Otolaryngology- Head and Neck Surgery最新文献

Objective: To (1) track the incidence of pleomorphic adenomas (PAs) and (2) compare demographic and treatment trends in PAs over the last five decades in a single county.

Study design: Retrospective cohort of all patients with a pathologic diagnosis of nonrecurrent PA from January 1976 to December 2022.

Setting: Olmsted County, Minnesota.

Methods: Incidence was calculated per 100,000 persons/year and age and sex-adjusted to the US 2020 census data. Incidence trends were identified using Poisson rate regression models. Changes in clinical features of diagnosis were evaluated using Spearman rank correlation coefficient tests, Wilcoxon rank sum tests, and Kruskal-Wallis tests.

Results: In total, 251 patients with PA were identified. The median age at diagnosis was 50.0 years with a slight female predominance (1.24:1). The adjusted incidence during this period is 4.79/100,000 person-years, increasing from 2.50 in 1976 to 1979 to 5.73/100,000 persons/year in 2020 to 2022. Less extensive surgery, including partial and superficial parotidectomies, increased significantly from 1976 to 2022, whereas total parotidectomies decreased (P < .0001). The number of patients who presented with an incidental imaging finding increased during this time period (P < .001), as did the age at diagnosis (45-51 years, P = .05) CONCLUSION: The average annual incidence of PAs in Olmsted County from 1976 to 2022 is higher than reported US estimates and has increased over the last five decades. The percentage of patients who presented with incidental imaging findings increased over this period, as did the age at diagnosis. These findings highlight modern imaging techniques and an aging population more willing to seek workup and treatment of a benign parotid mass.

Objective: Hearing loss has been reported after administration of the monoclonal antibody teprotumumab. The purpose of this study was to review available evidence regarding the patterns of teprotumumab-related ototoxicity.

Data sources: PubMed, EMBASE, and Cochrane Library.

Review methods: A systematic review was performed using standardized methodology. Studies were included if they included subjects who were prescribed teprotumumab. Exclusion criteria included non-English articles, abstracts, letters/commentaries, case reports, and reviews. Subjects without both pre- and posttreatment audiometric data were also excluded. Bias was assessed using the Mixed Methods Appraisal Tool.

Results: From an initial search of 76 articles, 7 studies reporting on 109 unique patients were included. Four studies were level 4 evidence, 1 study was level 3 evidence, and 2 studies were level 2 evidence. Mean age was 55 ± 14 years with a female predominance (64%). The most commonly reported symptoms were hearing loss (22%), followed by fullness (18%) and tinnitus (14%). In total, 41% of patients with available data met criteria for ototoxicity, all exhibiting shifts in the middle frequencies or higher. Fifteen (14%) patients underwent ultrahigh frequency audiometric testing and 8 (53%, 8/15) demonstrated shifts exclusively in this range.

Conclusion: Ototoxicity may occur in patients treated with teprotumumab. Hearing loss occurs primarily in higher frequencies, and routine hearing screening with ultrahigh frequency testing may be warranted. The true incidence of ototoxicity with teprotumumab remains unknown, and more data is needed to elucidate underlying mechanisms and develop strategies to minimize risks.

Dynamic airway computed topography (4D-CT) can be used to evaluate the trachea in pediatric patients with tracheomalacia. The 4D-CT enables objective and quantitative evaluation throughout all phases of respiration; however, current systems focus on qualitative review of generated 4D images. Few analytic workflows are available to assist in the extraction of the quantitative geomorphic data generated. In this study, we share a protocol developed within the 3D Slicer framework that performs semi-automatic tracheal segmentation and subsequent geomorphic analysis. This methodology is applied to 4 sample cases with varying degrees of tracheal collapse throughout all phases of respiration to demonstrate output of cross-sectional area, aspect ratio (defined as the ratio between minor-to-major luminal axis lengths), and tracheal volume (bound by the subglottis and carina) metrics.

Hypoglossal nerve stimulation has become an increasingly popular treatment for obstructive sleep apnea. Some patients express concerns about the appearance of the anterior chest incision scar. Here, we describe the feasibility of the lateral axillary approach for placing the fifth-generation implantable pulse generator, which does not require a respiratory sensor. The first three patients were successfully implanted, had excellent respiratory waveforms, and had no complications. The surgical times were not substantially different than for implanting the fourth-generation or fifth-generation device through a standard anterior chest incision.

