virtual care may be a viable complement for delivering OHNS care that leads to fiscal and environmental savings for patients and ensures equitable access to care.

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.