Otolaryngology- Head and Neck Surgery最新文献

Objective: We aimed to explore the role of connexin26 (Cx26) and connexin30 (Cx30) in the cochlea in noise-induced permanent threshold shifts (PTS) and temporary threshold shift (TTS).

Study design: Prospective, controlled.

Setting: Laboratory.

Methods: A mouse model of noise-induced PTS and TTS was constructed. Western blots were used to detect the expression of Cx26 and Cx30 in the cochlea. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to assess the potential biological pathways.

Results: Both the expression of Cx26 and Cx30 showed a trend of first rising and then falling in noise-induced PTS. The expression of Cx26 increased greatly in the 24 hours noise exposure (P < .05) and reached the highest level in the 4 hours after noise exposure (P < .05), then decreased gradually and returned to the control level on the seventh day after the noise exposure, when compared with the control group. The expression of Cx30 showed a similar trend in noise-induced PTS. However, both the expression of Cx26 and Cx30 showed a trend of first falling and then rising in noise induced TTS. The expression of Cx26/Cx30 reached its lowest level in the 4 hours after noise exposure (P < .05), and then increased to the control level on the second day after noise exposure (P > .05), compared with the control group. The first KEGG and GO pathway may be related with oxidative phosphorylation.

Conclusion: Cx26 and Cx30 may have an effect in noise induced PTS and TTS. Future studies are needed to confirm the results.

Objective: To review the literature concerning long-term functional outcomes and quality of life (QoL) in patients undergoing transoral laser microsurgery (TLM) versus radiotherapy (RT) for early glottic cancer.

Data sources: A systematic search was conducted across PubMed, Scopus, and Cochrane Library from inception until April 2024.

Review methods: Articles considered were primary studies directly comparing the 2 treatment modalities in a population of T1 and T2 glottic cancer. Interest outcomes were patient report outcome measures (PROMs) of vocal function and QoL, clinician-reported measures, and acoustic analyses parameters.

Results: There was no significant difference between TLM and RT in grade, roughness, breathiness, asthenia, strain (relative risk, 1.11; 95% confidence interval [CI], 0.60-2.07; I² = 90.96; P < .001), Voice Handicap Inventory-30 scores (standardized mean difference [SME] 0.51; 95% CI, -0.04-1.07; I² = 89.72; P < .001), or fundamental frequency (SME 0.56; 95% CI, -0.14-1.25; I² = 91.12; P < .001). The TLM group had significantly better performance with regards to jitter (SME 0.54; 95% CI, 0.08-1.00; I² = 79.42; P < .001) and shimmer (SME 0.53; 95% CI, 0.11-0.95; I² = 74.94; P < .001). The risk of bias was assessed to be serious.

Conclusion: The findings suggest comparable long-term PROMs between TLM and RT in the treatment of early glottic carcinoma, with TLM showing better acoustic analysis outcomes. However, the available evidence remains scarce, of high heterogeneity, and at risk of bias. A direct comparison between TLM and RT through large randomized controlled trials is needed to provide more substantial evidence to determine the optimum treatment.

Objective: Head and neck cancer affects patient swallowing function. We set out to examine how objective measures of swallowing compare against subjective patient-reported outcomes in a cohort of head and neck cancer patients.

Study design: Retrospective analysis of data collected from a large dysphagia HNC registry.

Setting: Tertiary Academic Cancer Center.

Methods: Between 2006 and 2019, objective measures of swallowing as scored on Modified Barium Swallow Study or Fiberoptic Endoscopic Evaluation of Swallowing and subjective measures using the SWAL-QOL were collected. Objective measures were scored by the Penetration-Aspiration Score (PAS); subjective measures were assessed by the Dysphagia Domain Score (DDS), collectively forming paired data points. Data on tumor site, T-stage, and treatment modality was collected and evaluated.

Results: A total of 253 paired data points were included in this study. A statistically significant relationship between PAS and DDS was observed across all patients (P < .05, chi sq). When stratified by tumor subsite, PAS and DDS relationships were strongest for oral cavity. When stratified by AJCC T-stage, T4 tumors had the strongest relationship between PAS and DDS. The relationship of PAS and DDS was less congruent the further removed from treatment completion.

