Otolaryngology- Head and Neck Surgery最新文献

Objective: The purpose of this study was to evaluate how various sociodemographic factors such as rurality, age, race, body mass index, and sex affect the surgical management of cholesteatoma. Canal wall-down (CWD) tympanomastoidectomy and longer surgical times were used as potential proxies for increased severity of disease.

Study design: Retrospective.

Setting: A tertiary academic center.

Methods: All patients who underwent primary tympanomastoidectomy for cholesteatoma at the University of Kentucky from January 2008 through September 2023 were reviewed in this study. The rurality of the patient's home county was defined as metro, rural, or very rural as delineated by Rural-Urban Continuum Codes. Unadjusted and adjusted linear and logistic regression models were used to assess differences in the rate of CWD procedure and surgical times, respectively, across sociodemographic variables.

Results: A total of 604 patients were included in the study. Male sex and increased age were positively and inversely correlated with length of surgery, respectively, in the adjusted models. No significant difference was found in the rate of CWD procedures in rural or very rural patients compared to metro (P = .989). No significant difference was found in surgical time in rural or very rural patients compared to metro (P = .885).

Conclusion: Age and sex were significant predictors of surgical time, while no associations were found between any sociodemographic factor and type of tympanomastoidectomy. No significant association was found between rurality and the 2 proxies used. Our findings refute the thinking that patients requiring surgery for cholesteatoma from socioeconomically and educationally disadvantaged areas require longer or more involved surgeries.

Objective: To investigate the presence and clinical value of salivary elastase, pepsin, trypsin, cholesterol, and bile salts in the development of laryngopharyngeal reflux disease-related chronic cough (LPRD-CC).

Study design: Prospective controlled study.

Setting: University hospital study.

Methods: Patients with LPRD at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring were recruited from two European hospitals. Symptoms and findings were evaluated with the reflux symptom score (RSS), quality-of-life RSS (QoL-RSS), and the reflux sign assessment (RSA) at baseline and following 3 months of treatment. Pepsin, trypsin, elastase, cholesterol, and bile acids were measured in the saliva of patients. Clinical presentation and enzyme patterns were compared between patients with LPRD-CC versus patients without chronic cough. Predictive values of digestive enzymes on clinical patterns were assessed.

Results: Of the 104 recruited patients, 54 had LPRD-CC and 50 did not. Patients with chronic cough demonstrated significantly lower pharyngeal upright reflux events but higher RSS compared to those without chronic cough. The CC group demonstrated significant reduction of RSS (164.4 ± 104.5 vs 105.1 ± 103.2) and RSA (27.7 ± 6.6 vs 21.6 ± 8.1) following treatment. RSS (78.4 ± 51.3 vs 50.2 ± 49.7) and RSA (24.8 ± 7.9 vs 21.5 ± 10.3) were similarly reduced in the non-CC group. The chronic cough group maintained significantly higher scores in otolaryngological RSS (P = .033), respiratory RSS (P = .036), overall RSS (P = .035), and RSS quality of life (RSS-QoL) (P = .007). Salivary elastase demonstrated moderate correlation with both chronic cough presence (r_s = 0.325) and RSS (r_s = 0.353), while salivary bile salts correlated strongly with RSS-QoL (r_s = 0.564). In patients with chronic cough, esophageal acid exposure time showed a significant negative correlation with salivary pH (r_s = -0.443).

Conclusion: LPRD patients with chronic cough demonstrated higher symptom severity than those without, with salivary elastase and bile salts as potential predictors of clinical findings.

Objective: This study aims to determine whether rigid autofluorescence imaging can differentiate cholesteatoma from surrounding tissues to reduce residual disease after cholesteatoma surgery.

Study design: Ex vivo proof-of-principle study.

Setting: Erasmus University Medical Center, Rotterdam, the Netherlands.

Methods: Autofluorescence signals of cholesteatoma, mucosa, and bone were measured using confocal microscopy to confirm distinguishable spectral differences. Subsequently, rigid autofluorescence imaging with specific filter settings (λ_e = 405 nm and λ_d > 570 nm) was applied to 14 resected surgical specimens to obtain signal intensity and tissue-specific fluorescence ratios.

