Otolaryngology- Head and Neck Surgery最新文献

Objective: Examine the demographic and social determinants of health linked to pediatric esophageal foreign body removals, with an emphasis on button battery ingestions.

Study design: A retrospective chart review was performed on pediatric patients who underwent operative removal of a foreign body from the esophagus (Current Procedural Terminologies [CPTs] 43215, 43194).

Setting: The study was conducted across four hospitals from November 2010 to December 2023.

Methods: Data on patient demographics and social determinants of health were analyzed. Exclusions included nonaccidental ingestions, patients older than 18 years, and cases with missing social determinants of health data. The Agency for Healthcare Research and Quality (AHRQ) database was used to link patient data to socioeconomic indicators.

Results: Of 825 cases, 50 were button battery ingestions. Age was comparable between button battery and nonbutton battery patients. Button battery patients were predominantly male. Socioeconomic analysis revealed that button battery patients were from households with higher median incomes, lower poverty rates, higher home values, and greater internet access. The incidence of button battery ingestion increased over the study period.

Conclusion: This study highlights significant demographic and socioeconomic differences in pediatric foreign body ingestions compared to button battery ingestions. Male gender and higher socioeconomic status were notable risk factors for button battery ingestion. These findings support the need for educational and preventive strategies to address the risks associated with button battery ingestion.

Objective: Intractable allergic rhinitis (iAR) remains a clinical challenge. This study aims to evaluate the efficacy and safety of endoscopic selective vidian branch neurectomy for iAR.

Study design: A prospective clinical study.

Setting: A tertiary referral center.

Methods: A total of 205 iAR patients were initially recruited and divided into 3 groups: endoscopic vidian-branch neurectomy (EVBN), endoscopic vidian neurectomy (EVN), and conservative treatment (control). All patients were followed up for more than 2 years, and the efficacy and postoperative complications were compared.

Results: After 2-year follow-up, a total of 195 patients were included, with 59 patients in EVBN group, 71 in EVN group, and 64 in control group. Post-treatment assessments at 6 months, 1 year, and 2 years revealed significant reductions in the total Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores and each domain in both EVBN and EVN groups compared to their baseline levels. However, no significant changes were observed in control group. Furthermore, the improvements in RQLQ 2 years post-treatment were higher in EVBN and EVN groups compared to control group. In EVBN group, only 3 (5.1%) patients reported mild eye dryness during the first month postoperation. However, in the EVN group, 15 (21.1%) patients experienced eye dryness, with 6 (8.5%) cases persisting for more than 1 year and remaining unresolved by the end of the 2-year follow-up.

Conclusion: Both EVBN and EVN were effective in iAR patients. However, EVBN appears to be a safer option, associated with fewer postoperative complications.

Objective: Little is known about emotional intelligence (EI) among otolaryngology trainees and its assessment during training. We aim to assess EI levels and identify demographic and training-related factors associated with higher EI.

Study design: Cross-sectional study.

Setting: Survey of otolaryngology trainees.

Methods: Residents and fellows completed a national single-response survey from the Governing Council of the Section for Residents and Fellows-in-Training (November 7 to December 31, 2018). The Trait Emotional Intelligence Questionnaire-Short Form provided a global EI score and subscores for well-being, self-control, emotionality, and sociability. Associations between sociodemographic and training factors with higher scores were assessed.

Results: The global EI score was high (5.2 ± 0.6). Fellows had higher global EI scores than residents (5.5 vs 5.23; P = .028). Fellows (6.33 vs 5.83; P = .024), trainees older than 35 years (6.17 vs 5.83; P = .021), and those in humanitarian efforts (P = .012) had higher well-being scores. Trainees older than 35 years had higher self-control scores (5.67 vs 5.17; P = .009). Fellows (5.88 vs 5.50; P = .002) and female trainees (5.62 vs 5.38; P = .001) had higher emotionality scores. Trainees with ≥4 publications had higher sociability scores (5.0 vs 4.83; P = .001).

Conclusion: Global EI scores were high in this national sample of otolaryngology trainees. Seniority, age, female gender, research experience, and humanitarian involvement were associated with higher scores in specific dimensions. Future studies should evaluate how training experiences or structured educational programs can enhance the development of EI.

Objective: In the unique clinical context of a retropharyngeal carotid artery (RPC), free flap reconstruction (FFR) may be used for small pathologic tumor (pT)1-2 human papillomavirus (HPV)+ oropharyngeal squamous cell carcinoma (OPSCC) tumors to provide vessel coverage, providing a unique case-control study model. This study aims to elucidate the impact of FFR on functional outcomes following transoral robotic surgery (TORS).

Study design: Retrospective review of electronic medical records between 2010 and 2022.

Setting: Single-institution tertiary care center.

Methods: Cohorts were defined as FFR (with RPC) and no FFR (nFFR). A 1:2 propensity score match (PSM) was performed. The functional oral intake scale (FOIS) was used to characterize swallowing outcomes. Statistical analysis was performed in R-Studio.