Conclusion: Objective and subjective measures of swallowing provide complementary evaluations of swallow function. The congruency of assessment varies by T stage and tumor subsite. Physicians and allied health professionals can use this information to better understand the value and limitation of objective and subjective swallowing assessments in evaluating head and neck cancer patients.

Objective: To evaluate patient-reported outcomes in postlaryngectomy communication rehabilitation.

Study design: Cross-sectional survey study.

Setting: (a) Patients who underwent laryngectomy at a single institution and (b) members of the International Association of Laryngectomees (IAL).

Methods: We examined demographics, treatment history, speech rehabilitation methods and outcomes postlaryngectomy.

Results: A total of 157 participants responded to the survey (124 IAL; 33 institutional cohort). The most used primary methods of communication were tracheoesophageal puncture (TEP) 61.5%, electrolarynx (EL) 24.4%, and writing 9%. In all categories, except for communication in a noisy environment, alaryngeal voice was rated superior to aphonic communication (P < .05). Subset analysis of the alaryngeal voice cohort demonstrated higher communication efficacy for TEP compared to other modalities in all environments except for conversation with family and friends. Among TEP users, a history of a regional flap for reconstruction compared to free tissue transfer was associated with higher communication effectiveness scores (16.3 vs 10.6; P = .0085). Neither treatment modality (primary vs. salvage laryngectomy vs. radiation therapy) nor engagement in speech therapy impacted communication effectiveness scores for alaryngeal voice users.

Conclusion: Alaryngeal voice users reported higher efficacy of communication in most social contexts compared to aphonic communicators. Among alaryngeal voice users, TEP speech performed better in most social situations compared to an EL. Treatment characteristics including timing of surgery and radiation therapy were not associated with the ability to acquire alaryngeal voice, while the extent of resection and the type of reconstruction did show potential to impact voicing outcomes in patients who desire to pursue alaryngeal voicing techniques.

Objective: To define the cost necessary to run an adult cochlear implant (CI) program, including assessment, subsequent implantation, and follow from the Canadian provincial government perspective.

Study design: Time-driven activity based costing (TDABC) of a CI program.

Setting: Adult provincial CI referral center.

Methods: Clinical scenario pathways were developed and verified with stakeholders. TDABC was then applied to all steps involved in the pathway. Costing was based on all patients referred to the CI program in 2019. All costs were calculated in Canadian (and American) dollars as of 2023.

Results: This is the first TDABC model of a CI program to the authors knowledge. In 2019, 296 referrals were placed to our CI program and 154 were surgical candidates. The calculated total annual cost for patients referred in 2019 was $4.542 million ($3.365 million USD), or $29,511 ($21,865 USD) per patient implanted. The largest cost contributors to patient cycles were surgical day costs ($23,164 [$17,185 USD] for unilateral, $43,356 [$32,165 USD] for bilateral), switch-on day costs ($1068 [$791 USD] for unilateral, $1511 [$1120 USD] for bilateral), and audiological assessment costs ($692 [$512 USD]). The highest single cost on the pathway was due to the actual CI device when used. Across other patient steps, the highest costs were related to labor.

Conclusion: This TDABC evaluation of a CI program found the annual cost required to meet all referrals was $4.542 million ($3.365 million USD), or $29,511 ($21,865 USD) per patient implanted. The highest single-cost was associated with the CI device itself.

Tracheoesophageal puncture (TEP) is the gold standard for voice rehabilitation after total laryngectomy (TL). Retrospective analysis was performed of TEP outcomes in patients between 2013 and 2020 at a single tertiary hospital. TEP was performed primarily in 79%, secondarily in 6%, and not placed in 15% of 226 patients. Within the study population, 53.4% utilized their TEP, including 52% of primary and 71.4% of secondary TEPs. TEP-related complication occurred in 50.8%, including 50.8% of primary and 50% of secondary TEPs. Secondary TEP was less likely in Black versus White patients, and more likely in patients undergoing pharyngectomy. Older patients and those with TEP complications were less likely to utilize TEP. Our study, performed in a TL population of predominantly lower socioeconomic status, showed high complication rates and low rates of utilization overall. Our findings suggest secondary TEP may be favorable to allow increased pre-operatively counseling and patient healing prior to procedure.