Results: Cholesteatoma matrix without keratin exhibited a significantly higher autofluorescence intensity compared to mucosa (P < .03), with a cholesteatoma-to-mucosa ratio of 2.15. Similarly, autofluorescence intensity was elevated in the matrix with keratin (ratio: 2.25, P = .03) and perimatrix with keratin (ratio: 2.29, P = .04) relative to mucosa. Perimatrix without keratin showed a nonsignificant trend (ratio: 1.85, P = .06). Although cholesteatoma and bone showed no significant difference, this is clinically less relevant as bone is easily identifiable during surgery.

Conclusion: Rigid autofluorescence imaging demonstrates significant potential for improving cholesteatoma surgery by reliably differentiating cholesteatoma matrix, both with and without accumulated keratin, from mucosa, showing 2.25- and 2.15-fold higher signal intensities, respectively. This technique could assist otologic surgeons in achieving more complete resections, thereby reducing residual disease rates while preserving surrounding structures. Future research should focus on optimizing the technology for in vivo application, particularly for detecting small cholesteatoma fragments, and further evaluate factors influencing specificity and sensitivity in clinical practice.

Objective: To characterize and examine gender differences in training paths, practice patterns, family dynamics, and career trajectories in the field of neurotology.

Study design: Cross-sectional survey.

Setting: Research Electronic Data Capture (RedCap) Framework.

Methods: A survey was created and distributed electronically to fellowship-trained neurotologists in the United States who were identified via publicly available information. Descriptive, univariate, and multivariate statistics were performed.

Results: Of the 223 neurotologists invited, 80 (35.8%) responded. Most participants were male (77.5%, n = 62), white (77.5%, n = 62), and aged 41 years or older (81.2%, n = 65). Training and practice patterns showed no significant gender differences. However, women were more likely to have a physician spouse (55.6% vs 25.8%, P = .02), have their first child post-fellowship (55.6% vs 24.2%, P = .007), rely on professional childcare (47.1% vs 22.6%, P = .05), and reduce work hours due to childcare needs (22.2% vs 6.45%, P = .05). Men were more likely to rely on their spouse as the primary caretaker (48.4% vs 5.9%, P = .001). Having a physician spouse was associated with post-fellowship childbearing (48.1% vs 28.9%, P = .041) and increased use of professional childcare (44.3% vs 30.1%, P = .05), regardless of gender.

Conclusion: Although training and practice patterns were similar across genders, significant differences in family structure, childbearing, and caretaking roles suggest that women in neurotology may face unique challenges that could influence their career progression.

Objective: To compare the safety and efficacy of nonopioid versus opioid pain management following adenotonsillectomy (AT) among pediatric patients.

Study design: An open-label randomized controlled trial.

Setting: Tertiary care children's hospital.

Methods: Patients aged 3 to 17 years undergoing AT were eligible. Participants were randomly assigned to receive either acetaminophen and ibuprofen (nonopioid group) or acetaminophen, ibuprofen, and oxycodone (opioid group). Pain scores and prevalence of emergency department (ED) visits, hospital readmission, and posttonsillectomy hemorrhage (PTH) were compared between groups.

Results: From January 2019 to March 2020, 267 patients were enrolled and randomly assigned; 144 completed a postoperative pain diary. Of the 144, 69 (48%) patients received an opioid prescription, and 75 (52%) did not. Mean pain scores before (opioid: 5.78, 95% CI: 5.29-6.27 vs nonopioid: 5.66, 95% CI: 5.20-6.12) and after (opioid: 2.33, 95% CI: 1.89-2.78 vs nonopioid: 2.24, 95% CI: 1.82-2.66) analgesics were not significantly different between opioid and nonopioid groups. Although 7/75 (9%) from the nonopioid group crossed over and requested opioids, only 43/69 (62%) randomly assigned to receive opioid prescription consumed opioids. The rate of opioid consumption increased with increasing age: 18/71 (25%) patients aged 3 to 7 years, 22/57 (39%) 8 to 12 years, and 10/16 (63%) 13 to 17 years, P = .015. Differences in ED visits, hospital readmissions, and PTH between opioid and nonopioid groups were not significant.

