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Obstructive Sleep Apnea and Chronic Rhinosinusitis: Understanding the Impact of OSA on CRS Disease Burden. 阻塞性睡眠呼吸暂停与慢性鼻窦炎:了解 OSA 对 CRS 疾病负担的影响。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-22 DOI: 10.1002/ohn.934
Emily Garvey, Alexander Duffy, Sruti Tekumalla, Bita Naimi, Chase Kahn, Angela Yang, Zachary Urdang, Douglas Farquhar, Marc Rosen, Gurston G Nyquist, Elina Toskala, Mindy Rabinowitz

Objective: Assess the impact of obstructive sleep apnea (OSA) on chronic rhinosinusitis (CRS) severeity.

Study design: Retrospective database review.

Setting: TriNetX US database.

Methods: TriNetX US Collaborative Network database was queried for cohorts of patients with OSA, CRS, and CRS with comorbid OSA (CRS-OSA). Data included demographics, CRS severity was assessed via rates of endoscopic sinus surgery (ESS), antibiotic, and oral steroid use. Propensity score matching was performed to account for differences in demographics and clinical variables.

Results: The query identified 1,818,879 patients with CRS, 481144 with OSA, and 93,153 CRS-OSA patients. OSA-CRS patients had higher rates of hypertension, diabetes mellitus, obesity, and asthma than either CRS or OSA populations (P < 0.0001). CRS-OSA patients demonstrated higher rates of ESS (odds ratio [OR]: 1.91, 1.82-2.02, P < 0.0001), antibiotic (OR: 1.90, 1.81-1.96, P < 0.001), and oral steroid use (OR: 2.23, 2.16-2.28, P < 0.001) compared to CRS-only patients. CRS-OSA patients not on continuous positive airway pressure had higher utilization of antibiotics (OR: 3.24, 2.82-3.71, P < 0.0001) and steroids (OR: 2.28, 2.05-2.55, P < 0.0001) than nonutilizers. CRS-OSA patients with sleep-related surgical interventions required fewer antibiotic courses (OR: 1.93, 1.62-2.28, P < 0.0001).

Conclusion: CRS-OSA patients experience higher rates of comorbidities associated with both diseases than those with CRS or OSA alone. OSA was associated with an increased risk of ESS, antibiotic, and steroid use in patients with CRS. There appears to be a correlation with treatment of OSA and CRS outcomes, however, further studies are required.

目的:评估阻塞性睡眠呼吸暂停(OSA)对慢性鼻炎(CRS)严重程度的影响:评估阻塞性睡眠呼吸暂停(OSA)对慢性鼻窦炎(CRS)严重程度的影响:研究设计:回顾性数据库审查:背景:TriNetX 美国数据库:对 TriNetX US 协作网络数据库中的 OSA、CRS 和合并 OSA 的 CRS(CRS-OSA)患者队列进行查询。数据包括人口统计学特征、通过内窥镜鼻窦手术(ESS)、抗生素和口服类固醇的使用率评估 CRS 的严重程度。为了考虑人口统计学和临床变量的差异,进行了倾向得分匹配:查询结果显示,共有 1818879 名 CRS 患者、481144 名 OSA 患者和 93153 名 CRS-OSA 患者。与 CRS 或 OSA 患者相比,OSA-CRS 患者的高血压、糖尿病、肥胖和哮喘发病率较高(P 结论:OSA-CRS 患者的高血压、糖尿病、肥胖和哮喘发病率较高):与 CRS 或 OSA 患者相比,CRS-OSA 患者同时患有这两种疾病的比例更高。OSA 与 CRS 患者使用 ESS、抗生素和类固醇的风险增加有关。OSA的治疗似乎与CRS的预后有关,但还需要进一步的研究。
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引用次数: 0
Risk Analysis Index Frailty Score as a Predictor of Otolaryngology Surgical Outcomes. 作为耳鼻喉科手术结果预测指标的风险分析指数虚弱评分
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-11 DOI: 10.1002/ohn.899
Lauran K Evans, Clare Moffatt, Keon Niknejad, Hong-Ho Yang, Laura Kodaverdian, Shady Soliman, Francis Reyes Orozco, Dinesh K Chhetri

Objective: The Risk Analysis Index (RAI) score is a screening tool to assess patient frailty. It has been shown to be predictive of postoperative outcomes and mortality in orthopedic, urologic, and neurosurgical patient populations. We sought to evaluate the predictive ability of RAI score for surgical outcomes in an otolaryngology patient population.

Study design: Retrospective study.

Setting: Academic tertiary medical center.

Methods: A retrospective study was conducted of adult patients undergoing otolaryngology surgery at a tertiary medical care center over 21 months. Patients were sent electronic RAI survey questionnaires via direct messaging, which was completed prior to surgery. Endpoint data were analyzed, including demographics, RAI score, and patient outcome data. Univariate analysis, ROC curves, and predictive modeling were utilized.

