Laryngoscope Investigative Otolaryngology最新文献

Objectives

Transnasal endoscopic sphenopalatine artery ligation (TESPAL) has been proposed as a first-line therapy for intractable epistaxis before utilizing posterior nasal packing and embolization. A specific procedure code for TESPAL was newly introduced in 2018, adding to two prior codes for procedural control of epistaxis. This study compares all-time utilization of the TESPAL CPT code in Medicare beneficiaries with alternative procedural codes for epistaxis management.

Methods

The publicly available data from the Centers for Medicare and Medicaid Services in the 2013–2022 period was analyzed for the reporting of TESPAL (31241), transcatheter permanent occlusion or embolization of noncentral nervous system, head, or neck (61626), and endoscopic control of epistaxis (31238) codes. Welch two sample t-test and linear regression were used to characterize CPT code utilization.

Results

From 2018 to 2022, TESPAL CPT code reporting averaged 378 instances annually, with a stable utilization trend (p = 0.432). CPT codes 61626 and 31238 averaged 1429 and 3779 instances annually, respectively. CPT 31238 showed a significant decline (p < 0.001), and CPT 61626 showed a stable trend (p = 0.082). There was a significant decline in CPT code 31238 use after 2018 (p < 0.01). CPT 61626 showed a significant increase in usage post-2018 (t = 2.90, p = 0.044).

Conclusion

After an initial increase in 2019, TESPAL reporting flattened, while CPT 61626 (which includes all embolization in head and neck vessels) significantly increased post-2018. As recent studies show significant advantages of TESPAL over embolization, these findings warrant further attention and study.

Level of Evidence

3.

Objectives

In ultrasonography, gels are used as conduction media to improve sound transmission and to obtain high-quality images; however, gels are rarely used in hearing devices. The application of gel to couple the transducer to the ear could potentially improve the benefits of hearing aids, particularly cartilage conduction (CC) hearing aids, which deliver sound through vibrating the aural cartilage. This study aimed to investigate the effects of gel application on the performance of CC hearing aids.

Methods

Twenty-three patients (30 ears) with aural atresia or severe canal stenosis were treated with CC hearing aids. The aided thresholds, maximum speech recognition scores (SRSs), and hearing levels at which the maximum SRS (dB [Max]) was observed were compared before and after gel application to the transducer of the CC hearing aids.

Results

Thresholds > 1 kHz significantly decreased (improved) when the gel was applied to the transducer (p < 0.05). The threshold improvement at 1 kHz was significantly better than that at 0.5 kHz, and that at 4 kHz was significantly better than at 0.25 and 0.5 kHz. No significant differences were observed in the maximum SRS or dB (Max).

Conclusions

Gel application, which is considered to have minimum risk, showed statistically significant improvements in hearing levels at higher frequencies. Therefore, the application of gel can be considered a beneficial option to enhance the performance of CC hearing aids by improving the coupling conditions.

Level of Evidence

4

Objectives

To determine the prevalence of positional obstructive sleep apnea (pOSA) in children undergoing adenotonsillectomy (AT) for OSA and to assess whether pOSA improves following AT.

Materials and Methods

Children with OSA diagnosed by polysomnography (PSG) at a tertiary care children's hospital were included. Data was collected on demographics, PSG parameters, and surgical management. Statistical comparisons between groups for the prevalence of pOSA were performed with the χ2 test or Fisher's exact test, for PSG parameters prior to AT with Student's t-test or Mann–Whitney Rank Sum Test, and for PSG parameters before and after AT with paired t-test and Wilcoxon Signed Rank Test. p < 0.05 was considered significant.

Results

Of the 1167 children (682 male, 485 female, median age = 5.7 years), 321 (28%) had pOSA. POSA children (median age = 7.4 years) were older than children with no pOSA (median = 5.2) (p ≤ 0.001). The prevalence of pOSA in the subgroups of gender and weight was not different. The prevalence of pOSA was significantly different amongst the race groups (p = 0.005). Compared with the Black/African American race, the white race had 1.4 times the odds of pOSA (95% CI, 1.07–1.98). The prevalence of pOSA was not significantly different between mild, moderate, and severe OSA groups (p = 0.7). Of the 66 POSA children who had PSG pre- and post-TA, 50 (76%) had resolution of pOSA. Children older than 6 years of age and children with obesity had a higher rate of persistent pOSA (p = 0.02 and p = 0.008, respectively).

