Otolaryngology- Head and Neck Surgery最新文献

Objective: Ankyloglossia and lingual frenotomy in young children and infants remains an area of debate, with a body of research with poor quality-but increasing number-of studies, a trend that has continued into the present day. To systematically review the published literature to identify the number, type, and quality of studies on the evaluation, diagnosis, and treatment of ankyloglossia.

Data sources: In this Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review, a literature search of PubMed, Embase, and Ovid MEDLINE was conducted in 2024 using keywords related to ankyloglossia and frenotomy.

Review methods: Studies from 2017 to 2024 were assessed by two independent reviewers. Articles were included if they focused on ankyloglossia in children and in the English language.

Results: Overall, 462 articles were included for full-text extraction, of which cohort studies were the most common (179, 38.7%), and randomized controlled trials (RCTs; 13, 2.8%) were among the least common. Studies on different frenotomy techniques were common, despite no evidence suggesting that no intervention may be superior. There was an overall lack of study endpoints with objective measures such as breastfeeding duration or infant growth rates postprocedure. Despite the presence of several classification systems for ankyloglossia, none of those described in the literature focuses primarily on function as opposed to appearance or other factors.

Conclusion: This systematic review provides an update demonstrating the continued exponential rise of publications focused on ankyloglossia and lingual frenotomy without a rise in evidence clarifying the controversies surrounding these important topics. Future studies in this area should be quality RCTs with meaningful outcome measures.

Objective: To determine if microbiome differences exist in head and neck squamous cell carcinoma (HNSCC) based on high-risk pathologic features, smoking, and outcomes using The Cancer Microbiome Atlas (TCMA).

Study design: Database study.

Setting: Database review.

Methods: TCMA is a publicly available database containing curated, decontaminated microbial profiles for tumors from 1772 patients. The data were limited to microbiome profiles, survival, and clinicopathologic features for HNSCC patients. Phyloseq objects were created, low-read samples were removed, and differential abundance analysis (DAA) using Analysis of Compositions of Microbiomes with Bias Correction 2 (ANCOM-BC2) was performed. Statistical analysis was done in R (v4.3.1).

Results: One hundred fifty-six patients with HNSCC were included from TCMA with a mean age of 59 (std 13, min 19, and max 90), 72% male (n = 113), and 91% white (n = 140). Primary sites encompassed oral cavity (n = 106, 68%), oropharynx (n = 26, 17%), and larynx/hypopharynx (n = 24, 15%). For all HNSCC in TCMA, rates of lymphovascular invasion were 17% (n = 26), perineural invasion, 34% (n = 53), and microscopic or gross extranodal extension (ENE), 19% (n = 30). DAA revealed significant changes in bacterial genera based on high-risk pathologic features, smoking status, vital status, and disease-specific survival (DSS). Genera observed with ANCOM-BC2 include Scardovia, Alloscardovia, Lactobacillus, and Corynebacterium genera for vital status and DSS.

Conclusion: Changes in the relative abundance of select intratumoral bacterial genera are associated with adverse pathologic features, DSS, and vital status in HNSCC. Shifts in the microbiome need further investigation to determine if they can provide any mechanistic insight or predictive role.

Objectives: This study aims to assess the feasibility and safety of a cochlear catheter (cannula) for inner ear drug delivery during cochlear implantation. We evaluated the otoprotective effect of L-N-acetylcysteine (L-NAC) administered via a cannula in combination with a dexamethasone-eluting cochlear implant (CI).

Study design: An animal model study.

Setting: Animal facility of an academic institution.

Methods: Animals were divided into 8 groups: (1) implantation with a CI; (2) implantation with a dexamethasone-eluting CI (CIDexel); (3) cannula injection of artificial perilymph (Can+AP); (4) cannula injection of Ringer (Can+R); (5) cannula injection of R and CI (Can+CI); (6) cannula injection of R and Dexel (Can+Dexel); (7) cannula injection of 2 mM L-NAC and CI (Can L-NAC 2 mM+CI); or (8) cannula injection of 2mM L-NAC and Dexel (Can L-NAC 2 mM++Dexel). The contralateral ear served as the control group. Hearing thresholds were determined preoperatively, and at postoperative day (POD 7) and POD 30 post-cochlear implantation, using auditory brainstem responses (ABRs). The organ of Corti dissections were performed at POD 30 for hair cell (HC) viability, and oxidative stress assessment using immunostaining.

Results: The L-NAC (2 mM) and dexamethasone-eluting electrode group had significantly lower hearing thresholds than the standard CI, Can L-NAC 2 mM, and Dexel groups. The animal group treated with L-NAC (2 mM) and dexamethasone-eluting electrode showed higher HC viability and reduced oxidative stress.

Conclusion: An intracochlear cannula can deliver pharmaceutical interventions without causing additional hearing loss. L-NAC presents strong anti-apoptotic potential and administration through a cannula together with Dexel implantation, and achieves a synergistic effect enhancing the otoprotection.

