Laryngoscope Investigative Otolaryngology最新文献

Objectives

To achieve glottal gap closure in unilateral vocal fold paralysis (UVFP) through complementary ansa cervicalis nerve muscle pedicle laryngeal reinnervation (ANMP-LR).

Introduction

ANMP-LR is easy to learn and does not require recurrent laryngeal nerve (RLN) transection.

Materials and Methods

Twelve patients with unilateral vocal fold paralysis (UVFP) were included, who received ANMP-LR and could be followed up for at least 6–24 months. At baseline, after 3–6 (T1), 12 (T2) and 24 months (T3), Voice Handicap Index (VHI), perceived roughness (R) and breathiness (B), sound pressure level (SPLmax), maximum phonation time (MPT), Dysphonia Severity Index (DSI) and glottal gap (GG) were recorded.

Results

R and B were significantly reduced at T1, MPT and SPLmax increased significantly up to T1 (MPT to 15.8 s; SPLmax to 91.5 dB). Similarly, VHI dropped significantly and the residual glottal gap (GG) was significantly reduced between T0 and T1. All outcomes remained stable until T3. There was a non-significant tendency to further improvement until T3 in SPLmax and GG.

Discussion

The T1–T3 outcomes of the complementary ANMP-LR are comparable with the standard LR and also with thyroplasty. As with all LR techniques, younger patients and those with shorter paralysis benefit more. Patients with evidence of unfavorable laryngeal synkinesis are more likely to benefit from a standard LR with RLN transection.

Conclusions

Younger patients with insufficient synkinetic reinnervation and persisting or progressive glottis closure insufficiency in UVFP benefit from early reinnervation. When the easy-to-learn ANMP technique is used, any partial rehabilitation that has already been achieved or any remaining chance of spontaneous reinnervation via the RLN is not compromised.

Level of Evidence: 3

Objective

The objective of this study is to determine the impact of an intensive and a less intensive speech therapy regimen on pediatric sialorrhea patient and caregiver quality of life (QoL) as described by drooling impact scales (DIS).

Methods

A retrospective chart review included all pediatric patients from a secretion management clinic. There were two outpatient speech therapy programs: intensive (4 sessions/week for 3 weeks) and less intensive (2 sessions/week for 3 months). Both regimens included similar interventions including neuromuscular electrical stimulation and facial taping. The primary outcome measure was reduction in caregiver reported DIS after completing their designated program. Children observed without therapy also obtained DIS assessments overtime to measure potential changes in QoL.

Results

There were 49 patients included in the study with a mean age of 7.5 years (SD = 4.6). The most common comorbidities were global developmental delay (n = 47; 96%), epilepsy (n = 35; 71%), and cerebral palsy (n = 32; 65%). After initial evaluation, 30 patients underwent speech therapy with significantly improved DIS scores compared to the 19 who had no therapy (43.4 vs. 54.5, p = 0.03). Of these 30, 16 (33%) underwent intensive therapy with mean DIS improving from 63.5 to 47.2 (p = 0.006). Fourteen (29%) completed the less intensive regimen with mean DIS improving from 51.9 to 39.1 (p = 0.07). There were 19 (39%) patients who underwent no therapy and mean DIS remained unchanged from 55.6 to 54.5 (p = 0.86).

Conclusion

Sialorrhea can drastically impact patients and their families. An intensive speech therapy program is associated with improved QoL as described by the DIS. Speech therapy should be considered as an effective treatment modality to improve outcomes for pediatric sialorrhea.

Level of Evidence

2.

Objective

Health policies affect clinical practice and outcomes, serving as an impetus for civic engagement. Voting participation among Otolaryngology–Head and Neck Surgery (OHNS) trainees is poorly characterized and may be afflicted by distinct barriers specific to training. This is the first study to evaluate voter participation among OHNS trainees.

Methods

We analyzed survey data from the 2020 American Academy of Otolaryngology Section for Residents and Fellows (AAO SRF), capturing voting practices among trainees as well as attitudes to promoting electoral participation among programs. Wilcoxon rank-sum test was used to assess statistical differences by voting practices.

Results

20.9% of 277 respondents experienced decreased electoral participation since starting residency. These rates did not vary significantly by trainees' subjective views on the importance of voting (p = 0.69, 95% CI = [−184, 23]). While 84.6% (226 out of 267) of eligible trainees voted in the 2016 election, eligible nonvoters most frequently cited reasons such as lack of time and perceived lack of impact. Additionally, the greatest proportion of trainees voted on election day (42.6%), followed by mail-in/absentee ballot (24.2%), and finally by early voting (14.8%). Trainees reported a wide range of attendings (71.5% responded ≤ 2 attendings) who explicitly advocated for trainee voting participation. Greater attending support was concordant with trainees' overall voting (p = 0.057, 95% CI = [−6, 84]) and voting in the 2016 election (p = 0.042, 95%. CI = [−95, 0]). Even if excused from clinical duties, 10.5% of respondents stated they would not leave work to vote due to guilt of being away from clinical duties, and 27.8% of respondents would do so reluctantly. These different practices among trainees did not significantly vary with overall voting participation (p = 0.20, 95% CI = [−8, 124]) or 2016 electoral participation (p = 0.20, 95% CI = [−136, 1]).