Results: A total of 517 patients responded to the RAI questionnaire, resulting in a 59.6% response rate. Mean RAI score was 21.38 ± 11.83. Higher RAI scores were associated with increased 30-day readmissions (P < .0015), postoperative complications (P < .001), hospital length of stay (P < .001), and discharge with home health (P < .001). Predictive models for RAI score and postoperative outcomes were created, and a cutoff score of RAI = 30 was established to identify frail patients.

Conclusion: We evaluated if RAI scoring predicted postoperative complications in an otolaryngology patient population. Increased RAI score is significantly associated with poorer surgical outcomes, including increased hospital length of stay, 30-day readmissions, and postoperative complications. We propose a predictive model with suggested RAI cutoff scoring for use in the otolaryngology surgical population.

目的:风险分析指数(RAI)评分是一种评估患者虚弱程度的筛查工具。在骨科、泌尿科和神经外科患者群体中,它已被证明可预测术后结果和死亡率。我们试图评估 RAI 评分对耳鼻喉科患者手术结果的预测能力:研究设计:回顾性研究:研究设计:回顾性研究:对一家三级医疗中心 21 个月内接受耳鼻喉科手术的成年患者进行回顾性研究。患者通过直接信息发送电子 RAI 调查问卷,并在手术前完成。对终点数据进行了分析,包括人口统计学、RAI评分和患者预后数据。采用了单变量分析、ROC 曲线和预测模型:共有 517 名患者回复了 RAI 问卷,回复率为 59.6%。平均 RAI 得分为 21.38 ± 11.83。RAI 评分越高,30 天再住院率越高:我们评估了 RAI 评分能否预测耳鼻喉科患者的术后并发症。RAI 评分的增加与较差的手术效果明显相关,包括住院时间延长、30 天再入院率和术后并发症。我们提出了一个预测模型,并建议在耳鼻喉科手术人群中使用 RAI 临界评分。
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引用次数: 0
Analysis of Opioid Prescribing Trends Following Thyroidectomy and Parathyroidectomy Before and After the 2021 American Academy of Otolaryngology-Head and Neck Surgery Opioid Prescribing Clinical Practice Guidelines. 甲状腺切除术和甲状旁腺切除术后阿片类药物处方趋势分析》(Apysis of Opioid Prescribing Trends Following Thyroidectomy and Parathyroidectomy Before and After the 2021 American Academy of Otolaryngology-Head and Neck Surgery Opioid Prescribing Clinical Practice Guidelines)。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-16 DOI: 10.1002/ohn.1008
Robert E Africa, Brian J McKinnon, Orly M Coblens, Viran J Ranasinghe, Sepehr Shabani

Objective: To evaluate the trends in opioid and nonopioid prescribing for thyroidectomy and parathyroidectomy before and after the publication of guidelines by the American Academy of Otolaryngology-Head and Neck Surgery in April 2021.

Study design: Retrospective.

Setting: Eighty-three health care organizations in the United States that contribute to the TriNetX database.

Methods: Deidentified patient data were retrieved from the TriNetX. Patients who were prescribed either opioids or nonopioid analgesic within 1 to 5 days following thyroid surgery and parathyroidectomy were included. Evaluation of the prescription trends was performed by interrupted time series analysis in Statistical Analysis System 9.4 with significance set at P < .05 to assess trends before and after the new opioid prescription guidelines.

Results: For thyroid surgery, there was an immediate effect of the guideline change indicated by a 3.3% decrease in the opioid prescription trend (P = .03) and a significant increase in nonopioid use of overtime by 0.13% every 3 months (P < .0001). The opioid prescription trend following parathyroidectomy significantly decreased over time by 0.28% every 3 months (P < .0001), while the nonopioid prescription trend increased by 0.14% (P < .0001).

Conclusion: There was an associated immediate reduction in the opioid prescribing trend for thyroidectomy, but the change was not sustained overtime. There was an associated decrease in the opioid prescribing trend for parathyroidectomy, but not immediately after the initial publication of the prescription guidelines.

Level of evidence: Level III.

目的评估2021年4月美国耳鼻咽喉头颈外科学会发布指南前后甲状腺切除术和甲状旁腺切除术阿片类药物和非阿片类药物处方的趋势:研究设计:回顾性:研究设计:回顾性研究。研究地点:美国向TriNetX数据库提供信息的83家医疗机构:方法:从 TriNetX 数据库中检索患者身份不明的数据。纳入了甲状腺手术和甲状旁腺切除术后1至5天内被处方阿片类或非阿片类镇痛药的患者。处方趋势的评估是通过统计分析系统 9.4 中的中断时间序列分析进行的,显著性设定为 P 结果:就甲状腺手术而言,指南的改变产生了立竿见影的效果,阿片类药物的处方趋势下降了 3.3%(P = 0.03),而非阿片类药物的超时使用每 3 个月显著增加 0.13%(P 结论:甲状腺手术和甲状旁腺切除术的处方趋势与指南的改变密切相关:甲状腺切除术的阿片类药物处方量有立即减少的趋势,但随着时间的推移,这种变化不会持续。甲状旁腺切除术的阿片类药物处方呈减少趋势,但并非在处方指南首次发布后立即减少:证据等级:三级。
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引用次数: 0
Complications Associated with AMBU™ Scope Use: An FDA MAUDE Analysis. 与使用 AMBU™ 镜有关的并发症:FDA MAUDE 分析。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-11 DOI: 10.1002/ohn.898
David R Grimm, Akash S Halagur, Noel Ayoub