Conclusion: Many children do not require opioid analgesics following AT, particularly children less than 8 years of age. Postoperative pain scores and outcomes were similar in opioid versus nonopioid groups. Opioid prescriptions should be limited or avoided altogether after pediatric AT.

Trial registration: Title: Nonopioids for analgesia after adenotonsillectomy in children; ID: NCT03618823, Clinicaltrials.gov.

Objective: Otolaryngology-related conditions impose a significant burden on low-income countries (LICs), lower-middle-income countries (LMICs), and, at times, upper-middle-income countries (UMICs), where health care resources are limited. International research collaboration with high-income countries (HICs), like the United States, can address these disparities by advancing global health knowledge. As such, the underlying objective was to define trends of collaborative otolaryngology publications among the United States and LICs, LMICs, UMICs, and other HICs as well as assess the global distribution of these publications by region.

Study design: A retrospective database review.

Setting: Scopus.

Methods: A bibliometric analysis of 163 collaborative publications (2018-2024) across 9 prominent US otolaryngology journals was conducted. Collaborations were categorized by country income level using the World Bank classification. Authorship positions, specialty classifications, and publication metrics were analyzed to assess representation across income groups.

Results: Publications involving LICs and LMICs were limited. LICs contributed 0.82% of authors, with no representation in significant positions, while LMICs contributed 2.07%, with 0.94% in significant positions. HICs dominated authorship, accounting for 92.54% of authors and 94.36% of significant positions. Collaborations with LICs and LMICs were mainly concentrated in specific regions, with Uganda and Egypt, respectively, being the top contributors from these categories. The majority of publications from LICs and LMICs appeared in Otolaryngology-Head and Neck Surgery and JAMA Otolaryngology.

Conclusion: This is the first study to examine US-LIC/LMIC collaborations in otolaryngology, revealing limited inclusion of authors from these regions in key roles. Strengthening equitable partnerships is crucial to advancing global health equity in the field.

Objective: To investigate the impact of severe obesity on the severity of pediatric obstructive sleep apnea (OSA).

Study design: Retrospective case series.

Setting: Tertiary stand-alone pediatric hospital.

Methods: Consecutive children with obesity (≥95th percentile body mass index [BMI]) who underwent full-night polysomnography between January 2021 and December 2021 were analyzed. Patients were categorized into obesity (≥95th percentile BMI and <120% of the 95th percentile) and severe obesity (≥120% of the 95th percentile BMI). The association between severe obesity and severe OSA was assessed using multiple logistic regression.

Results: The study included 282 patients with a median age of 9.2 years (interquartile range 5.9-12.3), 63% male, and 65% Hispanic. In total, 53% were severely obese. Severely obese children had a higher prevalence of severe OSA (53% vs 33%, P < .001) and very severe OSA (apnea-hypopnea index ≥ 24; 24% vs 11%, P = .006). Multiple logistic regression revealed that severe obesity was associated with severe OSA (adjusted odds ratio [aOR] = 3.44; 95% confidence interval [CI], 1.82-6.53; P < .001) after adjusting for age, sex, and tonsillar hypertrophy. Among 170 patients who underwent posttonsillectomy polysomnography, 29% exhibited residual OSA, with 19% having residual severe OSA. Class 3 severe obesity was associated with residual OSA (aOR = 4.05, 95% CI = 1.09-15.00).

Conclusion: Children with severe obesity face substantial sleep disturbances and a heightened risk of residual OSA following adenotonsillectomy.

Objective: The aim of this study is to compare the feeding outcomes between patients who underwent mandibular distraction osteogenesis (MDO) surgery; one subset received feeding throughout the distraction period, whereas the other subset was not fed until after distraction completion. The objective is to assess whether initiating feeding during the distraction phase can lead to enhanced postoperative care for patients with airway obstruction secondary to micrognathia or Pierre Robin sequence (PRS).

Study design: Retrospective chart review (2000-2024).

