Laryngoscope Investigative Otolaryngology最新文献

Introduction: A non-invasive test to accurately diagnose and quantify vocal fold (VF) scarring from other confounding pathologies would be advantageous to reduce the need for operative diagnostic laryngoscopy. Dynamic optical contrast imaging (DOCI) technology uses tissue autofluorescence to obtain real-time information of tissue composition. In this study, we describe a novel application of DOCI to identify scar tissue formation in rabbit VFs.

Methods: Rabbits underwent endoscopic unilateral VF cordectomy to induce scar formation. After 2 months, VFs were excised and a bench-top DOCI (UCLA) system was employed to capture images from sections. Results were verified with histologic staining for scar tissue.

Results: The DOCI system was capable of distinguishing healthy VF from contralateral scarred VF with discriminating power at the 405 low-pass filter (LPF), 440, 460-532, and 560-580 nm wavelengths (p < 0.05). All DOCI images of healthy and scarred VF sections correlated with histological assessment.

Conclusion: Our study demonstrated that DOCI technology can discriminate between normal and scarred VFs noninvasively and in real time with similar accuracy to that of histological analysis. This work lays the foundation for the development of a DOCI-based endoscope for diagnosis and quantification of VF scar formation as well as a tool to measure treatment response.

Objective: To evaluate how the Nordic Musculoskeletal Questionnaire (NMQ) is modified in studies of surgeons and to identify additional variables associated with musculoskeletal (MSK) injury, with the goal of informing a more standardized survey tool.

Data sources: Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection databases were searched for relevant studies published from 2000 to 2023.

Review methods: A systematic review was conducted following PRISMA guidelines. Studies were included if they utilized a modified NMQ to assess MSK symptoms among surgeons or proceduralists. Randomized controlled trials and systematic reviews were excluded. Three reviewers independently screened articles using Rayyan. Data were extracted on questionnaire content, demographics, lifestyle factors, and occupational variables.

Results: Of 1822 studies screened, 26 met the inclusion criteria. All assessed neck pain using a modified NMQ; other regions were inconsistently included. Frequently assessed supplemental factors included exercise habits, impact of pain on daily life, length of practice, specialty, and work hours. Common demographic variables were gender, age, and training level. Lifestyle factors such as sleep and substance use were rarely assessed. Studies using modified NMQs were more likely to include detailed anatomical and behavioral data.

Conclusion: The use of inconsistent modifications to the NMQ limits comparability across studies. A standardized survey incorporating key ergonomic, occupational, and lifestyle elements could improve the study of MSK pain in surgeons and inform targeted interventions.

Level of evidence: 4.

Objectives: To assess the clinical practicality, procedural characteristics, and short-term recovery outcomes of single-port transoral robotic surgery (SP TORS) for diverse head and neck pathologies, including malignancies, benign tumors, and obstructive sleep apnea, in a regional hospital setting in Taiwan.

Methods: A prospective case series was conducted at a regional teaching hospital from May to July 2025. Twelve patients underwent SP TORS utilizing the da Vinci SP system. Indications spanned oncologic, nononcologic, and functional conditions. Detailed perioperative data were collected, including exposure management, docking and console durations, blood loss, and complication profiles. Postoperative recovery trajectories, such as ICU admission, nasogastric support, and hospitalization length, were analyzed.

Results: All operations were successfully completed using the single-port platform without conversion or reoperation. Docking was efficient, with a median time of 4.5 min (range 4-11 min) and median console time of 71 min (range 18-150). Most procedures involved minimal intraoperative bleeding; only two required more substantial hemostasis. Enhanced workspace around the oropharynx was noted, improving assistant access. Postsurgical outcomes were favorable: no tracheostomies were needed and half of the patients avoided nasogastric tube insertion. Hospital stays varied by case complexity, with no major adverse events reported.

Conclusion: SP TORS can be effectively introduced in mid-volume institutions, demonstrating technical reliability, ergonomic benefits, and safe patient recovery. Its versatility across a spectrum of indications suggests broad clinical utility, warranting further multicenter studies to define long-term outcomes and expand implementation.

Level of evidence: IV.

Objective: To evaluate subjective and objective submental/neck aesthetic outcomes after hyoid myotomy and suspension (HMS) performed for obstructive sleep apnea (OSA).

Methods: Single-blind, single-center, prospective cohort study including 20 adults undergoing HMS (active) and 11 adults undergoing septoplasty (control) between July 2020 and November 2022. Participants completed FACE-Q Neck and Area Under Chin modules and underwent standardized frontal and lateral photography preoperatively and 6 weeks postoperatively. Primary outcomes were change in cervicomental angle (CMA), hyomental distance (HMD), Rainbow Scale (RS), and FACE-Q scores; frontal neck width was a secondary outcome. Between-group differences in change were assessed using ANCOVA adjusting for age and baseline values.

Results: HMS participants were older than controls (median 67 [IQR 54-74] vs. 47 [35-56] years; p = 0.021). In adjusted analyses, HMS demonstrated greater improvement than controls in FACE-Q Area Under Chin (adjusted mean difference + 17.48; 95% CI, 2.2 to 32.8; p = 0.022), FACE-Q Neck (+14.60; 95% CI, 2.1 to 27.2; p = 0.025), and CMA (-10.17°; 95% CI, -19.4 to -1.0; p = 0.026). Differences were not significant for RS (-0.36; p = 0.311), HMD (-0.69 cm; p = 0.095), or neck width (-0.20 cm; p = 0.547).

Conclusion: In this feasibility cohort with 6-week follow-up, HMS for OSA was associated with improved patient-reported aesthetic satisfaction and a greater reduction in CMA compared with septoplasty controls. Larger studies with longer follow-up are needed to assess durability and longer-term outcomes.

Level of evidence: 3.

