Otolaryngology- Head and Neck Surgery最新文献

Intraepithelial type 1 innate lymphoid cells (ieILC1s) are tissue-resident lymphocytes in the microenvironment of head and neck squamous cell carcinoma. Here, we evaluate how these cells influence T-cell trafficking to tumors. We generated cytotoxic ieILC1-like cells from natural killer (NK) cells in vitro. Using an in vivo tumor model, we show that intratumoral ieILC1-like NK cells induce greater T cell trafficking into the tumor. Co-culture of ieILC1-like NK cells with the tumor cells resulted in elevated CXCL10 in the supernatant. Flow cytometry demonstrated that ieILC1-like NK cells produce robust amounts of IFNy, a known CXCL10 inducer, while CXCL10 was produced by tumor cells. These results indicate ieILC1-like NK cells induce tumor production of CXCL10, a proinflammatory chemokine that promotes T cell infiltration into the TME. The role of ieILC1-like NK cells in modulating clinical responses to immune checkpoint blockade warrants investigation.

Objective: To compare differences in otolaryngology residents' salaries in different cities and states before and after adjusting for the cost of living.

Study design: Cross-sectional analysis.

Setting: Accreditation Council for Graduate Medical Education (ACGME) otolaryngology residency program websites.

Methods: US otolaryngology residency programs were identified via the ACGME database in December 2023. Stipends posted by each residency program were compared to the cost of living (COL) for related states and major cities. A baseline value of 100 was used as the mean COL, values over 100 indicate above-mean COL. The weighted salary by state and cities for postgraduate year (PGY) 1 to 5 combined was expressed as mean (SD). Comparisons between salaries before and after adjustment for the COL were assessed using t tests.

Results: The mean otolaryngology residency stipend across the nation, by city, was $70,572 (n = 1290, range: $58,100-$93,402; SD = $8370), with a post-COL adjustment mean stipend of $64,055 (range: $39,193-$76,674, SD = $10,094, p < .001). Otolaryngology residents in Manhattan, New York State faced a mean decrease from $89,282 to $39,193 (-56%) post-COL adjustments. Following that were Boston and Los Angeles programs which saw a -$26,402 (-32%) and -$24,761 (-32%) mean decrease after COL adjustments, respectively.

Conclusion: Otolaryngology residents in high-cost areas experience significant salary reductions because of COL adjustments, resulting in financial strain. Residents in such regions endure increased financial pressure compared to those in low-cost areas, as current salaries fail to align with living expenses.

Objective: Elucidate the representation of Asian and Asian Americans in academic otolaryngology and the influence of race on promotion and leadership opportunities.

Study design: Retrospective analysis of the Association of American Medical Colleges Faculty Administrative Management Online User System.

Setting: Full-time otolaryngology faculty from all US medical schools from 2020 to 2023.

Methods: Faculty demographics, tenure, and rank were collected. Descriptive statistics, Fischer's exact test, Rank Equity Index (REI), and multivariable logistic and ordinal regressions were used to characterize our cohort and assess the impact of race on academic advancement and leadership, defined as promotion to tenure or full professorship.

Results: Asians comprised 20.53% of 9056 faculty over 4 years. Asians were most likely to hold tenure-eligible positions (n = 600, 30.74%) but were significantly less likely than non-Asians to be tenured (43.00% vs 48.65%, P = .015). Asians were slightly above parity in promotion from assistant to associate professor (REI = 1.09) but below parity in promotion from associate professor to professor (REI = 0.78). Relative to whites, Hispanics, and African Americans, Asians reported the lowest associate/professor and assistant/professor REIs. On multivariable regressions, Asian race was not associated with decreased odds of tenure-eligible positions but was associated with decreased odds of tenure (odds ratio [OR] = 0.77, 95% confidence interval [CI] = [0.64-0.93]) and rank promotion (OR = 0.82, 95% CI = [0.74-0.90]).

Conclusion: Despite strong overall representation in otolaryngology, Asians are less likely to receive promotion, tenure, or full professorship relative to other racial groups. Future efforts should emphasize equitable advancement opportunities to ensure a diverse otolaryngology leadership.

Objective: This study aimed to assess how race, social vulnerability, and maternal age influence pediatric cochlear implant access and usage.

