World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

Objectives: The use of endoscopic approaches has revolutionized the management of frontal sinus (FS) lesions. However, external approaches still play a significant role in select conditions. Various factors determine the decision to utilize endoscopic or external approaches such as the lesion location, extension, and patient's characteristics. The study aims to define certain FS indices for accurate selection of the most suitable approach for each patient.

Methods: A descriptive study was performed, based on endoscopic and external cadaveric dissections. Quantitative analyses including horizontal, anteroposterior diameters, and exposure area were performed for each approach using the navigation system. Patients with various FS lesions were included and their data were collected and evaluated.

Results: Fifteen cadavers were analyzed. The average anteroposterior diameter on the midsagittal plane was 12.3 mm, distance from the midline to the lateralmost point was 21.8 mm on the right and 23.1 mm on the left side. The exposure area on the right side for Draf Ⅱa, and Draf Ⅱb were 64.6, 115.0 mm² while on the left side were 67.0, 125.0 mm². For Draf Ⅲ, the exposure area was 377.0 mm². A total of 41 patients were included in the clinical correlation.

Conclusions: FS with a narrow anteroposterior diameter and longer horizontal diameter are difficult to access endoscopically, especially for lesions affecting the lateral recess of the sinus, and may require a combination with an external approach. FS approaches can be selected according to the sinus morphology of each patient, the surgeon's preferences, institutional resources, and the lesion's nature and extension.

Objectives: Balloon sinuplasty (BSP) and functional endoscopic sinus surgery (FESS) have undergone changes in utilization over time. This study investigates national trends in BSP and FESS and postoperative outcomes over the last decade as well as the impact of Corona Virus Disease 2019 (COVID-19) on these trends.

Methods: The TriNetX database was queried for patients undergoing either FESS or BSP from 1/1/2011 to 5/4/2024. Data were collected on patient demographics, diagnoses, and postoperative outcomes.

Results: A total of 1738 patients underwent BSP and 90,311 underwent FESS. A greater proportion of FESS patients had diabetes (p = 0.001), hypertension (p < 0.001), and chronic pulmonary disease, p = 0.001) compared to BSP whereas a similar proportion of patients for both cohorts had a history of ischemic heart disease (p = 0.73). Body mass index was higher for patients undergoing FESS (28.6 ± 6.5) compared to BSP (28.1 ± 6.578; p = 0.02). Overall postoperative complications were similar between BSP and FESS (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.58-1.09) with similar rates of epistaxis (OR = 0.77, 95% CI = 0.53-1.12) and cerebrospinal fluid (CSF) leak (OR = 0.14, 95% CI = 0.01-2.25). Overall revision rate was higher for FESS (OR = 0.34, 95% CI = 0.21-0.57). Thirty-day readmission (OR = 0.44, 95% CI = 0.29-0.66) and Emergency Department visits (OR = 0.51, 95% CI = 0.28-0.92) were less common in patients who received BSP. Surgical volume consistently increased over time for both cohorts but at a more rapid pace for BSP (425.64%) compared to FESS (274.19%) and a dramatic decrease in volume by 44.85% and 22.28%, respectively, at the onset of COVID-19.

Conclusion: Overall, BSP and FESS surgical volume have steadily increased over time with a drastic reduction following the COVID-19 pandemic. BSP and FESS carry different complication profiles emphasizing the importance of patient selection and preoperative counseling.

Level of evidence: Level 4.

Background: Academic productivity is believed to be correlated with years of experience and departmental rank, yet there is a paucity of granular academic data between rhinology faculty regarding departmental rank and industry engagement, and how these relate to experience.

Objective: To examine the interrelationships between experience, department rank and reputation, funding, industry engagement, and academic output of rhinology faculty.

Methods: Demographics, academic metrics (publications, citations, h-index, National Institutes of Health [NIH] funding), program rankings, and industry compensation for academic U.S. rhinologists through June 2022 were collected and compared between academic rank and years of experience.

Results: A cohort of 278 rhinologists were included. Full professors had greater academic metrics (all p < 0.001) and industry compensation (all p < 0.05) than associate professors, assistant professors, and private practice rhinologists. Full professors were also more likely to receive NIH funding than other groups (p < 0.001). Years of experience and industry compensation positively correlated with each other and with academic metrics (all p < 0.001) with significant jumps between the 5th-9th and 10th-14th years of practice (p < 0.001). However, early career (≤8 years) rhinologists published more articles per year than later career (>8 years) rhinologists (p < 0.001). Rhinologists at Doximity top 10 and 25 residency programs by reputation and research output and top 50 U.S. News and World Report departments had significantly greater academic metrics and NIH funding compared to those who were not (p < 0.001). Top 10 and 25 reputations was associated with increased industry compensation (p = 0.024).

