Laryngoscope Investigative Otolaryngology最新文献_第2页

Variability in Physical Exam Documentation for Obstructive Sleep Apnea 阻塞性睡眠呼吸暂停体格检查文件的可变性。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-31 DOI: 10.1002/lio2.70338

Jacob Hauser, Alexandra Vacaru, Nihal Punjabi, Jared C. Inman

Objectives

This study evaluates variability in obstructive sleep apnea (OSA) physical exam templates, contrasts documentation between institutional settings, and identifies inter-specialty differences in documentation.

Methods

Cross-sectional analysis was performed using the Epic Community Library, a shared database of user-created documentation templates from institutions using the Epic electronic medical record system. Physical exam templates assessing sleep apnea were identified and evaluated against a checklist of 25 key physical exam characteristics from a clinical guideline.

Results

Of 6621 templates from 478 institutions, 579 relevant templates were identified. The most frequently included features were vital signs (89.1%), tonsil size (69.5%), and septal deviation (60.2%). The least frequently recorded features were waist-hip ratio (0.8%), hyomental distance (1.6%), and Cottle maneuver (1.6%). The median template included only 7 out of our 25 key features, with an IQR of 5. Body mass index (BMI) was documented in 36.7% of exams. Of the templates from academic centers, 63% were unique compared to 14% from community centers and 27% from health networks. Otolaryngology templates documented nasal cavity and nasopharyngeal features and specialized airway techniques significantly more frequently than sleep medicine, pulmonology, and unspecified templates. In contrast, sleep medicine and pulmonology documented neck circumference more often than otolaryngology, and sleep medicine recorded Mallampati scores more frequently.

Conclusion

Significant variability exists in OSA physical exam documentation across institutions and specialties. This may contribute to disparities in patient evaluation and treatment. Standardized OSA physical exam templates could provide a more consistent and comprehensive anatomic exam, facilitate subspecialty communication, and support more accurate patient treatment selections.

Level of Evidence

Level 3.

目的：本研究评估了阻塞性睡眠呼吸暂停（OSA）体检模板的可变性，对比了不同机构间的记录，并确定了不同专业间的记录差异。方法：使用Epic社区图书馆进行横断面分析，该图书馆是使用Epic电子病历系统的机构用户创建文档模板的共享数据库。评估睡眠呼吸暂停的体检模板被确定并根据临床指南的25个关键体检特征清单进行评估。结果：在478所院校的6621个模板中，鉴定出579个相关模板。最常见的特征是生命体征（89.1%）、扁桃体大小（69.5%）和间隔偏曲（60.2%）。最不常记录的特征是腰臀比（0.8%）、眼骨距离（1.6%）和卡托运动（1.6%）。中位数模板只包含了25个关键特征中的7个，IQR为5。36.7%的检查记录了身体质量指数（BMI）。在来自学术中心的模板中，63%是独一无二的，而来自社区中心的是14%，来自医疗网络的是27%。耳鼻喉科模板比睡眠医学、肺科和未指定模板更频繁地记录鼻腔和鼻咽特征以及专门的气道技术。相比之下，睡眠医学和肺科记录颈围的频率高于耳鼻喉科，睡眠医学记录Mallampati评分的频率更高。结论：不同机构和专业的OSA体检记录存在显著差异。这可能导致患者评估和治疗的差异。标准化的OSA体检模板可以提供更加一致和全面的解剖检查，方便亚专科交流，支持更准确的患者治疗选择。证据等级：三级。

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引用次数: 0

Chronic Rhinosinusitis and Autoimmune Diseases: A Comprehensive Large Population-Based Analysis 慢性鼻窦炎和自身免疫性疾病：一项基于人群的综合分析。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-30 DOI: 10.1002/lio2.70340

Robert E. Africa, Brian J. McKinnon, Charles A. Hughes, Scott A. Hardison

Objectives

To evaluate associations between a wide variety of autoimmune diseases and chronic rhinosinusitis without nasal polyposis (CRSsNP), CRS with nasal polyposis (CRSwNP), and the need for endoscopic sinus surgery.

Methods

This is a multicenter retrospective study from January 1, 2010 to July 31, 2025 utilizing data from 106 healthcare organizations in the United States. The TriNetX database was used to identify adult patients over 18 years with a specified autoimmune disease from a comprehensive list that were included in the study. These groups were compared to patients without autoimmune diseases. The evaluated outcomes included the rate of developing CRSsNP, CRSwNP, and the need for endoscopic sinus surgery.

