Otolaryngology- Head and Neck Surgery最新文献

Objective: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is often avoided during intraoral laser use due to the concern for an airway fire with the addition of high-flow oxygen. We aim to demonstrate that THRIVE can be safely used during transoral laser microsurgery (TLM) without causing an airway fire or other major complications.

Study design: Retrospective cohort study.

Setting: Emory University Hospital Midtown between January 2020 and April 2024.

Methods: A retrospective chart review of all patients who underwent TLM with the use of THRIVE was performed. A standardized laser safety protocol was followed, and either a carbon dioxide or potassium titanyl phosphate laser was used for all cases.

Results: In total, 369 cases were examined, and no fire, ignition, flash, or major complication occurred. In total, 270 (73.2%) patients were Caucasian females and 271 (73.4%) patients had a primary diagnosis of idiopathic subglottic stenosis. A total of 110 (29.8%) cases were completed with the use of THRIVE alone, 238 (64.5%) required the addition of jet ventilation, and 21 (5.7%) required intubation for the completion of the case. Increased body mass index was positively associated with the need for jet ventilation or intubation and reached statistical significance for the type of airway management employed during the case (P-value < .001).

Conclusion: Airway fire and other major complications are preventable with the use of THRIVE during TLM if standardized laser safety practices are implemented.

Objective: Evaluate the use of tranexamic acid (TXA) and observation as a management option for pediatric patients presenting with posttonsillectomy hemorrhage (PTH).

Study design: Retrospective analysis of a prospectively implemented quality improvement initiative with a historical control comparison group.

Setting: Tertiary children's hospital.

Methods: Patients <18 years of age who underwent adenotonsillectomy (AT) and returned to the Emergency Department for PTH were included. Patients who were stable without large volume or active bleeding were given intravenous TXA and admitted for overnight observation. Data were compared in a before-and-after analysis: preprotocol (April 2022 to March 2023) versus postprotocol (April 2023 to March 2024). For cost-effectiveness analysis, we analyzed aggregated claims data from a commercial claims database.

Results: Preprotocol 1800 adenotonsillectomies were performed, and 40 procedures were performed for control of hemorrhage (2.2 per 100 AT). Postprotocol 2356 adenotonsillectomies were performed, and 30 procedures were performed to control hemorrhage (1.3 per 100 AT) showing a significant reduction in return to the operating room (relative risk [RR] = 0.59, 95% confidence interval [CI] [0.358, 0.916], P-value .020). There were no reported adverse events attributable to TXA. An estimated 21 surgeries were avoided, and 26 additional patients were observed in the hospital during the postprotocol period, for an estimated net cost savings of $174,970.

Conclusion: The implementation of a standardized TXA protocol significantly reduced the need for return to the operating room for PTH in pediatric patients, without complications and with net cost savings to the healthcare system.

Objective: This study aims to characterize diuretic use among patients with and without benign paroxysmal positional vertigo (BPPV) using a population-level database.

Study design: A case-control study.

Setting: TriNetX US Collaborative Network.

Methods: Subjects with ≥1 hospital visit between 2019 and 2024 were queried and stratified by age (18-44, 45-64, and 65+ years) and sex. Each cohort was then divided into those with/without BPPV. Patients with head trauma, middle/inner ear surgery, central vertigo, or migraine were excluded. The prevalence of diuretic use and vitamin D deficiency of each case cohort was compared against the control cohort of the same age/sex using Chi-square analysis. This stratification and analysis were repeated for patients with a vestibular disorder, as well as those with/without Ménière's disease (MD).

Results: Diuretic use was significantly more common in case cohorts than in control cohorts in the general population. In vestibular patients, thiazide and carbonic anhydrase inhibitor (CAI) use were more common in control cohorts, and loop use was less common. In MD patients, thiazide and loop use were more common in control cohorts, and CAI use did not differ significantly. In patients without MD, CAI use also did not differ, while thiazide and loop use were less common in control cohorts.

Conclusion: All diuretics may alter the risk of BPPV. Their influences can be favorable or unfavorable, depending on the individual patient's medical history. Their effects might relate more directly to the efficacy of each diuretic class rather than their specific mechanisms of action.

Objective: This study evaluated outcomes of stapes surgery in otosclerosis patients by assessing audiometric results and health-related quality of life (HRQOL) using the Dutch Stapesplasty Outcome Test-25 (SPOT-25) questionnaire. Additionally, the role of SPOT-25 in preoperative decision-making and as a follow-up tool was explored.

Study design: A prospective, multicenter cohort study.

