Otolaryngology- Head and Neck Surgery最新文献

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.

Objective: Human papillomavirus (HPV) is a significant driver of elevated risk for oropharyngeal squamous cell carcinoma (OPSCC). In 2018, HPV vaccination eligibility was expanded to men and women aged 27 to 45. We evaluated changes in awareness of HPV, its association with OPSCC, and HPV vaccination among all US adults between 2018 and 2020, focusing on those aged 27 to 45.

Study design: Cross-sectional survey cycles.

Setting: The Health Information National Trends Survey (HINTS).

Methods: The HINTS, a nationally representative survey of US adults, was queried. A total of 3504 adults in 2018 and 3865 adults in 2020 were assessed for knowledge of HPV, its vaccine, its association with OPSCC, and changes in awareness between 2018 and 2020. Statistical significance was set at P < .05.

Results: Most respondents were aware of HPV (2018: 60.8%; 2020: 64.8%) and its vaccine (2018: 60.8%; 2020: 61.6%). A significant decrease in awareness of the association between HPV and cervical cancer was seen between 2018 and 2020 (75.0% vs 70.2%, P = .028). Knowledge of HPV+ OPSCC was poor and did not change over time (2018: 27.0%, 2020: 29.5%). Statistically significant increases in HPV awareness between 2018 and 2020 were found for individuals who reported completing high school as their highest level of education (P = .009), Caucasians (P = .013), males (P = .024), and those making more than $200,000 annually (P = .022).

Conclusion: Knowledge of the association between HPV and OPSCC remained poor despite expanded vaccine eligibility. Public health education on the association may increase awareness for groups likely to benefit from vaccination.

Objective: Otolaryngologists play an increasing role in managing cough, but little data exists examining the demographics of this patient population and the referral patterns that influence their access to care. This study sought to elucidate these factors using a longitudinal, nationwide database to minimize sampling bias and identify trends representative of the national population.

Study design: Nationally representative survey.

Setting: National Ambulatory Medical Care Survey (NAMCS).

Methods: Visits with a diagnosis and chief complaint of cough between 2005 and 2019 in NAMCS were examined. Univariable and multivariable analyses were performed to compare patient demographics between visits to surgical specialists, medical specialists, and primary care physicians.

Results: Otolaryngologists made up more than 84% of surgical specialist visits. There was a 0.52% [0.20%-0.84%] increase per year in the proportion of visits attributed to surgical specialists. Based on a sensitivity analysis of the multivariable model, Hispanic patients (adjusted odds ratio, aOR: 0.88 [0.78-0.99] vs White) and patients living outside of metropolitan areas (aOR: 0.77 [0.61-0.99] vs living within) were less likely to see surgical specialists than primary care doctors for their cough. Patients who were referred (aOR: 1.47 [1.28-1.72] vs not referred) and with chronic cough (aOR: 1.47 [1.23-1.75] vs acute/subacute) were more likely to see a surgical specialist.

Conclusion: Otolaryngologists are increasingly called upon to evaluate and consider treatment for cough. Identifying patient groups with limited access underscores the need for enhanced education about otolaryngologists' roles and integrated care approaches to improve access to specialized cough treatment.

Level of evidence: Level 4.

Objective: Surgical treatment of non-obstructive sleep apnea (OSA) pathology poses the risk of inappropriate surgical indications. Herein, we sought to determine the prevalence of non-OSA respiratory disorders, specifically central sleep apnea (CSA), in new referrals to a Sleep Surgery Clinic.

Study design: Prospective observational review.

Setting: Tertiary care academic medical center.

Methods: In a sleep surgery clinic cohort, the presence of clinically significant CSA was defined as having >25% of the total apnea-hypopnea index (AHI) being central and/or mixed events. Demographics, comorbid disorders, patient-reported outcome measurements, and sleep study results were compared among patients using linear or logistic regression analysis, unadjusted and adjusted for age, sex, and body mass index (BMI).

Results: On average, the cohort (n = 295) was male (74%), middle-aged (mean [±SD] 54.2 ± 13.9 years), and overweight (BMI 30.3 ± 5.4), with severe sleep apnea (AHI 30.6 ± 22.6 events/h). Twenty-nine patients (9.8%) were found to have clinically significant CSA yet only 10% of these cases carried a diagnosis of CSA upon presentation. The remainder were identified by reviewing the pre-visit sleep study tables (35%), raw data (17%), and tables and raw data of a repeat post-visit study (38%). Patients with CSA were older and had evidence of more cardiac comorbidities.

Conclusion: The prevalence of CSA in new referrals to a Sleep Surgery Clinic was nearly 1 in 10 despite only 1% (3 of 295) with a known diagnosis upon presentation. Sleep surgeons must remain vigilant for patients with occult CSA, especially in older patients with a history of significant cardiovascular disease.