Conclusion

POSA occurred frequently in OSA children undergoing AT. POSA is resolved in the majority of children after AT. Persistent pOSA was more prevalent in older and obese children. AT is used as the first-line treatment for pOSA in children. Future studies are needed to determine the role of positional therapy and other OSA therapies in the management of persistent pOSA after AT.

Level of Evidence

4.

Objectives

To investigate the clinical and audiological features in auditory neuropathy (AN) patients with different image performance of cochlear nerve (CN) on MRI.

Methods

AN patients were selected from the Multicenter Study on Clinical Diagnosis and Intervention of AN (2003–2023). Subjects were divided into four groups by CN size on MRI: bilateral AN with CN normalization (BAN^cnn), bilateral CN deficiency (BAN^cnd), unilateral AN with CND (UAN^cnd), and CN normalization (UAN^cnn) groups. Clinical and audiological features were analyzed, alongside differential analysis using the Internal auditory meatus (IAM) grading system.

Results

Totally 132 cases were included. The rate of CND was 35.6% (47/132), with 32.7% (36/110) and 50.0% (11/22) in bilateral and unilateral AN patients. The proportion of IAM I to IV grades increased progressively. Clinical and audiological characteristics differed between bilateral and unilateral AN patients. For bilateral AN patients, the age of onset and diagnosis of BAN^cnd were older, which were 11.8 ± 7.2 years and 19.5 ± 11.1 years, respectively, compared to patients in BAN^cnn group. UAN^cnd patients exhibited more severe hearing loss at all frequencies compared to UAN^cnn. Prognostic analysis indicated that AN patients with CND had no lower intervention rates.

Conclusion

The detection rate of CND was 35.6%, predominantly in unilateral AN patients and IAM IV was the most common type. Some clinical and audiological indicators were associated with imaging features of CN but varied between bilateral and unilateral AN. Variation in image performance may not be related to prognosis in AN patients.

Purpose

This study aims to elucidate the incidence of cancer-related post-traumatic stress (PTS) and the fluctuations in anxiety and depression levels before and one year after laryngectomy.

Methods

A prospective longitudinal study was conducted on 97 consecutive patients scheduled to undergo laryngectomy (total laryngectomy or pharyngolaryngectomy) at a single university hospital between 2007 and 2022. To assess cancer-related PTS, anxiety, and depression, participants completed two brief self-reported questionnaires: the Impact of Event Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS).

Results

Prior to laryngectomy, 32 patients planning for the procedure were considered as cancer-related PTS based on IES-R. The prevalence of anxiety and depression before surgery was 56% and 76% in the 32 patients with PTS, respectively, compared to 8% and 20% in the 65 patients without PTS. Patients with PTS exhibited significantly worse HADS-anxiety and HADS-depression scores compared to those without PTS at baseline (p < 0.001 for both). Although no significant difference was found in the HADS-anxiety score between the two groups (p = 0.15), patients with PTS exhibited a significantly worse HADS-depression score than those without PTS one year after surgery (p = 0.03).

Conclusion

Early identification of possible depressive disorders and active psychiatric interventions are crucial for patients undergoing laryngectomy during the follow-up period. Preoperative assessment of cancer-related PTS may offer an opportunity to implement appropriate psychological interventions.

Level of Evidence

4.

Objective

Hypoalbuminemia (HA) is a proxy for malnutrition that has been associated with postoperative complications in several surgical subspecialties. This study investigates the association between pre-operative HA and complications following major salivary gland (MSG) resection.

Methods

Patients undergoing outpatient, elective MSG resection were extracted from the 2005 to 2020 National Surgical Quality Improvement Program database. Demographics and comorbidities were compared between HA (preoperative serum albumin < 3.5 g/dL) and non-HA cohorts. To determine associations between albumin status and postoperative complications, univariate and multivariable binary logistic regression analyses were performed.

Results

A total of 5774 patients undergoing MSG resection were included, of which 321 (5.6%) had preoperative HA. HA was associated with older age on univariate analysis (65.2 vs. 60.2 years, p < 0.001). Multivariable analysis found HA to be independently associated with any surgical complication (OR 2.03, 95% CI 1.09–3.56, p = 0.019) and length of stay (LOS) ≥ 90th percentile (OR 1.58, 95% CI 1.04–2.38, p = 0.032).

Conclusion

Preoperative HA may be a poor prognostic factor associated with an increased risk of surgical complications and prolonged LOS among patients undergoing MSG resection.

Level of Evidence

4.

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.