Objective: To investigate the effects of modified central-part laryngectomy with pharyngeal space reduction (CPL-PR) on patients with weak deglutitive pharyngeal contraction, as seen in late-stage amyotrophic lateral sclerosis (ALS).

Study design: Retrospective case series.

Setting: Single-institution academic center.

Methods: Patients with late-stage ALS confined at The University of Tokyo Hospital between 2019 and March 2024 in whom CPL-PR had been performed were identified. Patients who had undergone simultaneous pharyngeal flap surgery or had no preoperative high-resolution manofluorography done were excluded. Preoperatively, penetration-aspiration scale (PAS) scores were determined via videofluoroscopic swallowing study. Functional oral intake scale (FOIS) scores and high-resolution manometric parameters were measured and compared preoperatively and postoperatively.

Results: Eighteen patients were identified with a median age of 66.5 (interquartile range [IQR]: 58.0-74.8). The median preoperative PAS score was 7.5 (IQR: 5.5-8.0), indicating severe dysphagia. There was significant improvement in oral intake status with FOIS scores increasing from 1 (IQR: 1-1) to 3 (IQR: 2-3) at 3 months postoperatively (P = .0002). Significant increases in velopharyngeal closure integral (P = .024) and mesohypopharyngeal contractile integral (P = .0001) were observed. Upper esophageal sphincter (UES) resting pressure was reduced (P = .0002), and UES relaxation time was prolonged during swallowing (P < .0001).

Conclusion: There were tangible improvements in pharyngeal contraction, UES bolus passage, and oral intake status following CPL-PR, which contribute to regaining oral intake in late-stage ALS. CPL-PR is an option for patients requiring tracheostomy who wish to prevent aspiration and regain their ability to take food orally.

Objective: To investigate the diagnostic accuracy of various combinations of patient-reported outcome measures (PROMs) and upper aerodigestive tract finding instruments dedicated to the clinical diagnosis of laryngopharyngeal reflux disease (LPRD).

Study design: Prospective, multicenter study.

Setting: University hospital.

Methods: Patients with LPRD at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring were recruited from three European hospitals. Asymptomatic individuals served as the control group. Participants completed the Reflux Symptom Index (RSI), Reflux Symptom Score (RSS), and Reflux Symptom Score-12 (RSS-12) at baseline and 3-month posttreatment. Clinical signs were evaluated with the Reflux Finding Score (RFS), Reflux Sign Assessment (RSA), and Reflux Sign Assessment-10 (RSA-10). Sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated for each instrument and their combinations.

Results: A total of 542 LPRD patients and 204 healthy controls were included. The RSS was the PROM with the highest SE (95.4%), whereas RSS-12 reported the highest SP (94.7%). RSA had the highest SE (94.0%), and RSA-10 reported the highest SP (76.3%). The highest SE and SP of combination tools were found for RSS+RSA (90.4%) and RSS+RSA-10 (99.4%), respectively. RSS+RSA-10 achieved the highest PPV value (99.7%) and RSS+RSA had the highest NPV (79.3%). Overall, the RSS demonstrated the greatest diagnostic accuracy with an area under the curve (AUC) of 0.985. The combination RSS+RSA reported an AUC of 0.934.

Conclusion: The combination of RSS and RSA provided the most accurate diagnostic performance, maximizing SE, SP, PPV, and NPV. This combination offers enhanced utility for the preliminary diagnosis of LPRD.

Objective: Vestibular schwannomas influence the magnetic resonance (MR) signal intensity (SI) in the vestibular cistern and cochlear perilymph. The aim of this study is to evaluate the relationship between perilymphatic signal changes on gradient-echo T2-weighted 3 T MR sequence and the clinical symptoms.

Study design: Retrospective case-control study.

Setting: The study was conducted at the Institute of Image-Guided Surgery in Strasbourg, France.

Methods: Patients with vestibular schwannoma who underwent magnetic resonance imaging at our institution between 2008 and 2016 were retrospectively reviewed. A control group consisted of individuals without past or present otological symptoms. The vestibular schwannomas were divided into three groups, based on the degree of internal auditory canal obstruction. The SI ratios of the vestibular cistern to cerebrospinal fluid (CSF) and cochlea to CSF were compared with clinical data.

Results: We included 172 patients with vestibular schwannoma and 61 controls. Vestibular schwannoma was associated with a significant decrease of the SI ratio of the vestibular cistern to CSF (0.716 ± 0.297 vs 1.06 ± 0.21, P = .004) and cochlea to CSF (0.66 ± 0.199 vs 0.903 ± 0.011, P = .004) compared to controls, with significant negative correlation between both the SI ratios of the vestibular cistern and cochlea to CSF with tumor volume (P < .001). Among all the symptoms studied, the SI ratio of the cistern normalized by CSF was significantly associated with progressive hearing loss (P = .003).

Conclusion: Perilymphatic vestibular cistern and cochlear SI changes appear to be a promising noninvasive biomarker for hearing impairment in vestibular schwannoma.

