Laryngoscope Investigative Otolaryngology最新文献

Objectives

Subglottic stenosis (SGS) is a challenging complication post-airway interventions. Effective preventive strategies lack sufficient evidence. This study investigated the preventive effect of inhalation therapy with dexamethasone/ciprofloxacin on acute SGS in a rabbit model.

Methods

Twenty New Zealand White rabbits underwent subglottic injury via endoscopy and received inhalation therapy twice daily starting on the injury day. Group 1 (n = 4) received saline for 5 days and was sacrificed on day 5; Group 2 (n = 4) received dexamethasone/ciprofloxacin for 5 days and was sacrificed on day 5; Group 3 (n = 4) received the same therapy for 5 days and survived for one week, and was sacrificed on day 15; Group 4 (n = 4) received the therapy for 10 days and was sacrificed on day 15; Group 5 (n = 4) received the therapy for 10 days and survived for one week, and was sacrificed on day 22. Rabbits underwent repeat endoscopy and were euthanized at the designated time point. Histological measurements were analyzed statistically.

Results

Histological analysis revealed median cricoid lumen measurements of 20.01 ± 1.42 mm² for group 1, 17.94 ± 3.05 mm² for group 2, 14.84 ± 2.55 mm² for group 3, 17.18 ± 5.31 mm² for group 4, and 11.87 ± 5.68 mm² for group 5. No significant differences were found between treatment and control groups (p = 0.486) or between 5-day and 10-day treatments (p = 0.686). Multivariate statistical analysis indicated that cessation of inhalation therapy (p < 0.05) and prolonged survival (p < 0.05) were associated with shorter cricoid lumen measurements.

Conclusion

Short-term dexamethasone/ciprofloxacin inhalation does not prevent acute SGS. No improvements in cricoid lumen diameter were found. Extended survival correlated with shorter cricoid lumen, suggesting SGS progression is time dependent.

Level of Evidence

NA.

Background

Tonsillar hypertrophy is a common condition in children, and human adenoviruses (HAdVs) may contribute to its development. However, the mechanisms underlying HAdVs' persistence in tonsils remain unclear. This study investigates the role of HAdVs in tonsillar hypertrophy.

Methods

In a case–control study, oropharyngeal swabs and tonsillar tissues were collected from 50 children with and without tonsillar hypertrophy. HAdV viral load, mRNA expression, and virus shedding were considered to differentiate lytic and persistent infections.

Results

HAdV genomes were detected in 32% of hypertrophic tissues, exclusively HAdV-C, with no presence in controls. Viral loads varied, peaking in children under 5 years old, ranging from 4 × $��{10}^3�$ to 1.9 × $��{10}^6�$ copies/g, with a median of 2.6 × $��{10}^4�$ copies/g. Predominantly, infections were persistent (81%), with a smaller number of lytic or reactive cases.

Conclusion

The study supports and extends previous findings regarding HAdV-C persistence in tonsillar tissues and its potential contribution to hypertrophy, with viral loads tending to decrease with age. These findings contribute to the growing body of evidence on HAdVs' role in tonsillar hypertrophy, reinforcing the importance of persistent infections in the tonsils.

Aims

Immigrants face various challenges in the process of becoming established in a new country, one of which is language acquisition. A key factor for language acquisition is hearing function. The aim of this study was to investigate the prevalence of hearing problems in immigrants in comparison with the general population. Furthermore, this study aimed to explore the risk factors for hearing problems as well as the relationships between self-reported hearing and audiometry results among immigrants.

Methods

The study was based on prospectively collected audiometry data and questions from the Swedish National Health Survey regarding health and hearing problems in immigrants attending language classes for immigrants in Sweden.

Results

A total of 506 study participants were included, the mean age was 38 years, and the M:F ratio was 1:3. We found that 17% of the newcomers attending Swedish language education classes reported problems hearing a conversation and that more than half of the participants had hearing loss to some extent according to screening audiometry in this prospective cohort study. High-frequency hearing loss and worse perceived general health were the most important factors related to reporting hearing problems.

Conclusions

Compared to those of the general population, perceived hearing problems were 1.6 times more common among all immigrants and twice as common for immigrants above the age of 44. Audiometric screening should be offered to immigrants to detect hearing problems to facilitate language acquisition and social integration.

Level of Evidence: 1b.

Background

Bony inner ear malformations (IEMFs) account for ~20% of congenital sensorineural hearing loss, often requiring cochlear or auditory brainstem implants. To ensure safe cochlear implantation in patients with IEMFs, understanding their anatomical features, particularly related to the facial nerve (FN), is crucial.

Methods

We examined 28 TBs obtained from donors with bony IEMFs. We classified cochlear and vestibular malformations and analyzed several anatomical features, including the diameter of the internal auditory canal (IAC), the angle of the first genu, the relationship of FN with the oval window (OW), the facial recess (FR), and the overall development of the FN.