Conclusions: Although early career rhinologists published more frequently, ascending professorial rank, years of experience, and affiliation with top-ranked departments were associated with total academic productivity. Industry engagement was linked to reputation and years of experience.

Inverted papillomas (IP) are rare sinonasal tumors (Schneiderian papillomas) characterized by local invasion, with high recurrence rates and potential for malignant transformation into squamous cell carcinoma (SCC ex-IP). Traditionally, the mainstay of treatment has been surgical resection, often challenging due to invasion of the skull base or vital neurovascular structures. In advanced cases, prognosis is poorer and radiation therapy is the current standard of care with limited role of systemic therapy. We present a case of unresectable SCC ex-IP treated with sequential chemoradiation and PD-1 immunotherapy (pembrolizumab) and achieving complete response at 1 year. This case suggests that immunotherapy can effectively treat SCC ex-IP and we propose that programmed death ligand-1 (PD-L1) testing should be performed in all advanced cases. Prospective studies are needed to validate immunotherapy in adjuvant or frontline treatments for advanced SCC ex-IP, and the role of PD-L1 as a predictive biomarker.

Objectives: With an estimated disease burden of one billion adults aged 30-69, obstructive sleep apnea (OSA) offers considerable challenges in terms of both identification and management Neuroelectric stimulation offers benefit with studies showing improvement in both the respiratory disturbance index and apnoea-hypopnoea index. This systematic review aims to examine the effects of non-invasive neuroelectric stimulation of the oral cavity utilized in the treatment of OSA.

Methods: A systematic search of PubMed, EBSCO CINAHL Plus, EBSCO Dentistry and Oral Sciences Source and Wiley Cochrane Library was utilized to identify articles. A total of 4 articles investigating 154 participants were included in the final synthesis. Data was extracted to by two authors (MOA and HI) working independently of each other. Any discrepancies that arose were discussed and resolved.

Results: Our results demonstrated that non-invasive neurostimulation serves as an avenue for management that can allow for improvements in functionality as well as oxygen saturation amongst patients suffering from mild to moderate OSA.

Conclusion: Due to the dearth of research, it is imperative that further studies are done to investigate the efficacy of neuromuscular stimulation, as these findings cannot be generalized across different populations.

Objectives: To compare the effectiveness of vacuum-assisted closure (VAC) against traditional drainage technique, using a retrospective case-control study design, in terms of managing deep neck infections (DNIs).

Methods: Patients presenting to Peking Union Medical College Hospital diagnosed with DNIs were recruited in this study. We analyzed the clinical characteristics of DNI patients and divided them into (a) VAC placement group (26 cases) and (b) traditional drainage group (57 cases) according to whether VAC was placed. The differences in length of stay (LOS), wound healing time, and debridement frequency were compared between the two groups.

Results: Eighty-three patients had multiple-space infections, i.e. infection at two or more sites. The debridement frequency of the VAC group was significantly lower than that of the traditional drainage group (p = 0.001). The wound healing time of the traditional drainage group and VAC group was 38 days (a range of 13-98 days) and 40 days (a range of 11-106 days), respectively; the average LOS was 15 days (a range of 2-68 days) and 16 days (a range of 4-35 days), respectively; and the debridement frequencies were one time (a range of 0-3 times) and zero times (a range of 0-2 times), respectively. The two groups did not differ significantly in wound healing time and hospitalization duration (p = 0.319 and 0.937).

Conclusions: VAC treatment of DNIs has significant advantages in reducing the frequency of debridement and patient suffering, but it does not show significant advantages in wound healing. Randomized trials are still needed to demonstrate its efficacy.

Introduction: Perioperative myocardial injury (PMI) is associated with increased mortality. We describe risk factors for and outcomes of PMI in patients undergoing tracheotomy.

Methods: Retrospective study of patients undergoing tracheotomy from 2007 to 2016. PMI was defined by a postoperative cardiac troponin I (cTnI) > 99th percentile. Demographics and comorbidities were extracted from the electronic medical record and compared between patients with and without PMI. Significant univariate predictors were included in a multivariable logistic regression model to determine independent predictors of PMI. Thirty-day and 1-year mortality of patients with and without PMI were compared.

Results: Of 861 patients undergoing tracheotomy, 41 (4.76%) had PMI and 820 (95.24%) did not. PMI was associated with higher mortality at both 30 days (40.5% vs. 11.2%, p < 0.001) and 1 year (73.2% vs. 44.1%, p < 0.001). Patients with PMI were older (median age 65 vs. 60, p = 0.002) and more likely to have prior myocardial infarction (MI) (36.6% vs. 10.7%, p < 0.001) and chronic kidney disease (31.7% vs. 16.7%, p = 0.024). Cancer diagnosis was associated with a lower risk of PMI (24.4% vs. 41.8%, p = 0.041). Older age (odds ratio [OR] = 1.033, p < 0.001) and prior MI (OR = 3.686, p < 0.001) were independently associated with PMI.