Results

Higher rates of CRSsNP and CRSwNP were noted in patients with certain autoimmune diseases. In patients with CRSsNP, a higher likelihood of undergoing sinus surgery was identified for Graves' disease, multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus (RR: 1.84 [1.60–2.13]; 1.20 [1.02–1.43]; 1.19 [1.09–1.29]; 1.30 [1.05–1.61]). Among patients with CRSwNP, a higher rate of surgery was associated with eosinophilic esophagitis, Hashimoto's disease, and ulcerative colitis (RR: 1.08 [1.02–1.14]; 1.06 [1.02–1.11]; 1.15 [1.04–1.32]).

Conclusions

A wide variety of autoimmune diseases are associated with CRSsNP and CRSwNP. The autoimmune diseases that were associated with a higher rate of surgery were rheumatoid arthritis and Graves' disease.

Level of Evidence

3.

目的：评估多种自身免疫性疾病与慢性鼻窦炎无鼻息肉（CRSsNP）、慢性鼻窦炎伴鼻息肉（CRSwNP）以及鼻窦内窥镜手术的必要性之间的关系。方法：这是一项从2010年1月1日至2025年7月31日的多中心回顾性研究，利用了来自美国106家医疗机构的数据。TriNetX数据库用于从纳入研究的综合列表中识别患有特定自身免疫性疾病的18岁以上成年患者。这些组与没有自身免疫性疾病的患者进行比较。评估的结果包括CRSsNP、CRSwNP的发生率和鼻窦内窥镜手术的必要性。结果：在某些自身免疫性疾病患者中，CRSsNP和CRSwNP的发生率较高。在crsssnp患者中，Graves病、多发性硬化、类风湿性关节炎和系统性红斑狼疮接受鼻窦手术的可能性更高（RR: 1.84[1.60-2.13]; 1.20[1.02-1.43]; 1.19[1.09-1.29]; 1.30[1.05-1.61]）。在CRSwNP患者中，较高的手术发生率与嗜酸性粒细胞性食管炎、桥本氏病和溃疡性结肠炎相关（RR: 1.08[1.02-1.14]; 1.06[1.02-1.11]; 1.15[1.04-1.32]）。结论：多种自身免疫性疾病与crsssnp和CRSwNP相关。与高手术率相关的自身免疫性疾病是类风湿关节炎和格雷夫斯病。证据等级：3。

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引用次数: 0

Geospatial Analysis of Rural–Urban Access of Otolaryngology-Head and Neck Surgeons and Clinics in Vermont 佛蒙特州耳鼻喉头颈外科医生和诊所城乡通道的地理空间分析。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-30 DOI: 10.1002/lio2.70308

Christopher P. Kruglik, Josephine Yalovitser, John L. Rustad, Sara F. Santagostino, Erin T. Ostby, Heather C. Herrington, Mirabelle B. Sajisevi

Objective(s)

This study examines the distribution of Otolaryngology-Head and Neck Surgeons (OHNS) in Vermont to identify gaps in OHNS clinic accessibility between rural and urban areas and better understand the disparities faced by Vermonters.

Methods

A geospatial, population-based cross-sectional study was conducted, and the OHNS workforce was assessed using public databases. The ArcGIS Pro Near Analysis tool was used to assess the travel burden to OHNS clinics. Wilcoxon rank sum tests were used to compare the average distances to Comprehensive Otolaryngology Care Centers (COCC) and General Otolaryngology Clinics (GOC) between rural and urban towns.

Results

Vermonters have access to 15 OHNS clinics in Vermont, with 10 additional clinics in counties of bordering states. Nearly 43% of counties in Vermont lacked any OHNS clinic. While urban areas of Vermont had the fewest OHNS clinics, they had the largest number of practicing otolaryngologists. On average, Vermonters in urban towns were 31.0 km from a COCC, while those in rural towns were 68.7 km away (p < 0.001). Conversely, on average, Vermonters in urban towns were 25.9 km from a GOC, compared to 22.0 km for those in rural towns (p < 0.001).

Conclusion

Rural residents in Vermont must travel farther distances to obtain OHNS services. However, rural Vermonters face significantly less travel burden to GOCs than urban residents, suggesting that GOCs are well-positioned to reduce disparities in travel burden to OHNS for rural populations. GOCs tend to provide less comprehensive care than COCCs and may, therefore, incompletely improve the distribution and availability of comprehensive otolaryngology services in rural areas.

