Laryngoscope Investigative Otolaryngology最新文献

Objective

This study aims to document and analyze the challenges and outcomes of performing complex airway surgery in a low-resource, post-war setting in Mekelle, Ethiopia.

Methods

This prospective case series examines clinical data from five patients who underwent airway reconstruction surgeries and one patient who underwent total laryngectomy at Ayder Comprehensive Specialized Hospital in Mekelle. Data included patient demographics, airway stenosis etiology and severity, operative details, postoperative outcomes, complications, and hospital length of stay. Ethical approval was obtained from institutional review boards at Mayo Clinic and Mekelle University.

Results

The study included six patients aged 9–62 years, with surgeries comprising three cricotracheal resections, two tracheal resections, and one laryngectomy. Three reconstructions were for war-related injuries. Challenges included power outages during surgeries, limitations in medical supplies and equipment, and inadequate perioperative care. Despite these, three patients requiring tracheostomies were successfully decannulated within a year. However, complications such as restenosis, infections, and the need for reintubation were common.

Conclusion

Airway surgeries in a low-resource, post-war setting face significant hurdles, including perioperative care quality, resource limitations, and infrastructure issues. Successful outcomes require multidisciplinary training tailored to local contexts, investments in hospital infrastructure and reliable electricity, and proper perioperative nutrition. This study highlights the need for comprehensive interventions to improve surgical care in such settings.

Level of evidence: IV.

Objectives

The study aimed to extract online comments of otolaryngologists in the 20 most populated cities in the United States from healthgrades.com, develop and validate a natural language processing (NLP) logistic regression algorithm for automated text classification of reviews into 10 categories, and compare 1- and 5-star reviews in directly-physician-related and non-physician-related categories.

Methods

1977 1-star and 12,682 5-star reviews were collected. The primary investigator manually categorized a training dataset of 324 1-star and 909 5-star reviews, while a validation subset of 100 5-star and 50 1-star reviews underwent dual manual categorization. Using scikit-learn, an NLP algorithm was trained and validated on the subsets, with F1 scores evaluating text classification accuracy against manual categorization. The algorithm was then applied to the entire dataset with comparison of review categorization according to 1- and 5-star reviews.

Results

F1 scores for NLP validation ranged between 0.71 and 0.97. Significant associations emerged between 1-star reviews and treatment plan, accessibility, wait time, office scheduling, billing, and facilities. 5-star reviews were associated with surgery/procedure, bedside manner, and staff/mid-levels.

Conclusion

The study successfully validated an NLP text classification system for categorizing online physician reviews. Positive reviews were found to have an association with directly-physician related context. 1-star reviews were related to treatment plan, accessibility, wait time, office scheduling, billing, and facilities. This method of text classification effectively discerned the nuances of human-written text, providing valuable insights into online healthcare feedback that is scalable.

Level of evidence: Level 3

Objective

The goal of this study was to develop an objective measure and predictor of cochlear implantation (CI) outcomes using functional near-infrared spectroscopy (fNIRS) for young children with prelingual deafness.

Methods

Sound-evoked hemodynamic responses were recorded from auditory and language-related cortical regions of 47 child CI recipients (35.47 ± 17.24 months of age) using fNIRS shortly after CI activation (0.26 ± 0.30 months). There were four sound conditions (natural speech, instrumental music, multi-speaker babble noise, and speech-in-noise). Post-CI auditory and verbal communication performance was evaluated using clinical questionnaires with caretakers. Both classification and individualized regression models were constructed to predict post-CI behavioral improvement from fNIRS data using support vector machine (SVM) learning algorithms.