Results: Post-PSM, 93 patients met inclusion criteria (59.8 years, 92% white, 88% male). In total, 31 (33%) underwent FFR, 77 (83%) had pT2 tumors, and 87 (93%) underwent adjuvant treatment. The FFR cohort saw increased return to the operating room (FFR 19% vs nFFR 3.3%, P < .001) and mean hospital stay (7.2 ± 2.2 vs 4.9 ± 3.1 days, P = .02). Median preoperative FOIS was similar between groups (FFR: 7.00 [interquartile range (IQR) 6.00-7.00] vs nFFR: 7.0 [7.00-7.00], P = .2) with comparable decline at first follow-up. The nFFR cohort had higher FOIS at 3 and 6 months (5.00 [5.00-6.00] vs 6.00 [5.00-7.00], P = .04). FOIS was similar after 1 year (6.00 [5.00-7.00] vs 6.00 [6.00-7.00], P = .3).

Conclusion: FFR achieved comparable functional outcomes to nFFR at 1 year. FFR is a viable reconstructive option for pT1-2 tumors for which TORS that are amenable to surgical resection via TORS despite an anatomic barrier such as RPC.

Objective: Pediatric otorhinolaryngology (ORL) addresses complex conditions in children, requiring a tailored approach for patients and families. With artificial intelligence (AI) gaining traction in medical applications, this study evaluates the quality of information provided by large language models (LLMs) in comparison to clinicians, identifying strengths and limitations in the field of pediatric ORL.

Study design: Comparative blinded study.

Setting: Controlled research environment using LLMs.

Methods: Fifty-four items of increasing difficulty, namely 18 theoretical questions, 18 clinical scenarios, and 18 patient questions, were posed to ChatGPT-3.5, -4.0, -4o, Claude-3, Gemini, Perplexity, Copilot, a second-year resident, and an expert in the field of pediatric ORL. The Quality Analysis of Medical Artificial Intelligence (QAMAI) tool was used for blinded evaluation of the quality of medical information by a panel of expert members from the Young Otolaryngologists Group of the Italian Society of ORL and the International Federation of ORL Societies.

Results: LLMs performed comparably to specialist in theoretical and standardized clinical scenarios, with Bing Copilot achieving the highest QAMAI scores. However, AI responses lacked transparency in citing reliable sources and were less effective in addressing patient-centered questions. Poor interrater agreement among reviewers highlighted challenges in distinguishing human-generated from AI-generated responses. Rhinology topics received the highest scores, whereas laryngology and patient-centered questions showed lower agreement and performance.

Conclusion: LLMs show promise as supportive resources in pediatric ORL, particularly in theoretical learning and standardized cases. However, significant limitations remain, including source transparency and contextual communication in patient interactions. Human oversight is essential to mitigate risks. Future developments should focus on refining AI capabilities for evidence-based and empathetic communication to support both clinicians and families.

Objective: The minimal clinically important difference (MCID) represents the smallest change in treatment outcome deemed clinically meaningful. This study estimates the MCID for 2 widely used tinnitus measures: the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI), using anchor-based approaches while accounting for baseline severity and time interval.

Study design: A multi-center randomized clinical trial.

Setting: European tinnitus centers.

Methods: Anchor-based approaches, including the effect size, receiver-operating characteristics, and ΔTHI/TFI methods, were employed to determine the MCID. The "minimally improved" category of the Clinical Global Impression Scale-Improvement (CGI-I) served as the anchor. The standard error of measurement was used to assess random variation.

Results: For the THI, MCID estimates ranged from 7.8 to 12, with a point estimate of 11 after 12 weeks of treatment (N = 364). For the TFI, MCID estimates ranged from 7.3 to 9.4, with a point estimate of 9 points after 12 weeks (N = 359). Both measures indicated that higher baseline severity and longer time intervals required greater score reduction for clinical relevance.

Conclusion: This study highlights the context-specific nature of MCID values for tinnitus measures and emphasizes the need for consensus on optimal anchor-based approaches to improve comparability.

Objective: Shoulder and neck dysfunctions resulting from spinal accessory nerve injury impair quality of life. This study aims to investigate the effects of manual therapy in combination with standard physiotherapy on the mechanical properties of muscle, neck and shoulder function, pain, and quality of life in head and neck cancer patients.

Study design: Prospective, randomized, controlled, double-blind clinical trial.

Setting: Department of Otorhinolaryngology Head and Neck Surgery of a university hospital.

Methods: A total of 26 participants were randomized into two groups. The control group (n = 11) received standard physiotherapy including therapeutic exercises, scar tissue massage, and education. The intervention group (n = 10) received manual therapy consisting of soft tissue, myofascial release, and mobilization techniques in combination with standard physiotherapy. Outcome measures were mechanical properties of muscle, neck and shoulder active range of motion, shoulder pain and disability, and quality of life.

Results: Upper trapezius and sternocleidomastoid muscle stiffness increased significantly in the control group (P < .01), whereas a significant reduction was observed in the intervention group compared to the control group (P = .001). A reduction in muscle thickness was observed bilaterally in both groups (P < .01). Moreover, all participants showed improvements in neck and shoulder active range of motion, shoulder pain, and quality of life (P < .01).