Study design: Retrospective cohort.

Setting: Tertiary Pediatric University Hospital.

Methods: This study included individuals aged 0 to 18 who received a cochlear implant at our center between the years 2000 and 2022. Social vulnerability data from 2020 was obtained from the Centers for Disease Control and Prevention.

Results: Of the 302 patients included in our study, 43% were black and 50% were white. Patients from the highest to lowest social vulnerability quintiles comprised 31%, 25%, 18%, 10%, and 14% of our sample, respectively. Race was associated with social vulnerability index (SVI) (P < .001), with a mean score of 0.70 (±0.26) and 0.49 (±0.27) for black and white patients, respectively. Later age at hearing loss (HL) diagnosis and cochlear implantation (CI) were associated with more and most vulnerable SVI (P < .05). Delayed diagnosis was also associated with black and other racial groups (P = .041), and adolescent maternal age (P = .03). Greater SVI was associated with less daily cochlear implant usage (P = .004). The most vulnerable patients were more likely to be lost to follow-up (P = .03) despite no difference based on maternal age (P = .59) and insurance status (P = .47).

Conclusion: This study underscores the significance of mitigating disparities in timely diagnosis of HL, consistent CI usage, and appropriate follow-up care. This is a first step toward the formulation of novel strategies aimed at overcoming barriers and developing appropriate intervention programs.

Objective: Pediatric chronic rhinosinusitis (PCRS) is a common condition with a significant impact on quality of life. This study compares the microbiome of pediatric patients with and without chronic rhinosinusitis.

Study design: Single-center, prospective, quantitative case-control.

Setting: Metropolitan.

Methods: Patients undergoing adenoidectomy for PCRS (subjects, n = 20) or obstructive sleep apnea (controls, n = 20) were recruited. 16S ribosomal RNA sequencing was performed on the right middle meatus (MM), adenoid, and palatine tonsil samples from each patient. Alpha diversity was measured by the Simpson's diversity index, beta diversity was measured by the Bray-Curtis dissimilarity index, and the differential abundance of bacteria genera was analyzed.

Results: There were 40 adenoid, 40 tonsil, and 37 MM samples analyzed. There was no significant difference in alpha diversity between controls and subjects. Tonsils were significantly more diverse than the adenoids, which were more diverse than the MM (P < .001). There was no difference in bacterial composition between controls and subjects, but the composition of the 3 sites were significantly different (P < .001). The dissimilarity in bacterial composition between the adenoid and MM sites was larger in the control group than in the subject group.

Conclusion: There were significant differences in alpha diversity and bacterial composition between the anatomic 3 sites; however, there was no difference between the controls and subjects. The larger dissimilarity in bacterial composition between adenoid and MM sites in controls compared to subjects suggests there may be colonization of the MM by the adenoid in PCRS patients.

Objective: To examine the effect of perioperative celecoxib and acetaminophen administration on opioid consumption in the first 24 hours after palate surgery for obstructive sleep apnea (OSA).

Study design: Retrospective cohort study.

Setting: Tertiary academic center.

Methods: Adults with OSA undergoing soft palate surgery and admitted to the hospital postoperatively between July 2013 and June 2023 were included. Study participants were also included if they underwent concurrent nasal surgery but excluded if they underwent any pharyngeal surgery other than tonsillectomy or were taking opioids prior to surgery. Opioids administered after surgery were converted to morphine milligram equivalents (MME). Multiple linear regression was used to examine the association between total MME consumed in the first 24 hours postoperatively and celecoxib and acetaminophen usage.

Results: A total of 210 study participants (15.7% female) were included with a mean age of 48.8 ± 37.5 years. The mean MME consumed in the first 24 hours after palate surgery was 80.2 ± 63.9. One hundred and twenty-six (60%) study participants received perioperative celecoxib, while 195 (93%) received perioperative acetaminophen. Celecoxib use was associated with lesser MME (-2.7 ± 1.1 MME per 100 mg; P = .018) consumed postoperatively, while acetaminophen was not (-0.3 ± 0.3 MME per 100 mg; P = .43). Female gender, Asian race, and African American race were also associated with lesser MME consumed postoperatively, while autoimmune/immunosuppressive conditions and tonsillectomy were associated with greater MME consumption.