Objective: To investigate the state and trajectory of gender, racial, and academic authorship diversity in the otolaryngology clinical trial literature over the past 2 decades.

Study design: Bibliometric analysis.

Setting: Otolaryngology clinical trial literature.

Methods: Clinical trials published in the 9 major otolaryngology journals between 2000 and 2020 were included. The gender, race, and academic seniority of the first, senior, and corresponding authors were recorded for each trial. Multivariable regression models assessed the temporal trajectory of authorship diversity over time and the disparity in citations across author characteristics. Models adjusted for relevant confounders pertaining to publication environment and study design.

Results: Among 2117 trials, first, senior, and corresponding authors have been predominantly White (60%-64%), male (76%-80%), and attending physicians (63%-69%). Trials led by Black (<1%) and Hispanic (<5%) authors were severely underrepresented. Over time, the representation of female (adj. β 0.8%, 95% CI [0.5%, 1.1%] per year), Asian (1.0% [0.7%, 1.3%] per year), and MD resident (0.4% [0.1%, 0.7%] per year) first authorship increased, but representation of female (0.2% [-0.1%, 0.5%] per year), Black (0% [-0.03%, 0.02%] per year), Hispanic (-0.2% [-0.33%, -0.02%] per year) senior authorship remained persistently low. Asian-led trials were cited significantly less compared to White-led trials even after adjusting for study design and publication year (aIRR 0.82 [0.73, 0.92]).

Conclusions: Despite promising signs of improving authorship diversity over time, persistent underrepresentation of female, Black, Hispanic senior authorship underscore the need for additional efforts to diversify the otolaryngology clinical science workforce.

Objective: To compare the incidence, etiology, demographics, and treatment of craniomaxillofacial (CMF) trauma before, during, and after COVID-19.

Study design: Retrospective cohort.

Setting: Eighty-three health care organizations across the United States.

Methods: The TriNetX Research Network identified 77,977,880 patients during 2017 to 2022. CMF fractures and soft tissue injuries during March to August of each year, aligning with the 2020 pandemic lockdown, were analyzed.

Results: In 2020, compared to immediately prepandemic in 2019, there were significant reductions of -17.5% in facial fractures and -19.0% in soft tissue injuries (P < .001). Conversely, in 2021, both injury types increased by +16.7% and +16.3%, respectively, compared to 2020 (P < .001). Changes in injury mechanisms in 2020 included significant decreases in athletic injuries (-57.6%), falls (-16.8%), assaults (-15.5%), motor vehicle collisions (-8.7%), and pedestrian accidents (-6.9%) (P < .01), while off-road vehicle (+48.4%), bicycle (+16.2%), and motorcycle (+8.9%) accidents increased (P < .01). The 10- to 14- and 5- to 9-year-old age groups experienced the most substantial reductions in facial fractures (-39.7% and -29.9%, respectively) and soft tissue injuries (-29.2% and -28.3%, respectively) in 2020 compared to 2019 (P < .001). Operative management of fractures and soft tissue injuries dropped by -20.3% and -12.4%, respectively, in 2020 versus 2019, and then rebounded with +15.8% and +14.6% increases in 2021 compared to 2020 (P < .001). In 2022, compared to prepandemic rates of 2019, there were fewer patients with facial fractures (-2.8%), soft tissue injuries (-4.5%), and operative repairs (-6.9% for fractures, -1.2% for soft tissue injuries) (P < .03).

Conclusion: CMF trauma decreased in 2020, with subsequent years showing a rebound to levels slightly below those immediately prior to pandemic onset. Changes in etiology, demographics, and treatment highlight the complex dynamics of traumatic injuries during periods of societal disruption.