Setting: Single academic institution.

Methods: Data were collected in the REDCap database. Demographics and clinical outcomes were reported with frequency (percent) and mean (standard deviation) for categorical and continuous measures, respectively. Linear regression models were fit to compare groups for continuous outcomes.

Results: Eighty-three patients who underwent MDO for micrognathia at the Children's Hospital of Colorado from 2000 to 2024. For patients who started feeding during distraction, they reached full feeds on average 1.4 days after distraction was complete as compared to 12.8 days for those patients who initiated feeding after distraction was complete (P = .027). In total, 42% of patients who started feeding after distraction was completed achieved full feeds, compared to 72% who started during (P = .01). Patients who were fed after distraction, whether or not they achieved full oral feeds before discharge, had on average a 15-day longer hospital stay than those patients who were fed during distraction (P < .01).

Conclusion: Our findings indicate that initiating feeding while undergoing distraction could result in quicker achievement of full feeds and earlier discharge from the hospital.

Objective: To quantify the tracheostomy-related morbidity and mortality, readmissions, and airway interventions in tracheostomy-dependent children with bronchopulmonary dysplasia (BPD).

Study design: Retrospective chart review.

Setting: Tertiary care children's hospital.

Methods: Infants with BPD who received tracheostomy by an otolaryngologist between January 2016 and December 2022 at a single institution were included. Surviving patients were followed to at least 2 years of age. Data were extracted from electronic medical records for patient characteristics, clinical encounters, and surgical visits.

Results: There were 76 patients included in this study. The overall mortality was 30.3% (23/76) with one tracheostomy-related death. Tracheostomy occurred at a median 56 weeks postmenstrual age (PMA). Tracheitis was the most common short- and long-term adverse event (within the first postoperative week, 21%; after postoperative day 7, 81%). Other complications observed include stomal granuloma (77%), airway stenosis (69%), and accidental decannulation (38%). The 30-day and 2-year readmission rates were 32% and 61%, of which 61% and 76% were for tracheostomy-related causes, respectively. The most common reason for readmission over these time periods was tracheitis. Overall decannulation rate for surviving patients was 68%, and decannulation occurred at a median 3.1 years of age. Most surviving patients returned for operative airway intervention (85%); 43% required open airway reconstruction.

Conclusion: Tracheostomy-related morbidity was low in this cohort despite a majority of patients experiencing multiple tracheostomy-related adverse events and readmissions. Patient comorbid conditions, BPD severity, and socioeconomic status were not significantly associated with outcomes. Larger studies are needed to assess the airway interventions and outcomes in this population.

Objective: Cisplatin is an effective antineoplastic drug used worldwide in the treatment of various malignancies. However, it is associated with side effects, including cisplatin-induced hearing loss (CIHL). N-acetylcysteine (NAC) has been suggested as a promising drug to prevent or reduce cisplatin-derived ototoxicity. To evaluate the evidence supporting the efficacy of NAC in preventing CIHL, we conducted a systematic review and meta-analysis of the literature.

Data sources: A systematic search was conducted on PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library.

Review methods: Articles reporting the administration of systemic or transtympanic injection of NAC for CIHL prevention were considered. The outcomes of interest included the presence of hearing loss events and changes in hearing thresholds at 0.5 through 12 kHz following cisplatin treatment.

Results: A total of 7 studies involving 217 patients met inclusion criteria. Of these patients, 175 received systemic administration of NAC, and the remaining received transtympanic injection of NAC. No significant differences were found in CIHL prevention between the use of either systemic or transtympanic NAC administration compared to placebo (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.54-1.19; P = .28, and RR 0.89; 95% CI 0.51-1.54; P = .67, respectively). No significant differences were found at 0.5 to 8 kHz between groups. Qualitative analyses suggested a tendency to otoprotection in ultra-high frequencies (10 and 12 kHz).

Conclusion: Our findings suggest that, regardless of administration route, current published evidence does not show that NAC is effective in preventing CIHL in the standard clinical audiogram range. Further studies with larger samples are needed to confirm our findings.

Level of evidence: I.