Setting: One tertiary academic medical center and 3 secondary referral centers.

Methods: Data from 115 adult patients undergoing primary stapes surgery was analyzed. Audiometric outcomes were measured using pure-tone audiometry results and word recognition score (WRS). HRQOL was assessed using SPOT-25, Glasgow Health Status Questionnaire, and Glasgow Benefit Inventory. Pre- and postoperative outcomes were compared, and correlations between pure-tone audiometry results, WRS, and HRQOL were analyzed. Outcomes were compared between patients receiving 0.4 and 0.6 mm diameter pistons, and the impact of preoperative pure-tone audiometry results was analyzed.

Results: Significant postoperative improvements were observed in all audiometric measures (mean air conduction gain of 22 dB and air-bone gap (ABG) improvement of 18 dB). HRQOL also improved significantly (mean SPOT-25 score improved from 48 to 27). The 0.6 mm piston group had a significantly smaller postoperative ABG than the 0.4 mm group. Patients with a preoperative ABG ≤ 15 dB had a mean SPOT-25 gain of 19 (SD 22), whereas those with a preoperative ABG > 15 dB had a gain of 21 (SD 18).

Conclusion: Stapes surgery significantly improves hearing and HRQOL. The SPOT-25 is a valuable tool for evaluating HRQOL and may assist in preoperative decision-making in patients with varying hearing impairments.

Level of evidence: III.

Objective: This study aims to systematically review the international literature for randomized trials presenting subjective, long-term outcomes (1-3 years) for nasal obstruction treated with inferior turbinoplasties, followed by a meta-analysis.

Data sources: PubMed/MEDLINE and 5 other databases.

Review methods: Two authors searched through October 27, 2024.

Results: Four randomized trials with 2874 patients provided outcomes after bilateral inferior turbinoplasties. At 2 years, the microdebrider visual analog scale (VAS) values reduced 81.7% from 8.2 ± 1.4 to 1.5 ± 0.7, the submucosal resection reduced 82.4% from 8.5 ± 1.0 to 1.5 ± 0.6, outfracturing reduced 82.8% from 8.7 ± 1.1 to 1.5 ± 0.7, and radiofrequency ablation increased 8.1% from 7.4 ± 1.0 to 8.0 ± 1.4. At 3 years, the microdebrider VAS values reduced 80.5% from 8.2 ± 1.4 to 1.6 ± 0.8, the submucosal resection reduced 82.4% from 8.5 ± 1.0 to 1.5 ± 0.7, outfracturing reduced 82.8% from 8.7 ± 1.1 to 1.5 ± 0.8, and radiofrequency ablation increased 12.2% from 7.4 ± 1.0 to 8.3 ± 1.4.

Conclusion: In this systematic review, evaluating data at 2 and 3 years after inferior turbinoplasties, the procedures that removed tissue or outfractured had approximately 80% improvement in the VAS, while techniques that did not remove tissue or outfracture tended to have a recurrence of their nasal obstruction. Additional research is needed.

Objective: This study aims to comprehensively review and compare the safety and efficacy of commonly used lasers in the management of head and neck capillary malformations (CMs).

Data sources: PubMed, Embase, Cochrane, and Web of Science.

Review methods: Databases were searched from inception to August 2023. Study protocols adhered to the PRISMA guidelines. Cohort studies reporting CM laser treatment outcomes were included. Study validity was tested using the Newcastle-Ottawa Scale. Meta-analysis was conducted using the inverse variance method and a fixed effects model, with treatment success defined as achieving 25% to 100% clearance of the lesion.

Results: A total of 725 studies were screened, and 14 full-text articles met the criteria, comprising 714 patients. Patients underwent a mean of 6.5 laser treatment sessions, consisting of 80% pulsed dye laser (PDL), 12% neodymium-doped yttrium-aluminum-garnet laser (Nd:YAG), and 8% 577 nm yellow laser treatments. Meta-analysis revealed an overall treatment success rate of 97% (95% confidence interval [CI]: 0.96-0.98). Subgroup analysis by laser type resulted a success rate of 96% (95% CI: 0.94-0.973) for PDL, 99% (95% CI: 0.979-1.008) for Nd:YAG laser, and 86% (95% CI: 0.7621-0.964) for 577 nm yellow laser. The complication rate by laser type was 9% (95% CI: 0.031-0.147) for PDL, 4% (95% CI: 0.007-0.080) for Nd:YAG laser, and no reported complication data for 577 nm yellow laser.