Conclusion

Voting participation among OHNS trainees is higher than the national average of adults but slightly lower than other medical specialties. Training program culture can mitigate barriers to electoral participation.

Level of Evidence

NA.

Objective

To prevent and reduce the incidence of tinnitus and to relieve the suffering of those with existing tinnitus.

Study Design

A study was conducted using a questionnaire.

Setting

Large number of patients come to ENT because tinnitus is seriously affecting their lives, and we found that these patients have some common factors that influence the development of this condition.

Method

This study was reviewed by the Medical Ethics Committee of the Hospital of Chengdu University of Traditional Chinese Medicine, Grant No. 2022KL-075. The investigation was conducted on patients with tinnitus as the main complaint who visited the Hospital of Chengdu University of Traditional Chinese Medicine from September 2020 to September 2023, to obtain basic information, tinnitus related information, Tinnitus Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI), and Self-rating Anxiety Scale (SAS) of the patients. And conduct correlation analysis and multivariate logistic regression analysis on the severity with age, sex, PSQI, SAS of tinnitus patients.

Result

A total of 1739 patients participated in the survey, with the majority being females, with an average age of 46.21 ± 16.08 years old. Majority of patients had tinnitus in both ears. The severity is related to sex, anxiety, and sleep of tinnitus patients (p = 0.000). Age (OR = 0.978, 95% CI: 0.971~0.985), sleep quality (OR = 1.229, 95% CI: 1.179~1.279), and anxiety (OR = 1.065, 95% CI: 1.040~1.090) are factors that affect the severity of tinnitus patients.

Conclusion

Age, anxiety, and sleep status are the main risk factors for the severity of tinnitus patients.

Objective

Ultrasound (US) is a well-established imaging modality for the evaluation of head and neck anatomy. The Butterfly iQ is a handheld ultrasound device that uses a semiconductor silicon chip array (capacitive micromachined ultrasound transducers, CMUT) instead of piezoelectric crystals used by traditional ultrasounds (TUS), but its accuracy has not been investigated with respect to salivary gland imaging and associated transcutaneous procedures. We aimed to perform a pilot cadaver study to determine the utility and fidelity of the CMUT-US for parotid and submandibular gland imaging and guiding transcutaneous gland injection.

Methods

One otolaryngologist injected 0.5 mL of dye into three distinct salivary gland sites (two intraparotid sites and one submandibular gland site) bilaterally on 20 cadavers (n = 120 glands), using either CMUT-US or TUS to guide injection. The cadavers were dissected to identify whether the dye was accurately injected into each site.

Results

The accuracies of CMUT-US and TUS-guided injections in the parotid gland were 95.0% (n = 40) and 90.0% (n = 40), respectively (p = 0.69). In the submandibular gland, the accuracies for the CMUT-US (n = 20) and TUS (n = 20) were both 75.0% (p = 0.72). Across all salivary gland sites, injection accuracy was 88.3% (n = 60) using TUS versus 85.0% (n = 60) using CMUT-US (p = 0.79). No significant differences between modalities were seen in the accuracy of injection based on injection subsite, laterality, cadaver sex, or age.

Conclusion

This pilot study demonstrates that CMUT-US-guided salivary gland injection offers similar high accuracy and reproducibility to TUS-guided injection.

Level of Evidence

V.

Objective(s)

We aim to identify the diversity of barriers to care for otolaryngology-head and neck surgery patients in Harare, Zimbabwe.

Methods

Interviews were conducted at four general otolaryngology clinics in Harare in October 2022.

The patient population included children and adults presenting to either government or private clinics. Via interpreter, six standardized questions were discussed with each patient. Survey responses were used to categorize patients into one or more of three types of delays: (1) deciding to seek care, (2) reaching the appropriate healthcare facility, and (3) receiving adequate care after reaching that facility.

Results

Forty-six patients participated in this survey. The average time from problem presentation to treatment in this population was 16.3 months. Twenty-six percent of patients experienced more than one type of delay. The most common type of delay was Type 3 (67%). Many of these patients reached appropriate facilities but could not receive timely treatment due to lengthy wait times. Type 1 delays affected 35% of patients. Notable causes were fear of doctors, preference for traditional healing, or ignorance to a treatable problem. Type 2 delays were also reported in 37%, commonly due to long distance and time to travel and insufficient finances for these journeys.

Conclusions

ENT patients in Zimbabwe experience a myriad of delays to receiving appropriate care. Systemic issues, including backlogged surgical lists, convoluted referral patterns, and poor transportation infrastructure, are significant contributors to patient delays. The 3-delay model is useful for identifying barriers to care for future efforts to improve patient access to safe and affordable surgical care.

Level of Evidence

Level VI.

Objective

The ease of access of online videos and the popularity of visual learning have made YouTube a popular educational resource. We analyzed the utility of YouTube videos for graduate medical education about free flap surgery using a cross-sectional study design.