Objective: To characterize international opioid prescribing patterns among otolaryngologists performing sleep surgery.

Methods: Cross-sectional online survey of otolaryngologists and health care professionals who are members of the International Sleep Surgical Society (ISSS).

Results: Surveys were completed by 88 respondents representing an international group of providers from North America (34%), Europe (30%), and South America (24%). Twenty-two (25%) were from the United States (US). Opioids were routinely prescribed after palate surgery by 87% of providers, with 95% of US surgeons prescribing opioids to all post-palatoplasty patients compared to 32% of international surgeons. The average number of opioid tablets per patient after palatopharyngoplasty was > 25 tablets for 57% of US providers compared to 8% of international providers out of 86 total respondents. After HNS surgery, 70% (n = 19) of 27 respondents prescribed postoperative opioids, including 90% of US providers, compared to 0% of international providers. Important patient factors influencing provider prescription choices were patient history of chronic pain or chronic opioid use, age, and patient preference. Concerns about opioid abuse, studies on non-opioid analgesia, and adequate control of patients' pain were major underlying themes in influencing opioid prescription patterns after sleep surgery.

Conclusions: International survey of sleep surgeons reveals diverse opioid prescribing patterns after palate and hypoglossal nerve stimulation surgeries. Patient factors, provider preferences, and concerns about opioid abuse influence prescription decisions and highlight the complex considerations involved in pain management.

Objective: New head and neck cancer (HNC) patients may prioritize "competing" supportive care needs (SCNs) over smoking cessation, yet the burden of these SCNs according to smoking status is poorly characterized. We aimed to address this gap in knowledge.

Methods: The study applied a cross-sectional design and was guided by the Supportive Care Framework. Newly diagnosed HNC patients seen at the UTSW head and neck surgical oncology clinic between January 2021 and August 2024 and who completed the Patient Health Questionnaire (PHQ)-4 were eligible. Clinically significant SCNs were derived from validated measures. The primary outcome was smoking status and the primary exposure was moderate-severe psychological distress (PHQ-4 ≥ 6).

Results: Among 250 new HNC patients, 16.4% were current smokers. Relative to never or former smokers, current smokers exhibited significantly more SCNs (median 4 [3-5] vs. 2 [1-4], p < 0.001) and higher prevalence rates of pain (72.2%, 41.0%, p = 0.001), malnutrition (54.8%, 24.9%, p = 0.001), and anxiety (46.3%, 24.0%, p = 0.004). On univariate analysis, moderate-severe distress was not associated with smoking status. On adjusted analyses of a subsample of 136 patients with ≥ 98% complete SCN questionnaires, malnutrition was significantly associated with smoking (adjusted odds ratio: 3.49, 95% confidence interval: 1.34-9.03, p = 0.010) after adjusting for pain and anxiety.

Conclusion: Pretreatment HNC patients who smoke exhibit a high burden of SCNs. Further research is needed to determine whether targeting common needs such as malnutrition, pain, and anxiety may improve patients' ability to prioritize smoking cessation.

Level of evidence: Level 3.

Objective: Malignant otitis externa (MOE) is a potentially life-threatening infection of the external auditory canal (EAC), often with skull base extension. Vascular complications are exceptionally rare, with only six reports of petrous internal carotid artery (ICA) pseudoaneurysm following MOE.

Methods: We present the first reported case of a nasopharyngeal hematoma as a complication of MOE.

Results: An 82-year-old male with poorly controlled diabetes presented with 2 months of recurrent left ear otalgia, purulent otorrhea, and facial nerve palsy. He was commenced on 6 weeks of antimicrobial therapy following diagnosis of MOE on imaging. One month post-treatment, an interval scan found a new collection in the left pharyngeal submucosal region expanding into the torus tubarius. Endoscopic examination revealed a left torus tubarius mass effacing the eustachian tube orifice with some blood-stained mucous. The patient was otherwise afebrile and reported only mild trismus with rust-colored sputum. Subsequent computed tomography (CT) imaging revealed that the mass was likely a subacute or evolving nasopharyngeal hematoma, in close proximity to the left petrous and caudal lacerum ICA, with mild luminal irregularities. An angiogram showed no active contrast extravasation or pseudoaneurysm. He was managed conservatively given the absence of active bleeding and a stable airway. A repeat nasoendoscopy 2 weeks later revealed interval decrease in size of the mass, with resolution of symptoms.

Conclusion: The pathophysiology of nasopharyngeal hematoma as a complication of MOE may involve direct infection-mediated and inflammatory-induced erosion of arterial walls. Though rare, nasopharyngeal hematomas should be considered in MOE patients with unexplained nasopharyngeal masses. These hematomas, especially when associated with luminal ICA irregularities, may represent a sentinel finding preceding the eventual formation of a carotid pseudoaneurysm. Thus, the presence of nasopharyngeal hematomas warrants vigilant surveillance, with escalation to urgent endovascular intervention in the event of vascular instability.

N. Bellamkonda, A. Naumer, L. O. Buchmann, et al., “Succinate Dehydrogenase Pathogenic Variants Among Older Adults With Head and Neck Paragangliomas,” Laryngoscope Investigative Otolaryngology 10, no. 6 (2025): e70302, https://doi.org/10.1002/lio2.70302.

In the last sentence of paragraph two of the Results section, the text—“Among the 21 patients with a HNPGL-associated PV, two were between 50 and 59 years of age, seven between 60 and 69, eight between 70 and 79, three between 80 and 89, and one between 90 and 99 (Figure 1)”—was incorrect.

It should have read: “Among the 21 patients with a HNPGL-associated PV, ten were diagnosed with their first HNPGL between 50 and 59 years of age, ten between 60 and 69, and one between 70 and 79 (Figure 1).”

We apologize for this error.