Results

Auditory cortical responses shortly after CI hearing onset yielded highly accurate prediction of behavioral development in young CI children. For classification models, optimal prediction was achieved using cortical responses to two or more sound conditions, with the highest accuracy of 98.20% (precision = 98.17%, sensitivity = 98.96%, area under the curve of the receiver operating characteristic curve = 99.61%) obtained with the combination of speech, noise, and music stimuli. Similarly, for regression models, best prediction of individual development was achieved using three (highest r = 0.919) or four (r = 0.966) sound conditions. The predictability of cortical responses far outperformed (Cohen's d: 18.56) that of the collection of audiological and demographic parameters (classification accuracy: 0.62) under the same SVM algorithms and could not benefit from the inclusion of the latter.

Conclusion

Machine learning models using auditory cortical hemodynamic responses shortly after CI activation were able to predict individualized post-CI behavioral improvement in children with prelingual deafness.

Level of Evidence

Level 5.

Objective

This study analyzed the causes of sphenoid sinus (SS) infection (SSI) following endoscopic transsphenoidal skull base surgery and determined appropriate treatment methods.

Methods

This study included 31 cases of secondary SSI following the endoscopic transsphenoidal approach (ETSA; SSI group) and 246 cases without SSI (non-SSI group). Data collected included post-ETSA pathological results, types of artificial skull base reconstruction materials, and SS patency. For the SSI group, data included time from ETSA to symptom onset, endoscopic and imaging findings, intraoperative conditions during the second surgery, and changes in visual analog scale (VAS) scores.

Results

The incidence of secondary SSI was 11.19%. In the SSI group, 26 patients (83.87%) reported headaches, and 24 (77.42%) had stenosis or closure of the SS ostium (SSO). The non-SSI group reported no symptoms, and 236 patients (95.93%) had well-opened SSOs. Centripetal hyperosteogeny (CHO) in the SS walls was observed in 20 patients (64.5%) in the SSI group. Absorbable materials were used in five cases (16.13%) and 215 cases (87.40%) in the SSI and non-SSI groups, respectively, while non-absorbable materials were used in 24 cases (77.42%) and 20 cases (8.13%), respectively. SSI risk was 9.42 times higher with non-absorbable synthetic materials. VAS scores for SSI symptoms and Lund–Kennedy scores significantly decreased at 3 and 12 months post-second surgery.

Conclusion

Secondary SSI after ETSA can cause persistent symptoms. Non-absorbable synthetic repair materials should be avoided to prevent secondary SSI. Extended sphenoidectomy and removal of artificial materials can lead to rapid resolution of SSI symptoms.

Level of Evidence

4.

Background

This study aimed to clarify the prognosis of asymptomatic endolymphatic hydrops (EH) in healthy volunteers via five-year follow-ups with inner ear magnetic resonance imaging (MRI).

Methods

Inner ear MRI was performed on 115 participants recruited as controls in a previous study on Meniere's disease. The endolymphatic space was visualized using Naganawa's method of contrast-enhanced MRI with intravenous gadolinium injection and evaluated using Nakashima's method of 2D imaging analysis.

Results

Cochlear or vestibular EH was present in 7.0% of participants (n = 8), with all cases being unilateral (laterality), moderate (severity), and asymptomatic (onset). Only cochlear-localized EH, only vestibular-localized EH, and both EH were present in 1.7% (n = 2) (C group), 4.3% (n = 5) (V group), and 0.9% (n = 1) (CV group) of participants, respectively. Conducting inner ear MRI after 5 years showed that EH had almost disappeared in two participants in the C and V groups (4/8, 50.0%). EH was still present in three participants in the V group and one in the CV group (4/8, 50.0%). One participant in the V group and another in the CV group presented with residual inner ear EH and developed typical symptomatic Meniere's disease (2/8, 25.0%).

Conclusions

Approximately 7% of healthy participants showed asymptomatic EH. Therefore, EH is not the definitive marker for making a diagnosis of Meniere's disease or the suitable predictor for the development of Meniere's disease. Among these participants, 25% maintained EH and subsequently developed typical Meniere's disease within the next 5 years. Schellong-positive participants maintained persistent EH in the inner ear, and participants with higher scores on the self-rating depression scale developed Meniere's symptoms after 5 years.