Results

Among the TBs, 5 (17.8%) were cochlear hypoplasia-type II, 20 (71.4%) were cochlear hypoplasia-type III, 2 (7.1%) were incomplete partition-type II, and 1 (3.5%) had an isolated vestibular malformation. The IAC diameter was narrow in 2 of 26 TBs (7.7%). The first genu angle was obtuse or perpendicular in 14 of 20 TBs (70.0%). The FN was abnormally located in 8 of 27 TBs (29.6%). The FR was narrow (< 2.5 mm) in 16 of 27 TBs (59.3%). Additionally, the FN was hypoplastic in 18 of 28 TBs (64.3%).

Conclusion

Our study revealed a high prevalence of FN abnormalities among patients with IEMFs. Some of these abnormalities could pose significant challenges when using the traditional FR approach for cochlear implantation. Our findings underscore the importance of thoroughly evaluating the FN course preoperatively to mitigate the risks of surgical complications.

Evidence Level

N/A.

Objective

Examine improvements in hearing and tinnitus-related quality-of-life metrics that occur after cochlear implant surgery in patients with single-sided deafness (SSD) and asymmetric hearing loss (AHL).

Methods

Adult patients undergoing cochlear implant surgery for SSD or AHL during a 2-year period at a quaternary academic medical center completed the validated survey instruments tinnitus functional index (TFI) and Speech, Spatial, and Qualities of Hearing Scale (SSQ) before surgery, and at least 3 months after cochlear implant activation. Standardized protocols for audiometric assessment were completed pre- and postoperatively.

Results

Twenty-four patients met inclusion criteria and had complete audiometric and survey data. Overall, composite TFI score improved significantly from a mean severity of 48.2 ± 9.2–18.6 ± 6.53; after cochlear implantation (q = 2.01, p < 0.001) and there was statistically significant improvement in all eight subdomains of the TFI after surgery. The SSQ composite scores significantly improved from a mean of 2.5 ± 0.30–5.07 ± 0.44 after CI (q = 2.01, p < 0.001). All three subdomains of the SSQ improved significantly after cochlear implantation though the magnitude of the changes were higher for Speech Hearing and Spatial Hearing compared with the Qualities of Hearing domain.

Conclusions

Cochlear implantation surgery in patients with SSD or AHL leads to significant overall improvements in hearing related quality of life, but particularly in the areas of speech understanding, spatial aspects of hearing, and tinnitus severity.

Level of Evidence

3

Objective

This study analyzed the clinical characteristics, treatment outcomes, and prognostic factors of sinonasal sarcomas through a single-institution experience involving 76 cases over 27 years.

Methods

A retrospective review was conducted on 76 patients diagnosed with sinonasal sarcoma at a tertiary medical center from 1995 to 2022. Data collected included demographic information, tumor characteristics, and treatment modalities. Survival outcomes were assessed using Kaplan–Meier analysis, and prognostic factors were identified through univariate and multivariate Cox proportional hazards models.

Results

The cohort included 45 males and 31 females, with a mean age of 42.6 years. The most common presenting symptom was nasal obstruction (22%). Rhabdomyosarcoma was the most prevalent subtype, accounting for 27.6% of cases. The 5- and 10-year overall survival (OS) rates were 62% and 56%, while the disease-free survival (DFS) rates were 51% and 41%. Survival outcomes were significantly worse in patients aged ≥ 61 years (p = 0.030), with a smoking history (p = 0.005), or with neurovascular extension (p = 0.015). In the univariate analysis, smoking history increased the mortality risk by 2.95-fold (p = 0.008) and neurovascular involvement by 2.87-fold (p = 0.020). Multivariate Cox analysis confirmed smoking history as an independent predictor of mortality (HR = 2.38, 95% CI: 1.05–5.40, p = 0.038).

Conclusions

The results showed that advanced age, smoking history, and neurovascular involvement were key contributors to reduced survival, with identified as a significant independent predictors of higher mortality risk. These findings offer critical insight into the therapeutic management of this rare malignancy.

Level of Evidence

4

Objective

Speech matrix tests offer information about a person's capacity to comprehend speech in noisy environments, which is an essential component of everyday communication, in contrast to pure tone audiometry, which primarily assesses hearing sensitivity. This study aimed to assess the test–retest reliability of the Arabic Speech Matrix test.

Methods

This is a prospective cohort study that included three groups: normal hearing individuals, cochlear implant users, and those using hearing aids. Seventy-five participants were included in the study. The test was administered in two different settings with noise presented from various angles. The test was re-administered to participants after a 7–14 days interval, and Intra-class Correlation Coefficient (ICC) and Bland–Altman plots were used to evaluate reliability.