Conclusion: Patients with PMI following tracheotomy had increased short- and long-term mortality. Increased age and history of prior MI were independent predictors of PMI, while cancer was associated with a lower risk of PMI following tracheotomy. ICU patients likely have more acute ailments contributing to a higher risk of PMI and poorer outcomes compared to cancer patients requiring tracheotomy. We propose routine screening for PMI with cTnI in the postoperative period in all tracheotomy patients.

Objectives: Sinonasal inverted papilloma (IP) is a rare and benign tumor that affects the nose and sinuses. This tumor has a recurring nature and can be associated with malignancy or transform into a malignant lesion. Various factors have been proposed as potential recurrent and malignancy risk factors in sinonasal IP. This study examines some of these factors and the relationship between tumor location and recurrence and malignancy.

Methods: A retrospective analysis was conducted on patients diagnosed with IP for 10 years or more, assessing the patients' demographic statistics and intraoperative observations. Additionally, CT scan results of the patients were investigated.

Results: Finally, 207 patients with an average age of (52.0 ± 13.8) years were included in the study. A hundred and fifty-five (74.9%) of patients were male and the most substance abuse was tobacco (72, 34.8%). Fifty-five (26.6%) patients had a recurrence and 21 (10.2%) patients showed malignancy or dysplastic changes. The most common site of the tumor was the maxillary sinus (131, 63.3%).

Conclusions: Long-term follow-up of IP patients is necessary due to the risk of recurrence and malignancy. The probability of recurrence was higher in cases where the tumor involved the frontal sinus or multisite attachment. Therefore, for accurate diagnosis of this tumor and complete resection of the lesion, especially in cases where achieving a free margin may be challenging, the intraoperative frozen section seems necessary.

Objectives: Observational studies imply that noise may increase the likelihood of developing tinnitus. However, no causal relationship has been established between the two using Mendelian randomization (MR) analysis, we aimed to determine the potential causal relationship between noise and various categories of tinnitus.

Methods: We extracted single nucleotide polymorphisms (SNPs) associated with noise and tinnitus from a large genome-wide association study (GWAS) of European individuals. UK Biobank (UKB) provided summary data for both entities. Inverse variance weighting (IVW) was implemented as the primary method for evaluating effect estimates. Using Weighted median and MR-Egger regression, heterogeneity and pleiotropy were evaluated using sensitivity analyses.

Results: The random-effects IVW approach revealed a causal relationship between noise and the three onset tinnitus (odds ratio [OR] = 1.052, 95% confidence interval [CI] = 1.013-1.092, p = 0.008; OR = 1.248, 95% CI = 1.177-1.323, p = 0.001; OR = 1.133, 95% CI = 1.058-1.213, p = 0.001). Noise was not a risk factor for tinnitus in the past (OR = 0.999, 95% CI = 0.934-1.068, p = 0.969). Validation with various Mendelian randomization methodologies and sensitivity analyses confirmed the findings' consistency.

Conclusion: This Mendelian Randomization study provides causal evidence that noise is a risk factor for the onset of tinnitus but is not a risk factor for developing tinnitus in the past.

Objectives: Children with a difficult airway are prone to severe complications in unplanned intubation events. The otolaryngologist is often required to secure the airway using advanced techniques once the traditional methods have failed to establish safe tracheal intubation. The goal of our study was to describe the otolaryngologist's experience in the management of bedside difficult pediatric airway events.

Methods: A case series with chart review of children intubated by the difficult airway response (RaDAR) team in an academic tertiary-care children's hospital. The electronic medical charts of patients intubated by the RaDAR team between Jan 2020 and Dec 2021 were reviewed. The steps taken to recognize and signal patients with a difficult airway are described.

Results: Of the 78 airway code events managed by the RaDAR team, 28 (37.2%) were intubated by an otolaryngologist. Of these, 20 (71.4%) were recognized and signaled as a "difficult airway" before emergent intubation. The methods to secure the airway were direct laryngoscopy (n = 7), flexible bronchoscopy with/without a laryngeal mask (n = 10), rigid bronchoscopy (n = 8), and video laryngoscopy (n = 1). On average, there were 1.93 attempts to secure the airway following RaDAR activation. The airway was secured by an otolaryngology trainee in 24/28 patients. None of the patients required bedside tracheostomy.

Conclusions: Otolaryngologists have unique skills and instruments that may assist with the management of a child with a difficult airway. Close collaboration with anesthesia colleagues, proper training, and proactive recognition and signaling of patients at risk for difficult airway are key factors for safe airway securement.