Level of evidence

2a

Objectives

Congenital laryngomalacia (CLM) is the most common cause of stridor in neonates and is commonly associated with reflux disease (RD) such as gastroesophageal reflux and newborn esophageal reflux. This study investigates the impact of RD on the management and outcomes of neonates with CLM.

Methods

The 2016 Kids' Inpatient Database (KID) was queried for neonates with CLM (ICD-10: Q31.5). RD status, procedures, and complications were identified with ICD-10 codes. Univariate and multivariable analyses were implemented to determine statistical associations.

Results

Of 2212 neonates identified with CLM, 585 (26.45%) had RD. Patients with RD were more often female (p = .038) and premature (p < .001). Upon multivariable analysis, patients with RD had greater total charges (Mean $457,810.87 vs. $259,020.90, p < .001) and longer length of stay (Mean 46.03 vs. 26.44 days, p < .001). Those with RD had more diagnoses recorded (Mean 14.15 vs. 9.66, p < .001), underwent more procedures (Mean 5.47 vs. 3.49, p < .001), and had a longer wait until their first procedure (Mean 13.27 vs. 7.02 days, p < .001). Patients with RD had increased odds for undergoing laryngoscopy (OR 1.799, 95% CI 1.382–2.321, p < .001), bronchoscopy (OR 2.179, 95% CI 1.598–2.801, p < .001), and ventilator use (OR 1.526, 95% CI 1.197–1.886, p < .001) on multivariable regression adjusting for patient demographics, hospital characteristics, and comorbidities. Patients with and without RD had similar odds for undergoing tracheotomy (OR 1.540, 95% CI 0.934–2.522, p = .088) and mortality (OR 1.084, 95% CI 0.397–2.646, p = .874).

Conclusion

CLM is a common diagnosis in neonates that is associated with RD. In our cohort of neonates with CLM, those with RD had overall poorer outcomes.

Level of evidence

4.

Objectives

Present follow-up data comparing transoral and transfacial parotid gland procedures for stone removal to offer insight addressing technical considerations and complications.

Methods

Retrospective study of a consecutive series of surgical treatments for parotid sialolithiasis from 2013 to 2018 at an academic institution by one surgeon provided review of 16 transoral and 10 transfacial procedures supplemented by long-term follow-up through telephone or mail. Clinical and radiographic parameters, additional treatment, and persistence of symptoms were evaluated.

Results

Four of 10 patients treated with the transfacial approach had parotid-cutaneous fistulas addressed with transdermal scopolamine patches and pressure dressings (one also with intraductal steroid infusion) with closure at a median of 12.5 days. A fifth fistula failed to resolve at 23 days and was addressed with parotidectomy. All 8 patients who were contacted (median: 106 months) reported complete resolution of symptoms. None had facial weakness.

Six of 16 patients treated by a transoral approach had persistent stone fragments at the conclusion of operation. Four of these 6 patients underwent subsequent procedures (two transoral, one transfacial, one parotidectomy). Among the 11 patients who responded to long-term follow-up (median: 107 months), one reported mild symptoms insufficient to request treatment. Larger stone size coupled with proximal location correlated with the conversion from transoral to include transfacial approach.

Conclusion

Patients with retained stone remnants at the conclusion of transoral stone removal are more likely to require additional procedures that result in long-term favorable results. The transfacial approach to stone removal offers long-term favorable results following the common short-term complication of salivary fistula.

Level of Evidence

OCEBM Level 4.

Objective

Betahistine is a partial H1 receptor agonist and a potent H3 receptor antagonist commonly used for the treatment of MD and peripheral vertigo. The aim of this study was to investigate the impact of betahistine on the salt induced cytokine expression profiles of AIED and MD patients.