Conclusion: The vast majority of the available data on laser treatment of head and neck CMs suggest excellent outcomes and low complication rate using PDL treatment. Centers using Nd:YAG laser reported a slightly higher rate of successful treatment with fewer complications than PDL or 577 nm yellow laser treatment.

Objective: The primary objective was to investigate the effect of extra-nodal extension (ENE) grading on the survival of pN-positive patients with laryngeal squamous cell carcinoma (LSCC).

Study design: A retrospective cohort study.

Setting: A tertiary referral center.

Methods: The patients with LSCC were retrospectively reviewed. The histopathological slides of patients were re-examined, and ENE was graded. Survival analyses were performed.

Results: Seventy-six patients were enrolled in this study. The average age of patients was 61.29 years. 3-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) rates were 69.7%, 73.7%, and 73.7%, respectively. ENE grading had no statistically significant impact on survival rates.

Conclusion: While the presence of ENE in more than 4 lymph nodes, lymph node density (LND) greater than 0.2, poor histologic differentiation, and not receiving chemotherapy were identified as independent poor prognosticators in LSCC, the study did not show any effect of ENE grading on survival rates.

Objective: To evaluate whether rotating cochlear implant (CI) magnets improve patient comfort and preserve scan usability during magnetic resonance imaging (MRI).

Study design: Prospective cohort study.

Setting: Two tertiary academic centers.

Methods: Adult patients with CIs who underwent MRI of any body region were included. The primary outcome was the mean change in pain score from baseline (before any study procedure) to the highest reported pain level during MRI with a CI magnet in place. Secondary outcomes included patient-reported survey responses regarding their MRI experience and the interpretability of the brain MRI scans involving rotating magnets, as assessed by two independent, blinded neuroradiologists.

Results: Twenty-three MRI scans (21 patients) with CIs were analyzed. Eleven scans (47.8%) involved implants containing internal magnets designed to self-align with the magnetic field. The mean pain-score difference unrelated to headwrap use was significantly lower for rotating magnet devices than fixed magnets (0.7 vs 4.0, P = .02). No magnet displacement or depolarization occurred. In six MRI brain sequences, the mean maximal signal-loss artifact measured 6.1 cm (SD 1.2 cm) on axial images for rotating magnet devices. When assessing if the MRI could answer the question for which the scan was ordered, 100% of responses (n = 12) ranged from slightly agree to strongly agree. The majority of patients (70.0%) indicated they would undergo another MRI if medically necessary.

Conclusion: CIs containing rotatable magnets reduce MRI-related pain compared to those with fixed magnets. Although the magnets produce a measurable artifact, it does not substantially compromise scan utility in the majority of cases.

A characteristic short columella and decreased nasal projection is common in patients with bilateral cleft lip and palate following primary repair. The main disadvantage of the previously described secondary columellar lengthening procedures is the cosmetically undesirable "banking" of forked flaps in the nasal sill. We introduce a modified sliding flap cheilorhinoplasty that involves the recruitment of soft tissue adjacent to lip scars to achieve adequate columellar lengthening without the aforementioned banking of forked flaps. The end result is simultaneous columellar lengthening and lip scar revision.

Objective: To investigate whether platelet-rich plasma (PRP) has an efficacy on histopathologic changes in rhinitis medicamentosa (RM) in a rat model.

Study design: Experimental animal study.

Setting: University animal laboratory.

Methods: Forty Wistar albino rats were randomly assigned to five groups to assess the effects of various treatments on RM. Group 1 received intranasal normal saline solution (NSS) for 60 days and served as the negative control. Group 2 was administered intranasal oxymetazoline for 60 consecutive days to induce RM. After decapitation, histopathological evaluation confirmed the development of RM in group 2. The remaining three groups were then similarly treated with oxymetazoline for 60 days. Following this period, group-specific treatments were applied for an additional 15 days: group 3 received NSS, group 4 was treated with intranasal corticosteroids, and group 5 received intranasal PRP. Nasal mucosal samples were harvested and subjected to histopathological evaluation to determine treatment-related changes.

Results: Intranasal PRP treatment significantly reduced submucosal edema and improved submucosal gland degeneration (SGD) scores in the nasal mucosa. Moreover, PRP treatment led to a greater reduction in total histopathological score compared to steroid treatment (P = .007).

Conclusion: This study demonstrated that PRP administration effectively ameliorates submucosal edema, SGD, and total histopathologic score in experimentally induced RM. Given that PRP is an autologous product with a low risk of side effects, it may serve as a promising alternative to steroids in the treatment of RM.