Results

Moderate to excellent reliability was demonstrated, with higher consistency observed among hearing-impaired groups using cochlear implants and other devices. Minor learning effects were noted in the normal hearing group, with better reliability observed in the left setting.

Conclusion

The Arabic Speech Matrix test demonstrated strong test–retest reliability overall, indicating that it can be successfully incorporated into regular clinical audiological evaluations.

Level of Evidence

4

Introduction

It is unknown whether the publication productivity of facial plastic and reconstructive surgery (FPRS) fellowship applicants before fellowship can be a predictor of pursuing academics in the future. The objective of this study was to assess whether the publication productivity of a cohort of FPRS fellowship applicants was associated with their eventual career path of academic versus non-academic practice.

Methods

This was a retrospective analysis of a cohort of FPRS fellowship applicants who applied to a single institution from 2012 to 2016. Their submitted publication records at the time of the application process, and their current career positions were queried.

Results

Thirty-four (27%) of the 125 fellowship applicants are currently in academic positions with no difference in genders (p = 0.66). Academic FPRS clinicians had a significantly higher number of total publications (6.3 ± 5.1 vs. 4.4 ± 3.9, p = 0.03), first author publications (3.4 ± 3.2 vs. 2.1 ± 2.5, p = 0.01), and publications in otolaryngology or plastic/aesthetic surgery journals (4.5 ± 3.9 vs. 3.1 ± 3.3, p = 0.03). There was no difference in the number of plastics, aesthetic, or trauma-specific publications (p = 0.44).

Conclusion

The number of publications and publications in otolaryngology or plastic/aesthetic surgery journals, but not necessarily articles with specific plastic/aesthetic/trauma topics, may be a predictor of pursuing academia for FPRS fellowship applicants.

Level of Evidence

4.

Objective

To investigate the clinical characteristics and prognostic factors influencing treatment outcomes in pediatric sudden sensorineural hearing loss (PSSNHL).

Methods

A retrospective analysis was conducted on 63 children (64 ears) diagnosed with PSSNHL from January 2013 to December 2023. All patients received either systemic or intra-tympanic steroid therapy. Data on age, tinnitus presence, audiogram types, and initial hearing thresholds were analyzed using SPSS 25.0. Univariate and multivariate logistic regressions were performed to identify significant prognostic factors.

Results

The mean age was 16 years (interquartile range:14–17 years). Median time from symptom onset to treatment was 7 days (interquartile range: 4–13 days). Tinnitus was present in 85.7% of cases. Post-treatment hearing thresholds improved from 84.52 ± 3.29 dB HL to 64.17 ± 4.48 dB HL (p < 0.001). The overall therapeutic efficacy rate was 48.4%. Multivariate analysis identified time from onset to treatment (OR = 0.923; 95% CI: 0.789–0.997; p < 0.01) and initial hearing threshold (OR = 0.939; 95% CI: 0.869–0.981; p < 0.05) as independent prognostic factors.

Conclusions

Early intervention and lower initial hearing thresholds are associated with a better prognosis in PSSNHL. Prompt treatment significantly improves outcomes, highlighting the importance of early diagnosis and intervention.

Level of Evidence

Level 4.

Objectives

This systematic review and meta-analysis investigated the role of elective neck dissection (END) in the salvage management of clinically N0 necks.

Data Sources

PubMed/Medline, Google Scholar, and the Cochrane Library were systematically searched for relevant studies.

Methods

Both electronic and manual search strategies were conducted within the abovementioned databases and included articles and reviews to find the relevant studies. Rates of occult nodal metastasis, survival outcomes, and postoperative complications were analyzed in N0 patients undergoing salvage laryngectomy with END. Fixed and random effects models were used to calculate pooled estimates of overall survival metastasis rates with 95% confidence intervals, and heterogeneity was assessed using tau², I², and Cochran's Q test. Statistical analyses were performed in R software with p < 0.05 as significant.

Results

The included eight studies reported occult metastasis rates ranging from 4% to 10% in clinically N0 necks post-radiotherapy. Overall survival was approximately 52%, with mixed evidence on the survival advantage of END. Disease-free survival and recurrence-free survival rates ranged from 71.7% to 95.5% at 5 years. Complication rates associated with END were high, with up to 47.4% of patients experiencing postoperative morbidity. The metastasis rate was 10%–13% highlighting the ability of END to detect occult metastases.

Conclusion

The survival benefits of END are not consistently supported by current evidence, while the significant morbidity associated with the procedure raises concerns about its routine use. A conservative approach may be more appropriate for clinically node-negative patients, particularly when weighed against the elevated risks of complications. END demonstrates moderate overall survival rates and an ability to detect occult metastases, but its role in improving long-term outcomes remains unclear. Larger prospective studies and randomized trials are needed to better define the indications and outcomes of END in the salvage management of clinically N0 necks.