Ambu® aScope™ is a disposable flexible videoscope used for a wide range of medical procedures. However, adverse events associated with this device can occur. The Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was explored for patient-related adverse events associated with Ambu® aScope™ use between January 1, 2000 and December 15, 2023. Search terms included "Ambu" and "Ascope." Thirty unique adverse events were identified. Twenty-one of the events were associated with patient injury, and 9 with device malfunction. Eight patient-reported problems were documented as foreign bodies, 3 events as airway obstruction, desaturation, or hypoxic events, and 1 event as anxiety/cardiac arrest. The remaining 18 reported insufficient information other than associated with patient injury. We found that Ambu® aScope™ flexible nasolaryngoscopes and bronchoscopes are a common and effective tool for airway evaluations that may infrequently serve as a rare form of foreign body with potentially life-threatening consequences.

Ambu® aScope™ 是一种一次性柔性视镜,可用于各种医疗程序。然而,与该设备相关的不良事件也时有发生。我们在食品药品管理局 (FDA) 制造商和用户设施设备经验 (MAUDE) 数据库中搜索了 2000 年 1 月 1 日至 2023 年 12 月 15 日期间与 Ambu® aScope™ 使用相关的患者相关不良事件。搜索关键词包括 "Ambu "和 "Ascope"。共发现 30 起独特的不良事件。其中 21 起与患者受伤有关,9 起与设备故障有关。有 8 起患者报告的问题被记录为异物,3 起事件被记录为气道阻塞、饱和度降低或缺氧,1 起事件被记录为焦虑/心跳骤停。其余 18 起事件除与患者受伤有关外,其他信息不足。我们发现,Ambu® aScope™ 柔性鼻咽喉镜和支气管镜是气道评估的一种常见而有效的工具,但也可能偶尔成为一种罕见的异物,并可能造成危及生命的后果。
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引用次数: 0
Impact of Clinical Practice Guidelines on Pediatric Tonsillectomy for Tonsillitis. 临床实践指南对扁桃体炎小儿扁桃体切除术的影响。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-21 DOI: 10.1002/ohn.914
Avivah J Wang, Jeffrey Cheng

Objective: To determine the impact of the release of updated American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) Clinical Practice Guidelines (CPG) for Tonsillectomy in Children in 2019 on adherence to evidence-based practice.

Methods: Patients between ages 1 and 18 who had tonsillectomies and encounters for throat infection (tonsillitis or pharyngitis) between of February 5, 2015 and February 4, 2023 were identified by International Classification of Diseases and Current Procedural Terminology codes, excluding those with obstructive sleep-disordered breathing. Retrospective chart review was performed to determine adherence to evidence-based practice.

Results: There was a significant increase in adherence to evidence-based practice post-CPG release compared to pre-CPG (85.4% vs 73.1%, P = .0088). There was an observed trend for improved adherence to evidence-based practice for pediatric tonsillectomy for recurrent infection for most of the post-CPG period. There were fewer tonsillectomies performed post-CPG, despite more total encounters for throat infection.

Discussion: The publication of the updated AAO-HNSF CPG corresponded with improved adherence to evidence-based practice for tonsillectomy in children for recurrent infection and an observed decrease in overall rate of tonsillectomy. This suggests the CPG may be an effective quality improvement tool for reducing variation and unnecessary patient morbidity or harm.

Implications for practice: These findings suggest that the updated AAO-HNSF CPG for Tonsillectomy in Children may have effectively impacted practice patterns, and further work should be done to expand their reach to other specialties and settings. Consideration should also be given to further understand any balancing factors associated with reduced tonsillectomies for recurrent infections including quality of life impact on children managed expectantly.

目的目的:确定美国耳鼻咽喉头颈外科学会(AAO-HNSF)2019 年发布的最新《儿童扁桃体切除术临床实践指南》(CPG)对循证实践遵守情况的影响:根据《国际疾病分类》和《当前程序术语》代码,对2015年2月5日至2023年2月4日期间因咽喉感染(扁桃体炎或咽炎)而进行扁桃体切除术和就诊的1至18岁患者进行识别,不包括患有阻塞性睡眠呼吸障碍的患者。对病历进行了回顾性审查,以确定对循证实践的遵守情况:结果:与发布《循证指南》前相比,发布《循证指南》后坚持循证实践的比例明显增加(85.4% vs 73.1%,P = .0088)。在《指南》发布后的大部分时间里,小儿扁桃体切除术治疗复发性感染的循证实践依从性呈改善趋势。尽管咽喉感染的总就诊人次增加了,但CPG后实施的扁桃体切除术却减少了:讨论:AAO-HNSF CPG 更新版发布后,儿童扁桃体切除术治疗复发性感染的循证实践得到了改善,扁桃体切除术的总体比例也有所下降。这表明 CPG 可能是一种有效的质量改进工具,可减少变异和不必要的患者发病率或伤害:这些研究结果表明,更新后的 AAO-HNSF 儿童扁桃体切除术 CPG 可能有效地影响了实践模式,应进一步努力将其推广到其他专科和环境中。还应考虑进一步了解与减少复发性感染扁桃体切除术相关的平衡因素,包括对预期治疗儿童生活质量的影响。
{"title":"Impact of Clinical Practice Guidelines on Pediatric Tonsillectomy for Tonsillitis.","authors":"Avivah J Wang, Jeffrey Cheng","doi":"10.1002/ohn.914","DOIUrl":"10.1002/ohn.914","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of the release of updated American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) Clinical Practice Guidelines (CPG) for Tonsillectomy in Children in 2019 on adherence to evidence-based practice.</p><p><strong>Methods: </strong>Patients between ages 1 and 18 who had tonsillectomies and encounters for throat infection (tonsillitis or pharyngitis) between of February 5, 2015 and February 4, 2023 were identified by International Classification of Diseases and Current Procedural Terminology codes, excluding those with obstructive sleep-disordered breathing. Retrospective chart review was performed to determine adherence to evidence-based practice.</p><p><strong>Results: </strong>There was a significant increase in adherence to evidence-based practice post-CPG release compared to pre-CPG (85.4% vs 73.1%, P = .0088). There was an observed trend for improved adherence to evidence-based practice for pediatric tonsillectomy for recurrent infection for most of the post-CPG period. There were fewer tonsillectomies performed post-CPG, despite more total encounters for throat infection.</p><p><strong>Discussion: </strong>The publication of the updated AAO-HNSF CPG corresponded with improved adherence to evidence-based practice for tonsillectomy in children for recurrent infection and an observed decrease in overall rate of tonsillectomy. This suggests the CPG may be an effective quality improvement tool for reducing variation and unnecessary patient morbidity or harm.</p><p><strong>Implications for practice: </strong>These findings suggest that the updated AAO-HNSF CPG for Tonsillectomy in Children may have effectively impacted practice patterns, and further work should be done to expand their reach to other specialties and settings. Consideration should also be given to further understand any balancing factors associated with reduced tonsillectomies for recurrent infections including quality of life impact on children managed expectantly.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1949-1955"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Machine Learning Methods in Classification of Prolonged Radiation Therapy in Oropharyngeal Cancer: National Cancer Database. 口咽癌延长放疗分类中的机器学习方法:全国癌症数据库
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-31 DOI: 10.1002/ohn.926
Seungjun Ahn, Eun Jeong Oh, Matthew I Saleem, Tristan Tham

Objective: To investigate the accuracy of machine learning (ML) algorithms in stratifying risk of prolonged radiation treatment duration (RTD), defined as greater than 50 days, for patients with oropharyngeal squamous cell carcinoma (OPSCC).

Study design: Retrospective cohort study.

Setting: National Cancer Database (NCDB).

Methods: The NCDB was queried between 2004 to 2016 for patients with OPSCC treated with radiation therapy (RT) or chemoradiation as primary treatment. To predict risk of prolonged RTD, 8 different ML algorithms were compared against traditional logistic regression using various performance metrics. Data was split into a distribution of 70% for training and 30% for testing.

Results: A total of 3152 patients were included (1928 prolonged RT, 1224 not prolonged RT). As a whole, based on performance metrics, random forest (RF) was found to most accurately predict prolonged RTD compared to both other ML methods and traditional logistic regression.

Conclusion: Our assessment of various ML techniques showed that RF was superior to traditional logistic regression at classifying OPSCC patients at risk of prolonged RTD. Application of such algorithms may have potential to identify high risk patients and enable early interventions to improve survival.

目的调查机器学习(ML)算法对口咽鳞状细胞癌(OPSCC)患者放疗时间延长(RTD)(定义为超过50天)风险分层的准确性:研究设计:回顾性队列研究:国家癌症数据库(NCDB):2004年至2016年期间,对NCDB中以放疗(RT)或化放疗作为主要治疗手段的OPSCC患者进行了查询。为了预测RTD延长的风险,使用各种性能指标将8种不同的ML算法与传统的逻辑回归进行了比较。数据被分成70%用于训练,30%用于测试:共纳入了 3152 例患者(1928 例长期 RT,1224 例非长期 RT)。总体而言,根据性能指标,随机森林(RF)与其他 ML 方法和传统的逻辑回归相比,能最准确地预测延长的 RTD:我们对各种ML技术的评估表明,RF在对有延长RTD风险的OPSCC患者进行分类方面优于传统的逻辑回归。应用这种算法有可能识别出高风险患者,并进行早期干预以提高生存率。
{"title":"Machine Learning Methods in Classification of Prolonged Radiation Therapy in Oropharyngeal Cancer: National Cancer Database.","authors":"Seungjun Ahn, Eun Jeong Oh, Matthew I Saleem, Tristan Tham","doi":"10.1002/ohn.926","DOIUrl":"10.1002/ohn.926","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the accuracy of machine learning (ML) algorithms in stratifying risk of prolonged radiation treatment duration (RTD), defined as greater than 50 days, for patients with oropharyngeal squamous cell carcinoma (OPSCC).</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>National Cancer Database (NCDB).</p><p><strong>Methods: </strong>The NCDB was queried between 2004 to 2016 for patients with OPSCC treated with radiation therapy (RT) or chemoradiation as primary treatment. To predict risk of prolonged RTD, 8 different ML algorithms were compared against traditional logistic regression using various performance metrics. Data was split into a distribution of 70% for training and 30% for testing.</p><p><strong>Results: </strong>A total of 3152 patients were included (1928 prolonged RT, 1224 not prolonged RT). As a whole, based on performance metrics, random forest (RF) was found to most accurately predict prolonged RTD compared to both other ML methods and traditional logistic regression.</p><p><strong>Conclusion: </strong>Our assessment of various ML techniques showed that RF was superior to traditional logistic regression at classifying OPSCC patients at risk of prolonged RTD. Application of such algorithms may have potential to identify high risk patients and enable early interventions to improve survival.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1764-1772"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combination Tonsillectomy and Hypoglossal Nerve Stimulation for Sleep Apnea Patients With Oropharyngeal Lateral Wall Collapse. 合并扁桃体切除术和舌下神经刺激术治疗口咽侧壁塌陷的睡眠呼吸暂停患者
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-27 DOI: 10.1002/ohn.950
Phillip Huyett, Andrew Wellman, Victoria Caruso, Jeffrey Sumner, Atqiya Aishah, Ali Azarbarzin, Scott Sands, Daniel Vena

Objective: The efficacy of hypoglossal nerve stimulation (HGNS) therapy is limited by obstruction of the oropharyngeal lateral walls (OLWs). Our objective was to investigate the effect of palatine tonsillectomy on HGNS efficacy in obstructive sleep apnea (OSA) patients with OLW collapse.

Study design: Case-control study of patients with moderate-to-severe OSA, complete-or-partial OLW collapse, and small tonsils (1 - 2+). Concomitant palatine tonsillectomy and HGNS (HGNS+T) were compared against a control group of patients who underwent HGNS alone.

Setting: Single academic institution.

Methods: Study outcomes were measures of HGNS efficacy defined as a %reduction in apnea-hypopnea index (AHI) (primary) and successful treatment response (50% AHI reduction to <15/h, logistic regression), respectively. Regression analyses quantified the additional effect of tonsillectomy (HGNS+T vs HGNS alone, independent variable) on HGNS efficacy. Analyses were adjusted for OLW collapse severity (complete vs partial), tonsil size, age, sex, body mass index, and baseline AHI.

Results: Nineteen patients underwent HGNS+T and had follow-up sleep testing for the current analysis. The control group (HGNS alone) consisted of 78 patients. Baseline demographics and OSA severity were similar between the groups, except HGNS+T group had increased prevalence of complete OLW collapse. Linear regression demonstrated that adding tonsillectomy resulted in an additional 22.9% [7.5, 35.2] reduction in AHI [95% confidence interval, CI] (P = .006), and 8.6 [1.7,43.4] (P = .010) greater odds [95% CI] of a successful treatment response with HGNS.

Conclusion: Compared to historically poorer outcomes of HGNS in patients with OLW collapse, these early results suggest combining tonsillectomy with HGNS may represent a promising strategy to improve success rates.

目的:舌下神经刺激(HGNS)疗法的疗效因口咽侧壁(OLW)阻塞而受到限制。我们的目的是研究腭扁桃体切除术对口咽侧壁塌陷的阻塞性睡眠呼吸暂停(OSA)患者的舌下神经刺激疗法疗效的影响:病例对照研究:研究对象为中重度 OSA、OLW 完全或部分塌陷、扁桃体较小(1 - 2+)的患者。将同时接受腭扁桃体切除术和 HGNS(HGNS+T)的患者与仅接受 HGNS 的对照组患者进行比较:地点:单个学术机构:研究结果:HGNS疗效是指呼吸暂停-低通气指数(AHI)降低的百分比(主要指标)和成功的治疗反应(AHI降低50%):19 名患者接受了 HGNS+T 治疗,并在本次分析中接受了后续睡眠测试。对照组(仅接受 HGNS 治疗)有 78 名患者。两组患者的基线人口统计学特征和 OSA 严重程度相似,但 HGNS+T 组患者的 OLW 完全塌陷发生率更高。线性回归结果显示,增加扁桃体切除术可使 AHI 降低 22.9% [7.5, 35.2] [95% 置信区间,CI] (P = .006),HGNS 治疗成功的几率增加 8.6 [1.7, 43.4] (P = .010)[95%CI]:这些早期结果表明,将扁桃体切除术与 HGNS 相结合可能是提高成功率的一种有前途的策略。
{"title":"Combination Tonsillectomy and Hypoglossal Nerve Stimulation for Sleep Apnea Patients With Oropharyngeal Lateral Wall Collapse.","authors":"Phillip Huyett, Andrew Wellman, Victoria Caruso, Jeffrey Sumner, Atqiya Aishah, Ali Azarbarzin, Scott Sands, Daniel Vena","doi":"10.1002/ohn.950","DOIUrl":"10.1002/ohn.950","url":null,"abstract":"<p><strong>Objective: </strong>The efficacy of hypoglossal nerve stimulation (HGNS) therapy is limited by obstruction of the oropharyngeal lateral walls (OLWs). Our objective was to investigate the effect of palatine tonsillectomy on HGNS efficacy in obstructive sleep apnea (OSA) patients with OLW collapse.</p><p><strong>Study design: </strong>Case-control study of patients with moderate-to-severe OSA, complete-or-partial OLW collapse, and small tonsils (1 - 2+). Concomitant palatine tonsillectomy and HGNS (HGNS+T) were compared against a control group of patients who underwent HGNS alone.</p><p><strong>Setting: </strong>Single academic institution.</p><p><strong>Methods: </strong>Study outcomes were measures of HGNS efficacy defined as a %reduction in apnea-hypopnea index (AHI) (primary) and successful treatment response (50% AHI reduction to <15/h, logistic regression), respectively. Regression analyses quantified the additional effect of tonsillectomy (HGNS+T vs HGNS alone, independent variable) on HGNS efficacy. Analyses were adjusted for OLW collapse severity (complete vs partial), tonsil size, age, sex, body mass index, and baseline AHI.</p><p><strong>Results: </strong>Nineteen patients underwent HGNS+T and had follow-up sleep testing for the current analysis. The control group (HGNS alone) consisted of 78 patients. Baseline demographics and OSA severity were similar between the groups, except HGNS+T group had increased prevalence of complete OLW collapse. Linear regression demonstrated that adding tonsillectomy resulted in an additional 22.9% [7.5, 35.2] reduction in AHI [95% confidence interval, CI] (P = .006), and 8.6 [1.7,43.4] (P = .010) greater odds [95% CI] of a successful treatment response with HGNS.</p><p><strong>Conclusion: </strong>Compared to historically poorer outcomes of HGNS in patients with OLW collapse, these early results suggest combining tonsillectomy with HGNS may represent a promising strategy to improve success rates.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1904-1910"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Longitudinal Analysis of Hypoglossal Nerve Stimulator Therapy Uptitration Using Cloud-Based Usage Data. 利用基于云的使用数据纵向分析舌下神经刺激器疗法的优越性
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-24 DOI: 10.1002/ohn.911
Yi Cai, Yixuan J Zheng, Jolie L Chang

This preliminary study investigates hypoglossal nerve stimulator (HNS) amplitude changes and usage patterns during the initial HNS uptitration period to characterize when patients achieve their therapeutic amplitude. HNS therapy amplitudes, duration, and pause times were examined across the first 4 months of implant use. Average HNS therapy amplitude increased monthly from baseline (0.7 ± 0.3 V) to the first (1.1 ± 0.3 V), second (1.4 ± 0.4 V), third (1.7 ± 0.5 V), and fourth months (1.8 ± 0.5 V) (P < .001). After 4 months, 60% had reached a therapeutic amplitude. Average therapeutic amplitude was greater for patients who did not achieve therapeutic amplitude by month 4 than for those who did (2.6 vs 1.6 V; P < .05). Body mass index, baseline apnea-hypopnea index, respiratory disturbance index, and initial HNS amplitude did not differ between the 2 groups. Predictors for therapeutic amplitude and other usage patterns require further investigation.

这项初步研究调查了舌下神经刺激器(HNS)的振幅变化以及在 HNS 升压初期的使用模式,以确定患者何时达到治疗振幅。在使用 HNS 的最初 4 个月中,对 HNS 治疗振幅、持续时间和暂停时间进行了检查。从基线(0.7 ± 0.3 V)到第一个月(1.1 ± 0.3 V)、第二个月(1.4 ± 0.4 V)、第三个月(1.7 ± 0.5 V)和第四个月(1.8 ± 0.5 V),平均 HNS 治疗振幅逐月增加(P<0.05)。
{"title":"Longitudinal Analysis of Hypoglossal Nerve Stimulator Therapy Uptitration Using Cloud-Based Usage Data.","authors":"Yi Cai, Yixuan J Zheng, Jolie L Chang","doi":"10.1002/ohn.911","DOIUrl":"10.1002/ohn.911","url":null,"abstract":"<p><p>This preliminary study investigates hypoglossal nerve stimulator (HNS) amplitude changes and usage patterns during the initial HNS uptitration period to characterize when patients achieve their therapeutic amplitude. HNS therapy amplitudes, duration, and pause times were examined across the first 4 months of implant use. Average HNS therapy amplitude increased monthly from baseline (0.7 ± 0.3 V) to the first (1.1 ± 0.3 V), second (1.4 ± 0.4 V), third (1.7 ± 0.5 V), and fourth months (1.8 ± 0.5 V) (P < .001). After 4 months, 60% had reached a therapeutic amplitude. Average therapeutic amplitude was greater for patients who did not achieve therapeutic amplitude by month 4 than for those who did (2.6 vs 1.6 V; P < .05). Body mass index, baseline apnea-hypopnea index, respiratory disturbance index, and initial HNS amplitude did not differ between the 2 groups. Predictors for therapeutic amplitude and other usage patterns require further investigation.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1931-1933"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and Complications of Interarytenoid Injection for Dysphagia in Infants 1-Year-Old and Under. 蝶窦间注射治疗 1 岁及以下婴儿吞咽困难的疗效和并发症。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-26 DOI: 10.1002/ohn.1065
Trenton House, Patrick Scheffler, Mark E Gerber, Stuart Curtis, James Woodward, Stacey Killeen, Dana Williams, Clare M Richardson

Objective: The objective of this study was to assess the efficacy and complication rates of interarytenoid injection augmentation (IAIA) for the treatment of dysphagia in patients 1 year of age and under and to determine if concurrent feeding therapy (FT) affects outcome.

Study design: Retrospective case series.

Setting: Tertiary pediatric hospital.

Methods: Retrospective review of patients 13 months of age and younger with dysphagia treated by IAIA over a 4-year period. The efficacy of IAIA was determined by comparing perioperative videofluoroscopic swallow studies (VFSS) and Dysphagia Outcome and Severity Scale (DOSS) scores. Complication rates and utilization of concomitant FT were determined by evaluating postoperative admission and follow-up records.

Results: Sixty-five patients met inclusion criteria (median age 8 months, interquartile range [IQR]: 7-11). Sixty-seven percent of patients improved on postoperative VFSS scores (median improvement in aspiration of 2 thickness levels, IQR 0-3, P < .0001), and 56% improved in DOSS scores (median increase of 1, IQR: 0-1.5, P < .0001). Ninety-two percent of patients were discharged home on the day of surgery. The 30-day relevant readmission rate was 5%. No patients had intraoperative complications or severe complications at follow-up. No statistical difference in aspiration or DOSS was noted in the concomitant FT cohort due to a lack of sample size.

Conclusion: This study demonstrates that IAIA in children under 13 months old shows comparable rates of success and complications to older patients reported in the literature. No patients had long-term complications and most were discharged home on the day of surgery. More studies are needed to determine the effect of concomitant FT on IAIA.

研究目的本研究的目的是评估唇间腱膜注射隆鼻术(IAIA)治疗1岁及以下吞咽困难患者的疗效和并发症发生率,并确定同时进行的喂养治疗(FT)是否会影响疗效:研究设计:回顾性病例系列:研究设计:回顾性病例系列:方法:对 4 年内接受 IAIA 治疗的 13 个月及以下吞咽困难患者进行回顾性研究。通过比较围手术期视频荧光屏吞咽研究(VFSS)和吞咽困难结果和严重程度量表(DOSS)评分,确定IAIA的疗效。通过评估术后入院和随访记录来确定并发症发生率和同时使用 FT 的情况:65名患者符合纳入标准(中位年龄为8个月,四分位距[IQR]:7-11)。67% 的患者术后 VFSS 评分有所改善(吸入厚度中位数改善 2 级,IQR 0-3,P 结论:该研究表明,IAIA 对儿童的影响是非常大的:本研究表明,13 个月以下儿童的 IAIA 成功率和并发症发生率与文献报道的年龄较大的患者相当。没有患者出现长期并发症,大多数患者在手术当天就可以出院回家。还需要进行更多的研究,以确定同时服用 FT 对 IAIA 的影响。
{"title":"Efficacy and Complications of Interarytenoid Injection for Dysphagia in Infants 1-Year-Old and Under.","authors":"Trenton House, Patrick Scheffler, Mark E Gerber, Stuart Curtis, James Woodward, Stacey Killeen, Dana Williams, Clare M Richardson","doi":"10.1002/ohn.1065","DOIUrl":"https://doi.org/10.1002/ohn.1065","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess the efficacy and complication rates of interarytenoid injection augmentation (IAIA) for the treatment of dysphagia in patients 1 year of age and under and to determine if concurrent feeding therapy (FT) affects outcome.</p><p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Tertiary pediatric hospital.</p><p><strong>Methods: </strong>Retrospective review of patients 13 months of age and younger with dysphagia treated by IAIA over a 4-year period. The efficacy of IAIA was determined by comparing perioperative videofluoroscopic swallow studies (VFSS) and Dysphagia Outcome and Severity Scale (DOSS) scores. Complication rates and utilization of concomitant FT were determined by evaluating postoperative admission and follow-up records.</p><p><strong>Results: </strong>Sixty-five patients met inclusion criteria (median age 8 months, interquartile range [IQR]: 7-11). Sixty-seven percent of patients improved on postoperative VFSS scores (median improvement in aspiration of 2 thickness levels, IQR 0-3, P < .0001), and 56% improved in DOSS scores (median increase of 1, IQR: 0-1.5, P < .0001). Ninety-two percent of patients were discharged home on the day of surgery. The 30-day relevant readmission rate was 5%. No patients had intraoperative complications or severe complications at follow-up. No statistical difference in aspiration or DOSS was noted in the concomitant FT cohort due to a lack of sample size.</p><p><strong>Conclusion: </strong>This study demonstrates that IAIA in children under 13 months old shows comparable rates of success and complications to older patients reported in the literature. No patients had long-term complications and most were discharged home on the day of surgery. More studies are needed to determine the effect of concomitant FT on IAIA.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Nortriptyline-Topiramate and Verapamil-Paroxetine in Tinnitus Management: A Randomized Placebo-Controlled Trial. 去甲替林-托吡酯和维拉帕米-帕罗西汀治疗耳鸣的疗效:随机安慰剂对照试验》。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-26 DOI: 10.1002/ohn.1063
Mehdi Abouzari, Karen Tawk, Joshua K Kim, Eva D Larson, Harrison W Lin, Hamid R Djalilian

Objective: To evaluate the efficacy of 2 drug combinations on tinnitus severity and associated stress, depression, sleep, and anxiety.

Study design: A randomized, double-blind, placebo-controlled clinical trial conducted between 2019 and 2023 for an 8-week duration.

Setting: Single institution tertiary care center.

Methods: The study recruited adult patients with moderate to severe tinnitus for 6 months or more. In total, 81 patients were assessed for eligibility, 78 were enrolled and randomized, and 67 were included in the per-protocol analysis. Patients were randomized into 3 groups (1:1:1). Group NT received nortriptyline-topiramate, group VP received verapamil-paroxetine, and group P received placebo.

Results: A total of 19 patients in group NT, 22 in group VP, and 26 patients in group P were included in the per-protocol analysis. In group NT, the Tinnitus Functional Index (TFI) score decreased from 58.4 ± 13.9 (baseline) to 46.3 ± 17.5 (end-of-trial) (P < .001). Similarly, in group VP, the TFI score decreased from 54.6 ± 17.5 to 42.2 ± 16.1 (P = .004). However, group P did not demonstrate any significant decrease in the TFI score from 51.2 ± 18.6 to 45.2 ± 20.1 (P = .086). The between-arm analysis did not yield any statistical significance decrease in the TFI score (analysis of variance, P = .265).

Conclusion: Both combinations of drugs were promising in improving tinnitus severity. However, larger-scale trials with longer follow-up periods are warranted to validate our findings between groups.

研究目的评估两种药物组合对耳鸣严重程度及相关压力、抑郁、睡眠和焦虑的疗效:随机、双盲、安慰剂对照临床试验,时间为 2019 年至 2023 年,为期 8 周:单一机构三级医疗中心:研究招募了患有中度至重度耳鸣 6 个月或以上的成年患者。共有81名患者接受了资格评估,78名患者入组并进行了随机分组,67名患者纳入了每方案分析。患者被随机分为 3 组(1:1:1)。NT组接受去甲替林-托吡酯治疗,VP组接受维拉帕米-帕罗西汀治疗,P组接受安慰剂治疗:结果:共有 19 名 NT 组患者、22 名 VP 组患者和 26 名 P 组患者接受了按方案分析。NT组的耳鸣功能指数(TFI)从基线(58.4±13.9)分降至试验结束(46.3±17.5)分(P 结论:两种药物的联合治疗均有望改善患者的耳鸣功能:两种药物组合都有望改善耳鸣的严重程度。然而,需要进行更大规模的试验和更长的随访期,以验证我们在不同组别之间的研究结果。
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引用次数: 0
期刊
Otolaryngology- Head and Neck Surgery
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