Methods

Peripheral blood mononuclear cells (PBMCs) were obtained from 24 patients with autoimmune inner ear disease (AIED) or Meniere's disease (MD) during an acute exacerbation of hearing loss. These PBMCs were cultured with 80 mM NaCl or a combination of 80 mM NaCl and betahistine and IL-1β and IL-6 expression were measured by real time PCR and ELISA.

Results

In most patients, IL-1β expression in response to NaCl exceeded the unstimulated condition and this expression was abrogated by the addition of betahistine, which was statistically significant at p = .004. mRNA expression of IL-1β was not reduced when samples were treated with both salt and betahistine compared to samples treated with salt alone, inferring the mechanism of betahistine-mediated IL-1β suppression is post-translational. Similarly, IL-6 cellular release was augmented with salt exposure and reduced with co-culture of betahistine. Unlike IL-1 however, betahistine appeared to reduce IL-6 mRNA expression.

Conclusion

We observe that betahistine abrogates salt-induced IL-1β expression, suggesting an additional treatment option for AIED and MD patients with inflammatory mediated disease.

Level of evidence

Level 4.

Objectives

To study the predisposing factors, treatment, and complications of Aspergillus otitis externa.

Methods

A retrospective analysis of patients diagnosed with Aspergillus otitis externa at the Department of Otorhinolaryngology, Helsinki University Hospital, between January 2010 and December 2018 was performed.

Results

Of the 269 Aspergillus otitis externa (OE) patients, 96 developed otitis media (OM) and 7 developed mastoiditis. Antibiotic and steroid treatment and otological history were risk factors for Aspergillus OE. Systemic diseases and immunocompromising states were more common in mastoiditis patients. Repetitive ear cleaning and topical drugs are primary treatments, but systemic drugs and surgery were needed in resistant and invasive cases. Forty-five novel tympanic membrane (TM) perforations were reported. A strong association between Aspergillus species and final infection types was found; A. niger was the dominant species in OM and in novel TM perforations, whereas A. flavus and A. fumigatus caused mastoiditis. Some of the TM perforations persisted despite treatment. Permanent hearing impairment was associated with OM and mastoiditis.

Conclusion

As Aspergillus OE has the potential to cause acute and chronic complications, fungal OE should be suspected early on if the infection persists after conventional treatment. The identification of Aspergillus species could aid in spotting patients at risk for more severe disease and complications. Intensive local treatment is sufficient in most cases of OE and OM but effective topical antifungals are limited. Patients with Aspergillus OM and mastoiditis should be followed up for hearing impairment and permanent TM perforations after the infection resolves.

Level of evidence

Level 4 (The Oxford 2011 Levels of Evidence).

Purpose

Our study will analyze patients' clinical characteristics, treatment strategies, and complications with deep neck infection (DNI) using their medical records for five years.

Methods

The present study included 111 patients diagnosed with DNI in our clinic between January 2018 and March 2023. The patients' complaints at admission, sociodemographic characteristics, season of diagnosis, findings from laboratory tests, radiological imaging performed at the time of first diagnosis, abscess localization, medical and surgical treatment methods used, and complications developing during follow-up were retrospectively examined.

Results

The mean age of the patients included in the study was 38.51 ± 16.92 (6–87 years). There was a significant correlation between chronic disease, smoking behaviours, oral hygiene, and DNI among patients based on their sociodemographic characteristics and medical history (p < .005). DNI development did not differ by season (p > .005). Physical examination findings predominantly revealed neck masses (39.6%) and peritonsillar abscesses (32.4%), and patients with peritonsillar abscesses had a shorter length of hospital stay than those with other localizations. No severe complications occurred during the clinical follow-up.

Conclusion

Chronic diseases, smoking, and poor oral hygiene are the primary risk factors for developing DNIs. If an abscess is located in a critical area, it may require extended hospitalization and surgery under general anesthesia. Therefore, addressing these risk factors and encouraging good oral hygiene practices are crucial to preventing DNIs and reducing the need for intensive treatment.