目的：本研究考察了佛蒙特州耳鼻喉头颈外科医生（OHNS）的分布，以确定农村和城市地区OHNS诊所可及性的差距，并更好地了解佛蒙特州面临的差异。方法：进行了一项地理空间、基于人口的横断面研究，并使用公共数据库对OHNS劳动力进行了评估。使用ArcGIS Pro Near Analysis工具评估前往OHNS诊所的旅行负担。采用Wilcoxon秩和检验比较城乡居民到综合耳鼻喉科护理中心（COCC）和普通耳鼻喉科诊所（GOC）的平均距离。结果：佛蒙特人可以使用佛蒙特州的15个OHNS诊所，在边境州的县有10个额外的诊所。佛蒙特州近43%的县没有OHNS诊所。虽然佛蒙特州的城市地区拥有最少的OHNS诊所，但他们拥有最多的耳鼻喉科医生。佛蒙特州城镇居民与COCC的平均距离为31.0公里，而农村居民与COCC的平均距离为68.7公里。(p)结论：佛蒙特州农村居民必须走更远的距离才能获得OHNS服务。然而，与城市居民相比，佛蒙特州农村居民面临的goc旅行负担要少得多，这表明goc在减少农村人口到OHNS的旅行负担方面处于有利地位。GOCs提供的综合护理往往不如cocs，因此可能无法完全改善农村地区综合耳鼻喉科服务的分布和可得性。

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引用次数: 0

Transoral Approach for Balloon Dilation of the Eustachian Tube 经口入路治疗咽鼓管球囊扩张

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-26 DOI: 10.1002/lio2.70339

Jared Zhao, Bryan K. Ward

Objectives

Balloon dilation of the Eustachian tube (BDET) is typically performed by advancing a balloon through the nasal cavity into the Eustachian tube orifice using a guide catheter. However, in patients with challenging nasal or Eustachian tube anatomy, this transnasal approach may be unsuccessful. Here, we present a case in which transnasal BDET was not possible due to challenging Eustachian tube anatomy, but a transoral approach provided a successful alternative.

Methods

After unsuccessful attempts at BDET through the nasal passages, a Crowe-Davis mouth retractor was placed. With endoscopic visualization through the nasal passage, the guide catheter was advanced into the oral cavity and around the soft palate to the Eustachian tube orifice.

Results

The angle of insertion from the transoral approach enabled easy advancement into the Eustachian tube. After the procedure, the patient was able to ventilate the ears without difficulty.

Conclusion

We describe a transoral technique for BDET that bypasses obstructive nasal anatomy and offers greater flexibility in catheter angulation. This approach may serve as a useful alternative in select cases where standard access is not feasible.

目的：咽鼓管球囊扩张（BDET）通常是通过使用导尿管将球囊通过鼻腔进入咽鼓管孔来完成的。然而，对于鼻腔或咽鼓管解剖困难的患者，这种经鼻入路可能不成功。在这里，我们提出了一个病例，经鼻BDET是不可能的，因为挑战咽鼓管解剖，但经口入路提供了一个成功的选择。方法采用Crowe-Davis口腔牵开器对经鼻道BDET不成功的患者进行牵开。内镜下通过鼻道显示，引导导管进入口腔，绕过软腭到达咽鼓管口。结果经口入路的置入角度便于推进至咽鼓管。手术后，患者能够毫无困难地对耳朵进行通气。结论：我们描述了一种经口BDET技术，该技术绕过了阻塞性鼻解剖结构，并在导管成角方面提供了更大的灵活性。在标准访问不可行的特定情况下，这种方法可以作为一种有用的替代方法。

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引用次数: 0

Novel Combination Dexmedetomidine and Propofol Anesthetic Regimen for DISE Improves Procedural Efficiency Compared to Single-Agent Regimens 与单药方案相比，新型右美托咪定和异丙酚联合麻醉方案可提高手术效率。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-23 DOI: 10.1002/lio2.70329

Ryan Patrick, Ann Birmingham, Paul Allen, Sveta Karelsky

Objectives

This study examines a combination anesthetic regimen of propofol and dexmedetomidine during drug induced sleep endoscopy (DISE) and its procedure time, VOTE findings, and perioperative hemodynamic profiles when compared to procedures conducted with either anesthetic agent alone.

Methods

Retrospective chart analysis of 407 patients undergoing DISE at a single institution with anesthetic regimens of dexmedetomidine alone, propofol alone, or a combination of both. Demographic information, DISE findings via VOTE scoring, and perioperative vital signs and timing intervals were compared.