Conclusion: Manual therapy in addition to standard physiotherapy was more effective in improving neck and shoulder function, quality of life, and reducing muscle stiffness compared to standard physiotherapy alone. Therefore, clinicians should consider incorporating manual therapy into their treatment protocols to optimize patient outcomes.

Objective: Inaccurate patient triage contributes to suboptimal clinical capacity management and delays in patient care, which in cancer patients may significantly increase morbidity and mortality. We developed a natural language processing (NLP) model as an adjunctive tool for head and neck (H&N) patient triage workflows. This study assesses the model's ability to categorize and triage patient appointments based on available documentation.

Study design: A retrospective cohort study.

Setting: An academic institution.

Methods: A total of 83 new patients seeing an H&N surgeon from January to April 2024 with at least 1 referral record (clinic note, imaging, or pathology report) available were included in this study. Referral clinic, imaging, and pathology reports were entered into the NLP model to predict pathology type (non-endocrine H&N neoplasm, thyroid, parathyroid, and benign lesions), malignancy risk, and appointment urgency. The gold standard was the final diagnosis from pathology reports or surgeons' clinic notes.

Results: The NLP model achieved an accuracy of 81.9% for pathology type and 86.8% for urgency level. Sensitivity was high for non-endocrine H&N neoplasms (88.9%), thyroid pathology (88.9%), and parathyroid pathology (100%), although lower for benign lesions (67.9%). Specificity was 86.8% for non-endocrine H&N neoplasms, 91.9% for thyroid pathology, 97.6% for parathyroid pathology, and 96.4% for benign lesions. Prediction of appointment urgency achieved a Matthews correlation coefficient of 0.698, reflecting strong predictive performance.

Conclusion: This novel NLP model demonstrated robust performance characteristics for predicting H&N diagnoses based on referring documents and excelled at identifying patients requiring urgent care based on malignancy risk. This tool may help H&N practice coordinators screen referrals, potentially optimizing patient care.

Objective: To evaluate and compare socioeconomic factors associated with underuse and prolonged time to cochlear implant (CI) surgery for qualifying candidates.

Study design: Retrospective cohort study of adult patients who were CI candidates from January 1, 2018, to December 31, 2022.

Setting: Three tertiary academic centers.

Methods: Demographic factors (age, sex, race, zip code, insurance status, preferred language, and marital status) and speech recognition scores in quiet and distance to CI center were collected. Household income quintiles were determined based on zip code matching to US Census data. Main outcomes were decision to pursue CI surgery and time elapsed from initial candidacy to surgery.

Results: A total of 382 patients were evaluated for CI candidacy and included in the analysis (191 [50%] women; median age, 70 years; interquartile range [IQR] 58-78). Of these, 306 (80%) underwent cochlear implantation. Multivariable analyses revealed that, among those who qualified, patients with non-English-speaking status (odds ratio [OR] 0.31 [95% CI: 0.13-0.71]), older age (OR 0.97 [95% CI: 0.94-0.99]), male sex (OR 0.40 [95% CI: 0.23-0.72]), and higher speech recognition scores (21%-40%: OR 0.33 [95% CI: 0.15-0.70]; >41%: OR 0.24 [95% CI: 0.076-0.74]) were less likely to receive surgery. Among those who underwent surgery, only non-English-speaking patients experienced significantly longer time to surgery relative to English-speaking patients (hazard ratio [HR] 0.64 [95% CI: 0.43-0.97]).

Conclusion: Language is a potential enduring factor impacting both pursuit of and time to CI surgery. Future work should consider target strategies to account for these factors as a way to improve CI access.

Objective: Hearing loss is associated with deterioration of music enjoyment that can be mitigated with hearing aids (HAs). In this study, we assess HA users' music enjoyment and listening habits over time.

Study design: Longitudinal.

Setting: Tertiary academic medical center and community.

Methods: Adult HA users reported music listening habits and music enjoyment using 10-point Likert scales and underwent a melody discernment listening task, once in 2020 and again in 2023. Paired t-tests were used to compare individuals' responses across time points, and unpaired t-tests were performed to juxtapose participants who preferred music sound quality with HAs ("prefer HA") versus without ("prefer unaided").

Results: Forty-three HA users participated, with an average (SD) of 24.3 (18.3) years of HA use as of 2023. Despite an increase in pure tone average from 2020 to 2023 (47.2-52.6, P < .001), there was no significant change in time spent listening to music, overall music enjoyment, or melody discernment ability. In 2023, the "prefer unaided" group reported worse music enjoyment with HAs (5.7 vs 7.5, P = .022) and higher music enjoyment before their HL diagnosis (9.7 vs 7.6, P = .007); they also spent less time listening to music (4.0 vs 5.4, P = .038). Similar differences were also observed in 2020.

Conclusion: In individual HA users, worsening hearing over time may not translate to changes in music enjoyment or listening habits. However, HA users with higher levels of music enjoyment before HL diagnosis are more dissatisfied with aided music listening and spend less time listening to music.