Objective: Tracheostomy-related emergencies (TRE) such as decannulation, cannula obstruction, and hemorrhage contribute significantly to mortality, emergency department (ED) visits, and hospitalizations. High-fidelity simulation-based training (SBT) for family caregivers can improve their competence in TRE management. The aims of the study were to compare the frequency of ED visits, readmissions, and mortality in children with tracheostomy based on caregiver completion of SBT.

Study design: Retrospective study.

Setting: Single-center academic children's hospital.

Methods: Children who underwent tracheostomy from 2014 to 2020 were studied, with cohorts based on caregiver completion of SBT. Patients were followed for 1 year following hospital discharge after tracheostomy. The frequency and reasons for ED visits, readmissions, and mortality were evaluated.

Results: Among the 158 patients who met inclusion criteria, the caregivers of 83 (53%) patients completed SBT. Overall mortality was significantly lower (P < .001) among patients whose caregivers completed SBT (2%) compared to patients whose caregivers did not complete SBT (17%). There was no significant difference in mortality due to tracheostomy-related causes based on caregiver completion of SBT (P > .99). There were no significant differences in the total ED visits (P = .44) and readmissions (P = .11), or tracheostomy-related ED visits (P = .61) and readmissions (P = .45) based on caregiver completion of SBT.

Conclusion: Overall mortality was significantly lower among patients whose caregivers completed SBT. The frequency of ED visits, readmissions, and mortality due to tracheostomy-related causes did not differ between the groups. Although high-fidelity SBT may augment caregiver competence in TRE management, further study is needed to determine if SBT can measurably impact tracheostomy-related outcomes.

Objective: Increased hours of cochlear implant (CI) use have been shown to improve auditory and speech recognition outcomes in children with hearing loss. However, the impact of hours of CI use over time on patient-reported functional hearing skills is unknown. Increased duration of CI use, measured by hearing hour percentage (HHP), will coincide with improved long-term subjective hearing abilities, assessed by Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire.

Study design: Retrospective chart review from 2013 to 2023.

Setting: Pediatric CI recipients with at least 18 months of CI use at a single institution.

Methods: Demographic characteristics and audiology history were collected, and HHP was calculated. Changes in SSQ scores over time and HHP were correlated utilizing Spearman's rank correlation.

Results: Of 104 patients reviewed, 24 patients (54% female) met inclusion criteria. Median age at implantation was 6.0 years (4-7.25, Q1-Q3), and median duration of CI experience was 33 months (24.5-60.3, Q1-Q3). In patients with at least two SSQ measures postoperatively, a significant positive correlation emerged between average HHP and change in SSQ score from first to most recent test (r = 0.63, P = .01). Of patients with a preimplantation SSQ score, there was a significant positive correlation between average HHP and change in SSQ from pre-CI to most recent test (r = 0.68, P = .04).

Conclusion: Higher average HHP corresponded to a greater increase in SSQ scores in pediatric CI users over time, suggesting that increased hours of CI use may improve patient-reported outcomes in long-term hearing ability.

Objective: Characterize the demographic and clinical features of pediatric sharp foreign body aspiration (FBA).

Study design: Twenty-four-year retrospective chart review.

Setting: Four tertiary-care centers across four Canadian provinces.

Methods: A retrospective chart review was conducted on pediatric patients who underwent rigid bronchoscopy for sharp FBA below the vocal cords at the McGill University, McMaster University, University of Alberta, and Dalhousie health centers from January 1, 2000, to November 30, 2023.

Results: In total, 48 patients (27 males and 21 females, mean age of 10.1 years) met the inclusion criteria. Thumbtacks were the most common aspirated objects (66.7%). The mean age for thumbtack aspiration was 11.6 years, which was significantly higher than the 7.0-year mean for other sharp FBAs (P = .0263). Subgroup analysis of patients who resided in an Indigenous territory had a significantly greater rate of thumbtack aspiration (89.3%, P = .0001). Sharp FBA presented with typical symptoms of FBA with the addition of a higher incidence of chest pain (27.1%) and hemoptysis (18.8%), and it was characterized by a higher incidence of radiopaque FBs on chest radiography (89.6%). Most complications, including postoperative atelectasis (27.1%), pneumothorax (4.2%), perforation (2.1%), and vocal cord hematoma (2.1%), were observed with thumbtacks.

Conclusion: This is the largest pediatric study on sharp FBA in America, addressing a significant gap in the literature. Considering the trends and patient demographics identified in this study and in the literature globally, geographical or cultural variations may influence the nature of sharp FBA in pediatric populations. Insights from this study can inform future prevention programs.