Results

With respect to operative time, the combination regimen cohort demonstrated an average operative time of 22.1 min, 14% shorter than the dexmedetomidine only (25.8 min; p = 0.0001) and 42% shorter than the propofol only (38.4 min; p = 0.0001) cohorts. Recent intra-system analysis demonstrates a current average DISE time of 14 min with the combination regimen. With respect to perioperative vital sign findings, the combination regimen demonstrated a higher intra- and post-operative minimum heart rate (61.7, 60.9 bpm) compared to the dexmedetomidine regimen (56.9, 56.9 bpm; p = 0.0003, p = 0.0014) and a lower intraoperative O2 nadir (86.0%) than the dexmedetomidine regimen (90.0%, p = 0.0001). With respect to DISE findings, the propofol cohort demonstrated fewer patients with grade 2 tongue base obstruction and a greater portion with compete concentric collapse of the velum as compared to the combination cohort.

Conclusion

This novel combination anesthetic regimen of dexmedetomidine and propofol during DISE leads to increased procedural efficiency with preservation of vital sign stability.

Level of Evidence

3.

目的：本研究考察了异丙酚和右美托咪定联合麻醉方案在药物诱导睡眠内窥镜检查（dis）期间的手术时间、投票结果和围手术期血流动力学特征，并与单独使用任何一种麻醉剂进行比较。方法：回顾性分析407例在同一机构接受DISE的患者，麻醉方案分别为右美托咪定、异丙酚或两者联合。比较了人口统计学信息、通过投票评分的疾病诊断结果、围手术期生命体征和时间间隔。结果：在手术时间方面，联合方案队列平均手术时间为22.1 min，比单用右美托咪定（25.8 min, p = 0.0001）短14%，比单用异丙酚（38.4 min, p = 0.0001）短42%。最近的系统内分析表明，目前联合治疗方案的平均DISE时间为14分钟。在围手术期生命体征方面，联合用药组术中和术后最低心率（61.7,60.9 bpm）高于右美托咪定治疗组（56.9,56.9 bpm; p = 0.0003, p = 0.0014），术中O2最低点（86.0%）低于右美托咪定治疗组（90.0%,p = 0.0001）。关于DISE的发现，与联合用药组相比，异丙酚组较少患者出现2级舌根梗阻，更大比例患者出现舌膜同心性塌陷。结论：右旋美托咪定与异丙酚复合麻醉方案可提高手术效率并保持生命体征稳定。证据等级：3。

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引用次数: 0

Postoperative CT and Functional Analysis of New Larynx in Different Supracricoid Partial Laryngectomy Procedures 不同滑膜上部分喉切除术后新喉的CT及功能分析。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-22 DOI: 10.1002/lio2.70336

Chang Huang, Wei Liu, Kunyu Liu, Xiaohui Du, Weilin Dai, Rui Han, Pei Chen

<div> <section> <h3> Objective</h3> <p>To compare postoperative CT images of different supracricoid partial laryngectomy procedures and to analyze the formation of a new laryngeal.</p> </section> <section> <h3> Study Design</h3> <p>Observation and retrospective study.</p> </section> <section> <h3> Methods</h3> <p>Imaging data of 16 patients with supracricoid partial laryngectomy surgery were collected before and 6 months after different supracricoid partial laryngectomy surgeries. Parameters of larynx CT images were read and measured by three senior otolaryngologists at different layers. Function analysis of the new larynx was mainly focused on voice and swallowing. Two-way analysis of variance was employed to analyze the course data. Spearman correlation analysis was performed to evaluate the relationships between imaging parameters and mPAS score, as well as between imaging parameters and GARBS scales.</p> </section> <section> <h3> Results</h3> <p>In cricohyoidopexy and cricohyoidoepiglottopexy, the body of the hyoid, the residual arytenoid cartilage, and part of the cricoid dorsal plate could be visualized at the same layer. In Tucker procedure, the first display layer of the free edge of the epiglottis was significantly lower than that before operation. The new glottis is shown at the arytenoid layer, most of which is irregular. When compared with the Tucker group, the cricohyoidopexy and cricohyoidoepiglottopexy groups showed a statistical difference in the postoperative distance between the hyoid bone and cricoid cartilage respectively (<i>p</i> < 0.001). The sagittal distance of the new laryngeal cavity increased in the cricohyoidoepiglottopexy and Tucker groups after surgery when compared with the cricohyoidopexy group (<i>p</i> < 0.01). The voice recovery function of cricohyoidopexy patients was better than that of the other two groups, while the three groups had different degrees of swallowing function recovery.</p> </section> <section> <h3> Conclusion</h3> <p>All supracricoid partial laryngectomy procedures showed varying degrees of shortening of the new laryngeal body. The shape of the new laryngeal cavity at the narrowest point was different, but none of them affected respiration and pronunciation. Patients could acquire voice and swallowing recovery in all types of SCPL. It is necessary to evaluate postoperative CT images combined with function analysis to make a better understanding of new larynx structure and function in patie

目的：比较不同术式下喉部分切除术后的CT图像，分析新喉的形成。研究设计：观察和回顾性研究。方法：收集16例手术前及术后6个月的影像学资料。由3名资深耳鼻喉科医师从不同层次读取并测量喉部CT图像参数。新喉的功能分析主要集中在发声和吞咽方面。采用双向方差分析对课程数据进行分析。采用Spearman相关分析评价成像参数与mPAS评分、成像参数与GARBS量表之间的关系。结果：环状舌骨骨固定术和环状舌骨会厌骨固定术在同一层可见舌骨体、残余的杓状软骨和部分环状骨背板。在Tucker手术中，会厌自由缘第一显示层明显低于术前。新声门位于杓状层，大部分不规则。与Tucker组比较，环舌骨固定术组和环舌骨会厌软骨固定术组术后舌骨和环状软骨之间的距离均有统计学差异(p)。结论：所有的环舌骨上部分喉切除术均出现不同程度的新喉体缩短。新喉腔最窄处的形状不同，但对呼吸和发音没有影响。所有类型的SCPL患者均可获得声音和吞咽功能的恢复。对术后CT图像进行评价，结合功能分析，更好地了解患者的新喉部结构和功能。

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引用次数: 0

Patterns and Predictors of Cross-Applications Among Otolaryngology Residency Applicants 耳鼻喉科住院医师申请人交叉应用的模式和预测因素。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-20 DOI: 10.1002/lio2.70337

Angela Renne, Maria Armache, Francis Deng, Jenny X. Chen

Objective

To evaluate the applicant characteristics associated with cross-applying to otolaryngology-head and neck surgery (OHNS) and at least one additional specialty.

Methods

We analyzed all Association of American Medical Colleges Electronic Residency Application Service applications submitted to OHNS residency programs between 2020 and 2023. Cross-applicants applied to OHNS and at least one other specialty. Chi-square tests and t-tests compared the characteristics of OHNS-only applicants and cross-applicants. Multivariable logistic regression identified independent predictors of cross-application.

Results

Among 2440 applicants to OHNS, 53.0% (N = 1293) cross-applied, most commonly to General Surgery (N = 894, 36.6%) and Internal Medicine (N = 508, 20.8%). Cross-applicants comprised the majority of international medical graduates (IMG, 88.4%), osteopathic applicants (DO, 86.0%), and applicants 30 years of age or older (70.6%). Compared to those who applied to only OHNS, cross-applicants had significantly fewer research experiences (difference [Δ] = −1.50 ± 0.11 [mean ± standard error]; p < 0.001) and publication entries (Δ = −3.70 ± 0.54; p < 0.001). Independent predictors of cross-applying included IMG (odds ratio [OR]: 7.15; 95% CI: 3.78–13.96; p < 0.001) or DO status (OR = 7.04; 95% CI: 4.37–11.63; p < 0.001), age ≥ 30 (OR = 1.76; 95% CI: 1.32–2.36; p < 0.001), being a reapplicant (OR = 5.35; 95% CI: 3.25–9.08; p < 0.001), and having fewer research experiences (OR = 0.89; 95% CI: 0.86–0.92; p < 0.001).

Conclusion

Cross-applying to other specialties is common for OHNS applicants. These findings illustrate the complexity of the residency application process and the importance of tailored advising for applicants.

Level of Evidence

4.