Conclusion: Perioperative celecoxib was associated with reduced MME consumption in the first 24 hours after palate surgery. No association was found between acetaminophen and postoperative opioid use.

Objective: Laryngotracheal stenosis (LTS) describes fibrotic airway obstruction that is life-threatening without treatment. Targeted therapies are needed as an adjunct to surgical management. We have previously observed the upregulation of immune checkpoint programmed cell death (PD)-1 and its ligand, PD-L1, in patients with LTS. This study aims to determine whether PD-1 and PD-L1 play a role in the pathophysiology of LTS.

Study design: Basic science.

Setting: Laboratory.

Methods: Fibroblasts derived from the subglottic scar of 5 iSGS patients were cultured ex vivo with transforming growth factor β (TGFβ), PD-L1 agonist (PD-1), and PD-L1 blockade (anti-PD-L1). PD-L1, TGFβ receptor II (TGFβRII), and Collagen-1 expression were quantified by flow cytometry. A validated chemomechanical injury model of subglottic stenosis was applied in PD-1 knockout and wild-type (WT) mice, and subglottic thickening was assessed by histologic analysis.

Results: TGFβ significantly increased the expression of PD-L1 and Collagen-1 in human airway scar fibroblasts (P < .05). PD-1 knockout mice demonstrated no significant difference in subglottic airway fibrosis compared to WT mice. Ex vivo PD-L1 modulation had no impact on fibroblast Collagen-1 expression. PD-L1 high-intensity fibroblasts expressed greater Collagen-1 and TGFβRII compared to PD-L1 low-intensity fibroblasts.

Conclusion: PD-1 knockout does not protect mice from the development of laryngotracheal fibrosis. However, its ligand, PD-L1 is highly expressed on pathologic fibroblasts unique to scar, characterized by high Collagen-1 and TGFβRII expression. PD-L1 is also upregulated in conjunction with Collagen-1 by TGFβ stimulation. PD-L1 may act independently of PD-1 to sensitize fibroblasts to TGFβ, suggesting direct targeting of PD-L1 may have therapeutic potential in LTS.

It is estimated that 1 in every 200 US newborns has congenital cytomegalovirus (cCMV). Delayed identification of cCMV in newborns precludes timely intervention to mitigate sequelae of the infection such as hearing loss and other neurological complications. Newborn testing for cCMV enables appropriate diagnosis and intervention by multidisciplinary teams to properly manage the immediate sequelae of cCMV, avoid unnecessary additional testing that can result from delayed diagnosis, and monitor for future complications. It is the position of the American Cochlear Implant Alliance, the National CMV Foundation, and the American Academy of Otolaryngology-Head and Neck Surgery that universal newborn cCMV screening is necessary to best accomplish these goals.

Objective: Mandibular osteoradionecrosis (MORN) is a morbid complication of head and neck radiation therapy. Recent advances in surgical and medical therapies underscore the need for a shift in traditional treatment paradigms and a disease grading system that can guide appropriate management.

Data sources: Pubmed/MEDLINE.

Review methods: We conducted a detailed review of publications related to MORN, specifically focusing on its staging and management techniques. Articles meeting inclusion criteria were synthesized into a final narrative review.

Conclusion: There has been a paradigm shift away from hyperbaric oxygen therapy in the management of MORN. Growing evidence for the efficacy of pentoxifylline and tocopherol in early-stage disease and novel surgical techniques to manage moderate and late-stage disease warrant an updated staging stratification which is proposed.

Implications for practice: This review summarizes the clinical efficacy of established and novel therapeutic modalities currently available in treating MORN, emphasizing the significant advances achieved over the last decade. It introduces a contemporary staging and treatment algorithm which incorporates traditional, evidence-supported surgical and medical management with effective early intervention strategies.

Peer review is an essential cornerstone of scientific advancement. This process involves understanding study design, data analytics, and interpretation of the evidence. For clinicians who are performing their initial peer reviews, and even for seasoned reviewers who assess complex manuscripts, it can be helpful to have a standard approach. We therefore provide a conceptual framework for peer review which builds upon experiences that are already familiar to trainees and practicing clinicians, by drawing parallels between patient encounters and peer review. This framework has been used in successive years as a didactic tool for our trainees who are being mentored toward excellence in peer review.