Objective: This study aims to evaluate the impact of parity on the severity and recurrence rates of idiopathic subglottic stenosis (iSGS) in premenopausal females.

Study design: A retrospective cohort study.

Setting: Two tertiary care centers from 2002 to 2024.

Methods: We analyzed premenopausal iSGS patients under 40 years who underwent balloon dilation or laser wedge excision. Clinical features, including demographics and pregnancy history, were examined. Recurrence rates between nulliparous and parous patients were compared using Poisson regression, adjusting for age and follow-up duration. Linear regression assessed the relationship between pregnancy and iSGS recurrence.

Results: Forty-eight patients were included, with 36 parous and 12 nulliparous. Adjusting for age and follow-up, the mean recurrence rate was 2.6 times higher in parous patients (95% confidence interval [CI]: [1.5, 4.8], P = .0008). Each additional pregnancy was associated with 0.81 additional recurrences (95% CI: [0.05, 1.57], P = .0375). No significant differences in surgery-free time were observed between groups.

Conclusion: Parity and pregnancy significantly increase the risk of iSGS recurrence, although they do not accelerate subsequent recurrences. Health care providers should counsel women of childbearing age about these risks in family planning discussions, emphasizing shared decision-making regarding potential surgical interventions.

Level of evidence: 3:

Objective: This study aimed to investigate the association between body mass index (BMI) and histopathological features and postoperative recurrence risk of chronic rhinosinusitis with nasal polyps (CRSwNP).

Study design: A retrospective clinical study.

Setting: Recurrent group and nonrecurrent group.

Methods: We recruited CRSwNP patients who underwent functional endoscopic sinus surgery and classified them into three groups based on BMI: normal weight, overweight, and obesity. All patients were followed for 3 years and divided into recurrence and nonrecurrence groups. The histopathological features and the impact of BMI on the risk of postoperative recurrence were analyzed through comparative analysis.

Results: A total of 577 CRSwNP patients completed the follow-up, with 197 experiencing postoperative recurrence. Recurrence rates, tissue eosinophil counts, and interleukin (IL)-5 and IL-17A expression levels were significantly higher in the overweight and obesity groups compared to the normal weight group. Additionally, within the overweight and obesity groups, patients with recurrence had elevated tissue eosinophil counts and IL-5 and IL-17A levels compared to the other two groups. Notably, tissues collected during revision surgery showed increased eosinophil counts, IL-5 and IL-17A levels compared to baseline, particularly in obese patients. Both logistic regression analyses and Kaplan-Meier curves indicated that overweight and obesity were associated with an increased risk of CRSwNP recurrence.

Conclusion: Elevated BMI presented significant impacts on the histopathological changes and the risk of postoperative recurrence in CRSwNP patients. Overweight and obesity aggravated tissue eosinophil infiltration, and IL-5 and IL-17A expressions contributing to the recurrent mechanisms of CRSwNP.

Objective: To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1-4 N0M0 head and neck spindle cell carcinoma (HNSpCC).

Study design: Retrospective cohort study.

Setting: The 2006 to 2018 hospital-based National Cancer Database (NCDB).

Methods: Patients with surgically resected cT1-4 N0M0 HNSpCC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were implemented.

Results: Of 815 patients satisfying inclusion criteria, a high proportion were male (72.4%) and white (86.0%) with disease of the larynx (43.8%) classified as high grade (87.7%) and cT1-2 (74.8%). In total, 235 (28.8%) patients underwent END. END utilization between 2006 and 2018 increased for cT1-2 disease (4.0% vs 30.5%, R² = 0.731) and for cT3-4 disease (15.4% vs 84.6%, R² = 0.606). In total, 58 (24.7%) ENDs detected occult nodal metastases (ONMs). The 5-year overall survival (OS) of patients undergoing neck observation and END was 62% and 54%, respectively (P = .215). Among patients undergoing END, patients with ONM had worse 5-year OS than those without ONM (38% vs 60%, P < .001). On multivariable Cox regression, END was not associated with OS (adjusted hazard ratio [aHR] 0.74, 95% CI 0.68-1.32, P = .735); ONM (hazard ratio [HR] 2.01, 95% CI 1.29-3.12, P = .002) was associated with worse OS.

Conclusion: END is performed in a high proportion (30%) of patients with cN0M0 HNSpCC but is not associated with higher OS. The rate of ONM approaching 25% and the association between ONM and worse OS, however, justify consideration of END in HNSpCC.

Level of evidence: 4: