World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

This article provides an overview of gastro-esophageal (GERD) and laryngopharynegal (LPRD) reflux diseases in the context of obesity as a confounding entity. A detailed review of the clinical presentation, pathogenesis, diagnosis, and treatment of laryngopharyngeal reflux disease may be found elsewhere. The association between obesity and gastroesophageal reflux disease has been well established, and a similar Association exists between obesity and laryngopharyngeal reflux disease (LPRD). Reflux should be sought in obese patients with voice complaints, and a weight reduction should be recommended in patients in whom LPRD is diagnosed.

Objective: To discuss the current clinical application and usefulness, shortcomings and future directions of traditional and artificial intelligence (AI)-driven acoustic assessment techniques to detect voice dysfunction.

Data sources: Literature review.

Conclusion: AI-based acoustic voice analysis techniques have huge potential to improve the early recognition, diagnosis, and tracking of treatment success in patients with voice disorders or diseases affecting voice function. Through smartphones, wearable devices, and server-based solutions, acoustic voice assessment techniques have become widely available and may be extended to workplace and private settings. However, the transformative potential is thwarted by several limitations including a lack of (a) consistent data collection and reporting standards, leading to heterogeneity of current databases and literature; (b) characterization what acoustic analysis techniques including AI can detect or track reliably, and whether the derived outcomes serve as a reliable marker of dysfunction, pathology, or an improvement thereof; (c) clinical validation studies in unselected patients; and (d) ethical and legal controversies. Thus, substantial effort to research, define and establish guidelines for the collection, storage, and processing of acoustic data and valid clinical applications is warranted to design sensible strategies for analysis and use.

Objective: The aim of this study is to develop a multimodal MRI radiomics-based model for predicting long-term overall survival in hypopharyngeal cancer patients undergoing definitive radiotherapy.

Methods: We enrolled 207 hypopharyngeal cancer patients who underwent definitive radiotherapy and had 5-year overall survival outcomes from two major cancer centers in China. Pretreatment MRI images and clinical features were collected. Regions of interest (ROIs) for primary tumors and lymph node metastases (LNM) were delineated on T2 and contrast-enhanced T1 (CE-T1) sequences. Principal component analysis (PCA), support vector machine (SVM), and 5-fold cross-validation were used to develop and evaluate the models.

Results: Multivariate Cox regression analysis identified age under 50 years, advanced T stage, and N stage as risk factors for overall survival. Predictive models based solely on clinical features (Model A), single radiomics features (Model B), and their combination (Model C) performed poorly, with mean AUC values in the validation set of 0.663, 0.772, and 0.779, respectively. The addition of multimodal LNM and CE-T1 radiomics features significantly improved prediction accuracy (Models D and E), with AUC values of 0.831 and 0.837 in the validation set.

Conclusion: We developed a well-discriminating overall survival prediction model based on multimodal MRI radiomics, applicable to patients receiving definitive radiotherapy, which may contribute to personalized treatment strategies.

Purpose: To explore the clinical efficacy of unilateral modified arytenoidectomy (UMA) in the treatment of bilateral vocal fold paralysis(BVFP) based on animal models.

Methods: The UMA which had been tested in excised canine larynges with simulated BVFP was adapted into a clinical technique. The characteristics of this surgical technique involve contouring of the arytenoid cartilage. The procedure expands the vocal fold respiratory region and subglottic space of the arytenoid cartilage while preserving the muscular process to maintain partial vocal fold muscle function. A retrospective analysis was conducted on 19 patients diagnosed with BVFP who were admitted to the Department of Voice Medicine, Zhongshan Hospital of Xiamen University between April 2019 and November 2023. These patients underwent CO₂ laser arytenoid cartilage partial resection using a modified surgical technique. Dyspnea scores, voice handicap index scale (VHI-10), and subjective and objective acoustic analysis were collected pre-op and post-op assessments to evaluate the clinical efficacy.

Results: Data analysis of patients at 6 months post-op showed VHI-10: pre-op (21.68 ± 12.40) score, post-op (16.21 ± 7.68) score (p = 0.033); mMRC Dyspnea Scale: pre-op (2.79 ± 0.71) score, post-op (0.58 ± 0.69) score (p < 0.001); fundamental frequency (F0): pre-op (175.54 ± 50.72) Hz, post-op (190.36 ± 39.28) Hz (p = 0.196); maximum vocalization time (MPT): pre-op (4.69 ± 4.30) s, post-op (5.98 ± 3.24) s (p = 0.098); Jitter: pre-op (6.12 ± 6.14)%, post-op(2.39 ± 3.77)% (p = 0.090); Shimmer: pre-op (22.27 ± 11.29)%, post-op (13.02 ± 6.71)% (p = 0.048); Grade (G): pre-op (2.56 ± 0.73), post-op (1.78 ± 0.44) (p = 0.008); roughness (R): pre-op (2.44 ± 0.73), post-op (1.67 ± 0.50) (p = 0.020); breathiness (B): pre-op (2.11 ± 1.05), post-op (1.67 ± 0.50) (p = 0.102); asthenia (A): pre-op (1.33 ± 0.87), post-op (1.00 ± 0.00) (p = 0.257); and strain (S): pre-op (1.44 ± 0.88), post-op (0.56 ± 0.73) (p = 0.046).

Conclusions: The oral CO₂ laser UMA is safe, minimally invasive, and highly effective. Postoperative voice quality shows significant improvement compared to the preoperative state. Moreover, the postoperative extubation rate can reach 100%, striking a balance between improving ventilation and preserving voice function to a considerable extent.

Objective: To investigate the role of NF-κB in regulating myosin heavy chain (MyHC) content and muscle atrophy following laryngeal muscle denervation.

Methods: Rats were divided into five groups: (1) recurrent laryngeal nerve injury (RLNI), (2) RLNI with NF-κB inhibition, (3) sham operation, (4) sham operation with injection, and (5) blank control. MyHC content and muscle atrophy in the thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were assessed over 14 days post-operation.

Results: In the RLNI group, MyHC levels in TA muscle decreased progressively, with significant atrophy observed after 7 days. NF-κB inhibition delayed MyHC reduction until Day 11 and temporarily mitigated atrophy, though these effects diminished over time. In PCA muscle, MyHC levels showed a biphasic pattern, decreasing at Day 3, increasing on Days 7 and 11, and declining again by Day 14. PCA muscle atrophy progressed gradually, stabilizing by Day 11. NF-κB inhibition in PCA muscle led to delayed and less severe atrophy compared to the RLNI group, with higher MyHC levels observed on Days 3 and 7 but lower levels on Days 11 and 14.

Conclusions: Within 14 days of denervation, the extent and timing of MyHC decline and muscle atrophy differ between TA muscle and PCA muscle. PCA muscle exhibits earlier changes than TA muscle. NF-κB inhibition temporarily delays muscle atrophy and MyHC loss but cannot sustain these effects long-term.

Objective: To explore factors influencing voice outcome in patients with unilateral vocal fold paresis and paralysis (UVFP).

Methods: A total of 578 patients diagnosed with UVFP by laryngeal electromyography and follow-up were included, including 286 males and 292 females, with an average age of (43.18 ± 14.65) years (13-80 years). According to follow-up analysis, the patients were divided into a vocal improvement group (VIG) and a vocal nonimprovement group (VNG), and the differences in etiology, nerve injury type (recurrent laryngeal nerve [RLN] alone or with superior laryngeal nerve [SLN] injury) and degree (incomplete or complete RLN injury) between the two groups were compared.

Results: There were 232 patients in the VIG and 346 patients in the VNG. In the VIG, 121 patients (52.16%) had idiopathic vocal fold paresis or paralysis, with a significantly higher proportion than the VNG (41.62%, p = 0.013). Patients with tumor compression, radiotherapy, or congenital factors only presented in the VNG, and there was no significant difference in the proportion of patients with different injury sites between the two groups. There was no significant difference in proportions of RLN injury and RLN+SLN injury between the two groups (p = 0.98). In the VIG, 168 patients (72.41%) had complete RLN injury, which was lower than the VNG (79.77%, p = 0.04). The specific injury types in thyroarytenoid muscles (TA) showed no differences between the two groups. But in posterior cricoarytenoid muscles (PCA) of the VIG, the proportion of decreased recruitment pattern combined with synkinesis was significantly reduced (p < 0.01).

Conclusions: Idiopathic UVFP has a greater possibility of vocal improvement, while least possibilities were seen in those with tumor compression, radiotherapy, and congenital factors. Complete RLN injury is not conducive to vocal improvement, of which the PCA injury is more evident than TA muscle and PCA synkinesis may be a greater risk factor.

Objective: To explore the specific effects of unilateral injuries to the vagus nerve (VN), recurrent laryngeal nerve (RLN), and superior laryngeal nerve (SLN) on the vocal fold movement characteristics, and investigate the regulation pattern of current intensity on the vocal fold movement after the injuries.

Methods: Nine Beagle dogs were used to establish right-sided laryngeal nerve injury models, divided into three groups (VN, RLN, and SLN transection groups, n = 3 per group). The right (injured side) vocal folds served as the experimental group, while the left (healthy side) vocal folds acted as the control group. At 3 months postoperatively, a graded electrical current (1-4 mA, in 1 mA increments) was applied to the distal end of the injured RLN, 2 cm from the vocal fold plane, to stimulate either the healthy (left) or injured (right) RLN. Vocal fold movements were captured using high-speed laryngoscopy, and the pixel distances and velocities of adductory motions were quantified using PCC3.6 software. Independent samples t-tests were performed to compare vocal fold movements between the injured (right) and healthy (left) sides within each injury group, as well as bilateral vocal fold movements between the RLN and VN injury groups.

Results: (1) Healthy-side RLN stimulation: The amplitude and velocity of vocal fold movements on the injured side were significantly lower than those on the healthy side across all injury groups (p < 0.05). The RLN injury group exhibited higher movement parameters than the VN injury group at all current intensities, with a statistically significant difference at 1 mA (p < 0.05); (2) Injured-side RLN stimulation: Only the SLN injury group demonstrated bilateral vocal fold movements, with maximal performance observed at 4 mA; (3) Regulation pattern of current intensity: In the VN and RLN injury groups, the parameters reached their maximum at 2 mA. In the SLN injury group, the maximum parameters were delayed until 3 mA (healthy-side RLN stimulation) or 4 mA (injured-side RLN stimulation).

Conclusions: The vocal fold movement regulation pathways partially overlap between RLN and VN injuries. Residual vocal fold motion after SLN injury suggests potential cricothyroid-arytenoid mechanical coupling or neural compensation mechanisms. An electrical stimulation intensity of 2 mA is optimal for RLN/VN injuries, while 4 mA can activate compensatory pathways in SLN injuries. This study provides experimental evidence for the precise diagnosis of laryngeal nerve injuries and the optimization of electrical stimulation parameters.

Objective: The aim of this study is to compare the clinical characteristics and surgical outcomes of patients with traumatic and nontraumatic cerebrospinal fluid (CSF) rhinorrhea.

Methods: CSF rhinorrhea patients admitted between January 2007 and December 2022 were recruited and categorized into traumatic and nontraumatic groups. The clinical characteristics and surgical outcomes of the two groups were compared.

Results: A total of 94 patients with traumatic and 49 patients with nontraumatic CSF rhinorrhea were included. The prevalence of meningitis was significantly higher in traumatic CSF rhinorrhea patients (p = 0.012). Multifocal defects were more frequent in the traumatic group, while sphenoidal defects were significantly correlated with nontraumatic CSF rhinorrhea. Frontal defects were commonly identified in CSF rhinorrhea patients with meningitis than in those without, though no statistical significance was reported. Multivariate logistic regression revealed that male sex, iatrogenic traumatic CSF leak, and pneumonitis are independent factors for development of meningitis. An endoscopic approach combined with an external incision was performed in one patient and 24 patients in nontraumatic and traumatic groups, respectively (p = 0.001). Combined vascularized grafts were more commonly used in patients with traumatic CSF rhinorrhea (p < 0.05). No statistical difference in the success rate (100% vs. 97.9%) was documented between the two groups.

Conclusions: Multifocal defects and meningitis were more prevalent in traumatic CSF rhinorrhea patients, leading to increased complexity in treatment management. Iatrogenic rather than accidental traumatic CSF rhinorrhea is an independent risk factor for development of meningitis. The endoscopic combined coronal extradural approach, in conjunction with various vascularized flaps, can effectively supplement skull base reconstruction, especially for complex traumatic CSF rhinorrhea.