目的：评估交叉申请耳鼻喉头颈外科（OHNS）和至少一个额外专业的申请人特征。方法：我们分析了2020年至2023年间提交给OHNS住院医师计划的所有美国医学院协会电子住院医师申请服务申请。交叉申请人申请职业健康服务及至少一项其他专业。卡方检验和t检验比较了单纯ohns申请者和交叉申请者的特征。多变量逻辑回归确定了交叉应用的独立预测因子。结果：在2440名OHNS申请者中，交叉申请的占53.0% (N = 1293)，其中以普外科（N = 894, 36.6%）和内科（N = 508, 20.8%）最多。交叉申请人包括大多数国际医学毕业生（IMG, 88.4%），整骨疗法申请人（DO, 86.0%）和30岁或以上的申请人（70.6%）。与仅申请OHNS的学生相比，交叉申请者的研究经历显著减少(差异[Δ] = -1.50±0.11[平均值±标准误差]；pp pp pp p结论：交叉申请其他专业在OHNS申请者中很常见。这些发现说明了住院医师申请过程的复杂性以及为申请人提供量身定制的建议的重要性。证据等级：4。

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引用次数: 0

Feasibility Study of Preoperative CT-Derived Volume and Intraoperative Tissue Mass Measurements for Lymph Node Yield Prediction in Cervical Lymphadenectomy 术前ct体积和术中组织质量测量对颈淋巴清扫手术中淋巴结产量预测的可行性研究。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-19 DOI: 10.1002/lio2.70328

Jerome M. Tullo, Graham M. Tooker, Michael A. Kokko, Daniel W. Shen, Ryan C. Stoner, Brian D. Barnacle, Kwame Wiredu, Travis T. Byrum, Pablo Martínez-Camblor, Darcy A. Kerr, Ryan J. Halter, Joseph A. Paydarfar, David A. Pastel

Background

Standard treatment for oral cavity and oropharyngeal squamous cell carcinoma (SCC) includes cervical lymph node dissection (LND), where lymph node yield (LNY) is directly correlated with survival. Validated preoperative or intraoperative LNY prediction tools are lacking. This pilot study evaluates the feasibility of preoperative CT-derived volume estimates (CTV) of level II–IV neck dissection targets and direct intraoperative mass measurements (IOM) of resected lymphadenectomy specimens as potential tools for LNY prediction.

Methods

12 patients underwent standard-of-care level II–IV cervical LND by a single experienced surgeon with IOM recorded at closure. LNY was recorded using a standard LNY count and an additional comprehensive (CLNY) protocol. A novel segmentation protocol was designed to generate patient-specific level II–IV CTV estimates. Five independent readers tested protocol reliability using the Dice Similarity Coefficient (DSC) for segmentation overlap and the intraclass correlation coefficient (ICC) of CTV measurements. Pearson correlation coefficients (PCC) between IOM CTV and LNY metrics were reported.

Results

This segmentation protocol showed high inter-rater reliability of CTV estimates (ICC = 0.85; 95% CI, 0.70–0.94) and substantial spatial overlap amongst readers (mean DSC = 0.72 ± 0.06). The strongest correlations, for which the study had adequate statistical power, included IOM with CLNY (Pearson correlation coefficient, PCC =0.87; 95% CI, 0.58–0.96) and mean CTV with IOM (PCC = 0.89; 95% CI, 0.65–0.97). Moderate correlations were observed between CTV and CLNY (PCC = 0.70; 95% CI, 0.20–0.91) and between IOM and standard LNY (PCC = 0.73; 95% CI, 0.26–0.92).

Conclusions

The novel segmentation protocol produced reliable CTVs with strong correlation to intraoperative tissue-mass measurements (PCC = 0.89). While IOM showed strong correlation with CLNY (PCC = 0.87), both findings exceeded the threshold for adequate statistical power in this pilot study. The moderate correlations between CTV and LNY metrics (PCC = 0.59–0.70), though statistically significant, were below the study's power threshold and require validation in larger cohorts before conclusions can be drawn about their predictive utility.