Methods

Using the phrases “free flap surgery” and “free flap head and neck,” YouTube videos for inclusion were identified. Videos were analyzed by free flap surgeons using Modified DISCERN, Global Quality Score (GQS), and JAMA Benchmark metrics of video quality, educational value, and transparency, respectively. Statistical analysis of video metadata and expert-determined scores was performed.

Results

In total, 44 videos with 517,227 combined views were analyzed. Most videos were intra-operative (63.6%), published by physicians (34.1%) or medical institutions (22.7%), and had health professional target audiences (95.5%). The mean Modified DISCERN score was 15.4/25, with most videos classified as “fair” (54.6%). The mean GQS was 4.17/5 and the mean JAMA Benchmark was 2.7/4. Higher Modified DISCERN scores were significantly associated with health professional target audiences (p = 0.04) and webinars (p = 0.03). Higher GQS was also significantly associated with a health professional target audience (p < 0.01), and higher JAMA scores with YouTube verification (p = 0.04).

Conclusion

Routine YouTube searches may not yield results ideal for resident education in head and neck free flap surgery. While many videos are of good educational value, lower transparency and reliability scores raise concerns of biased information. It is important to consider vetted educational or health care sources for resident surgical education.

Level of Evidence

Level IV (cross-sectional study).

Objective

Availability of surgical equipment and access to essential clinical services remains an important barrier to surgical care delivery, particularly in low- and middle-income countries (LMICs). This study aims to characterize the relative availability of essential equipment for otolaryngology-head and neck surgery (OHNS) care across World Bank income groups.

Methods

We conducted a cross-sectional survey on otolaryngologists' perceptions on the availability of surgical equipment and ancillary services in their respective practice settings per a 5-point Likert scale ranging from never to always available. The study was disseminated online via professional societies, personal contacts, and social media. Eligible participants included otolaryngologists from 194 WHO-recognized countries, which were grouped by World Bank income group classification and WHO region.

Results

The study involved 146 otolaryngologists, 69 (47%) from high-income countries (HICs), and 77 (53%) from LMICs. LMIC respondents were predominantly from the African and South-East Asian regions, which comprised 48% and 7.8% of all LMIC respondents, respectively. Results revealed significant differences in the availability of otologic, rhinologic, and endoscopic airway equipment between HICs and LMICs. Differences existed among commonly used equipment such as tympanomastoidectomy equipment and rigid bronchoscopy, to subspecialized equipment such as functional endoscopic sinus surgery equipment and cochlear implants (p < 0.05 each).

Conclusions

The study highlighted key disparities in the availability of essential equipment for baseline OHNS care, especially for pediatric airway and otologic conditions. These results can be used to guide investment and advocacy efforts to improve specialty-specific surgical infrastructure relative to the global burden of OHNS diseases in low-resource settings.

Level of Evidence

3

Introduction

This study evaluates the readability of online patient education materials (OPEMs) across otolaryngology subspecialties, hospital characteristics, and national otolaryngology organizations, while assessing AI alternatives.

Methods

Hospitals from the US News Best ENT list were queried for OPEMs describing a chosen surgery per subspecialty; the American Academy of Otolaryngology—Head and Neck Surgery (AAO), American Laryngological Association (ALA), Ear, Nose, and Throat United Kingdom (ENTUK), and the Canadian Society of Otolaryngology—Head and Neck Surgery (CSOHNS) were similarly queried. Google was queried for the top 10 links from hospitals per procedure. Ownership (private/public), presence of respective otolaryngology fellowships, region, and median household income (zip code) were collected. Readability was assessed using seven indices and averaged: Automated Readability Index (ARI), Flesch Reading Ease Score (FRES), Flesch–Kincaid Grade Level (FKGL), Gunning Fog Readability (GFR), Simple Measure of Gobbledygook (SMOG), Coleman–Liau Readability Index (CLRI), and Linsear Write Readability Formula (LWRF). AI-generated materials from ChatGPT were compared for readability, accuracy, content, and tone. Analyses were conducted between subspecialties, against national organizations, NIH standard, and across demographic variables.

Results

Across 144 hospitals, OPEMs exceeded NIH readability standards, averaging at an 8th–12th grade level across subspecialties. In rhinology, facial plastics, and sleep medicine, hospital OPEMs had higher readability scores than ENTUK's materials (11.4 vs. 9.1, 10.4 vs. 7.2, 11.5 vs. 9.2, respectively; all p < 0.05), but lower than AAO (p = 0.005). ChatGPT-generated materials averaged a 6.8-grade level, demonstrating improved readability, especially with specialized prompting, compared to all hospital and organization OPEMs.

Conclusion

OPEMs from all sources exceed the NIH readability standard. ENTUK serves as a benchmark for accessible language, while ChatGPT demonstrates the feasibility of producing more readable content. Otolaryngologists might consider using ChatGPT to generate patient-friendly materials, with caution, and advocate for national-level improvements in patient education readability.