Objective: Spontaneous cerebrospinal fluid (sCSF) leaks of lateral skull base have little consensus on optimal management. We synthesized and evaluated current literature via systematic and meta-analysis to compare the success rates and complications of the different surgical techniques for middle cranial fossa (MCF) sCSF leak repair.

Data sources: MEDLINE, EMBASE, and Cochrane Library.

Review methods: Studies selected concerned surgical treatment of MCF sCSF leak. Data extracted included the following: study characteristics, patient characteristics, primary outcomes, and secondary outcomes.

Results: From 297 repairs with a MCF approach, the complication rate was 16.2% (95% CI: 12.3%-21.1%, I² = 0%, P = .052), compared to transmastoid (TM) 12.2% (95% CI: 6.7%- 21.2%, I² = 0%) in 82 repairs and for combined approaches 11.9% (95% CI: 4.2%-29.6%, I² = 58%) in 98 repairs. The rate of recurrence with the MCF approach was 3.2% (95% CI: 1%-6.4%, I² = 10%, P = .21) in 297 repairs, in the TM group the rate was 8.6% (95% CI: 4.7%-15%, I² = 0%) in 125 procedures and 1.1% in the combined approaches group (0%-4.5%, I² = 0%) in 139 procedures. Analysis of reoperation rates revealed a proportion of 0.9% (95% CI: 0%-4.4%, I² = 51%) in 287 repairs via the MCF approach. Reoperation rate was 8.6% (95% CI: 4.7%- 15%, I² = 0%) in 125 repairs via TM and 1.1% (95% CI: 0%-4.5%, I² = 0%) in 139 combined approach repairs.

Conclusion: There is no statistically significant difference in the outcomes of repair techniques. Decision making for the preferred approach will be dependent on the location, size and number of the defects, hearing status, and in consultation with the patient.

Objective: To differentiate pediatric chronic rhinosinusitis (CRS) into clinically relevant primary and secondary phenotypes based on clinical, radiographic, and laboratory findings.

Study design: Retrospective chart review of patients with CRS who underwent endoscopic sinus surgery over a 5-year period.

Setting: Tertiary referral children's hospital.

Methods: Relevant medical and surgical history inclusive of disease onset, clinical and radiographic findings, laboratory data, and operative culture results was recorded. Data analysis resulted, where appropriate, in phenotype and endotype characterization.

Results: In total, 94 patients, aged 6.8 to 22.0 years, with a mean age of 15.4 years, satisfied the inclusion criteria. Eosinophilic CRS was the most common primary phenotype (n = 19, 20.2%), and this group was the most likely to have recurrent disease requiring revision surgery. Additional primary phenotypes identified included allergic fungal rhinosinsusitis (n = 10, 10.6%) and central compartment atopic disease (n = 2, 2.1%). CRS associated with cystic fibrosis was the most common secondary CRS category (n = 13, 13.8%). Based on available data, over one-third of patients (n = 36, 38.2%) could not be categorized into a specific phenotype based on current clinical and radiologic criteria.

Conclusion: A phenotype and endotype-based classification system for CRS is evolving for the adult population. This study highlights that such a classification system is possible in the pediatric and adolescent age group, facilitating targeted biologic therapies at the underlying inflammatory mechanism. Further investigation is clearly required given an etiologic source of paranasal sinus inflammation could not be identified in approximately one-third of patients.

Objective: Hyaluronic acid (HA) can be degraded over time. However, the persistence of the effects after injection laryngoplasty (IL) for unilateral vocal fold paralysis (UVFP) has been observed. The relation between HA residue and clinical voice outcomes is undetermined. We aimed to develop a non-invasive method with clinical applicability for objective evaluation of the temporal change in HA volume using artificial intelligence-based ultrasonographic assessment. Furthermore, the volume outcome and its relation to voice outcomes were investigated.

Study design: A prospective cohort study.

Setting: A voice clinic at a tertiary medical center.

Methods: Adult patients who underwent HA IL for UVFP were recruited. The Voice Handicap Index-10 questionnaire, the grade, roughness, breathiness, asthenia, strain scale, and the normalized glottal gap were evaluated before IL. Patients received ultrasonography for the identification of HA and estimation of volume based on Temporal Convolutional Segmentation Network, and also voice outcome assessments at 2 weeks, and 2 and 6 months after IL.

Results: Contours of HA were well-described, and volumes were estimated accordingly. Clinical voice outcomes were significantly improved postoperatively and remained stationary. Contrarily, residual HA volume decreased significantly across time points (1.21 ± 0.53 at 2 weeks, 0.63 ± 0.35 at 2 months, P < .001; 0.32 ± 0.25 at 6 months, P < .001). Simple linear regression showed no significant relationship between the remaining volume at 2 months and patient age or duration of symptoms (P = .67).

Conclusion: Volume change of injected HA over time was estimated non-invasively. The prolonged voice improvement, longer than HA longevity, was demonstrated objectively. The knowledge on HA longevity and duration of benefit provides perspectives beneficial to counseling patients and future treatment planning.