背景：口腔和口咽鳞状细胞癌（SCC）的标准治疗包括颈部淋巴结清扫（LND），其中淋巴结产量（LNY）与生存直接相关。缺乏有效的术前或术中LNY预测工具。本初步研究评估了术前ct衍生的II-IV级颈部清扫目标体积估算（CTV）和切除淋巴结标本的直接术中质量测量（IOM）作为预测LNY的潜在工具的可行性。方法：12例患者接受标准护理II-IV级颈椎LND，由一名经验丰富的外科医生完成，手术结束时记录IOM。使用标准LNY计数和附加的综合（CLNY）协议记录LNY。设计了一种新的分割方案来生成患者特定的II-IV级CTV估计。五个独立的读者使用分割重叠的Dice Similarity Coefficient （DSC）和CTV测量的class内相关系数（ICC）来测试协议的可靠性。报告了IOM CTV与LNY指标之间的Pearson相关系数（PCC）。结果：该分割方案显示出较高的码间CTV估计信度（ICC = 0.85; 95% CI, 0.70-0.94）和大量的空间重叠（平均DSC = 0.72±0.06）。相关性最强的包括IOM与CLNY （Pearson相关系数，PCC =0.87; 95% CI, 0.58-0.96）和平均CTV与IOM (PCC = 0.89; 95% CI, 0.65-0.97)，该研究具有足够的统计效力。CTV与CLNY （PCC = 0.70; 95% CI, 0.20-0.91）、IOM与标准LNY （PCC = 0.73; 95% CI, 0.26-0.92）之间存在中度相关性。结论：新的分割方案产生可靠的ctv，与术中组织质量测量有很强的相关性（PCC = 0.89）。虽然IOM与CLNY有很强的相关性（PCC = 0.87），但在本初步研究中，这两个结果都超过了足够统计效力的阈值。CTV和LNY指标之间的中度相关性（PCC = 0.59-0.70）虽然具有统计学意义，但低于研究的能力阈值，需要在更大的队列中进行验证，才能得出关于其预测效用的结论。

{"title":"Feasibility Study of Preoperative CT-Derived Volume and Intraoperative Tissue Mass Measurements for Lymph Node Yield Prediction in Cervical Lymphadenectomy","authors":"Jerome M. Tullo, Graham M. Tooker, Michael A. Kokko, Daniel W. Shen, Ryan C. Stoner, Brian D. Barnacle, Kwame Wiredu, Travis T. Byrum, Pablo Martínez-Camblor, Darcy A. Kerr, Ryan J. Halter, Joseph A. Paydarfar, David A. Pastel","doi":"10.1002/lio2.70328","DOIUrl":"10.1002/lio2.70328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Standard treatment for oral cavity and oropharyngeal squamous cell carcinoma (SCC) includes cervical lymph node dissection (LND), where lymph node yield (LNY) is directly correlated with survival. Validated preoperative or intraoperative LNY prediction tools are lacking. This pilot study evaluates the feasibility of preoperative CT-derived volume estimates (CTV) of level II–IV neck dissection targets and direct intraoperative mass measurements (IOM) of resected lymphadenectomy specimens as potential tools for LNY prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>12 patients underwent standard-of-care level II–IV cervical LND by a single experienced surgeon with IOM recorded at closure. LNY was recorded using a standard LNY count and an additional comprehensive (CLNY) protocol. A novel segmentation protocol was designed to generate patient-specific level II–IV CTV estimates. Five independent readers tested protocol reliability using the Dice Similarity Coefficient (DSC) for segmentation overlap and the intraclass correlation coefficient (ICC) of CTV measurements. Pearson correlation coefficients (PCC) between IOM CTV and LNY metrics were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This segmentation protocol showed high inter-rater reliability of CTV estimates (ICC = 0.85; 95% CI, 0.70–0.94) and substantial spatial overlap amongst readers (mean DSC = 0.72 ± 0.06). The strongest correlations, for which the study had adequate statistical power, included IOM with CLNY (Pearson correlation coefficient, PCC =0.87; 95% CI, 0.58–0.96) and mean CTV with IOM (PCC = 0.89; 95% CI, 0.65–0.97). Moderate correlations were observed between CTV and CLNY (PCC = 0.70; 95% CI, 0.20–0.91) and between IOM and standard LNY (PCC = 0.73; 95% CI, 0.26–0.92).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The novel segmentation protocol produced reliable CTVs with strong correlation to intraoperative tissue-mass measurements (PCC = 0.89). While IOM showed strong correlation with CLNY (PCC = 0.87), both findings exceeded the threshold for adequate statistical power in this pilot study. The moderate correlations between CTV and LNY metrics (PCC = 0.59–0.70), though statistically significant, were below the study's power threshold and require validation in larger cohorts before conclusions can be drawn about their predictive utility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12715779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing the Safety of Endoscopic Sinus Surgery After COVID-19 Infection 评估COVID-19感染后鼻窦内窥镜手术的安全性

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-19 DOI: 10.1002/lio2.70326

Ella Prebel Jackert, Oluwatobiloba Ayo-Ajibola, Eric X. Wei

Objective

This study seeks to characterize the impact of COVID-19 infection on endoscopic sinus surgery (ESS) outcomes.

Methods

The TriNetX database identified patients with chronic rhinosinusitis who underwent ESS from January 1, 2020 to December 31, 2024. Cohorts included patients who had a diagnosis of COVID-19 infection within 2 months before ESS (recent infection), and those who did not. A cohort of those with COVID-19 infection between 2 months and 1 year before ESS (distant infection), was compared to a control without recent or distant infection. Propensity score matching (PSM) controlled for demographics and comorbid conditions. Relative risks (RRs) were calculated to determine risks for postoperative complications and healthcare utilization.

Results

A total of 49,609 patients underwent ESS during the study period. After PSM, there were 10,803 patients with and without recent COVID-19 infection, and 3804 patients with or without distant COVID-19 infection. Recent COVID-19 infection increased the risk of epistaxis [RR: 1.236, 95% CI: (1.036, 1.474)], and nasal congestion [RR: 1.273, 95% CI: (1.016, 1.596)] within 2 months of ESS. There was no difference in risk for major complications identified between any cohort.

Conclusion

Recent COVID-19 infection may increase the risk of post-operative epistaxis, but not major complications, highlighting the overall safety of ESS after recent COVID-19 infection and the importance of considering the timing of COVID-19 infection when evaluating surgical risk and postoperative care needs for ESS patients.

Level of Evidence

Level III.

目的：本研究旨在探讨COVID-19感染对内窥镜鼻窦手术（ESS）结果的影响。方法：TriNetX数据库收集了2020年1月1日至2024年12月31日期间接受ESS治疗的慢性鼻窦炎患者。队列包括ESS前2个月内诊断为COVID-19感染的患者（近期感染）和未诊断为COVID-19感染的患者。将ESS（远处感染）前2个月至1年的COVID-19感染患者与没有近期或远处感染的对照组进行比较。倾向评分匹配（PSM）控制人口统计学和合并症条件。计算相对风险（rr）以确定术后并发症和医疗保健利用的风险。结果：在研究期间，共有49,609例患者接受了ESS。经PSM后，近期感染和无近期感染的患者10803例，远处感染和无远处感染的患者3804例。近期感染COVID-19增加了ESS术后2个月内鼻出血的风险[RR: 1.236, 95% CI:(1.036, 1.474)]和鼻塞的风险[RR: 1.273, 95% CI:(1.016, 1.596)]。在任何队列之间确定的主要并发症的风险没有差异。结论：近期COVID-19感染可能会增加术后鼻出血的风险，但不会增加主要并发症，突出了近期COVID-19感染后ESS的总体安全性，以及在评估ESS患者手术风险和术后护理需求时考虑COVID-19感染时机的重要性。证据等级：三级。

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引用次数: 0

Ability to Adjust Head Position in a 3D-Printed Flexible Nasolaryngoscopy Model Improves Fidelity and Trainee Experience 在3d打印的灵活鼻咽镜模型中调整头部位置的能力提高了保真度和学员体验

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-18 DOI: 10.1002/lio2.70332

Felix E. Fernández-Penny, Anna Christina Clements, Michael Bindschadler, Ezgi Mercan, Huy Le, Tanya K. Meyer, Seth D. Friedman, Maya G. Sardesai

Objectives

To assess the utility of a novel 3D-printed model incorporating user-directed head position adjustments for flexible fiberoptic nasolaryngoscopy (FNL) training and simulation.

Methods

This proof-of-concept study utilized a CT-based, 3D-printed airway model permitting adjustments in head protrusion, flexion, and extension, with associated anatomical changes in oropharyngeal shape. Cervical flexion and atlantoaxial extension (“sniffing position”) represented the optimal head position (OHP) for laryngeal visualization, as determined by attending faculty otolaryngologists. During FNL trials, trainees simulated patient instruction for head adjustment and were asked to indicate their perceived OHP. Standardized photographs of trainees' OHP were taken and compared by training level using fiducial marker-based image analysis. Surveys evaluated trainee experience.

Results

A total of 26 medical students and residents (PGY-1 to PGY-4), completed FNL trials. Senior residents (R3+) showed little variability in their chosen OHP. While intermediate learners (R1–R2) showed the greatest variability in OHP there were no significant differences in final OHP among participants. Trainees rated the helpfulness of positional adjustments 8 ± 1.80 on a 10-point Likert scale.

Conclusions

Head position maneuverability improves fidelity and the FNL training experience. Using the model, participants at all training levels were able to achieve OHPs comparable with experienced practitioners. Greater OHP variability among those with moderate experience suggests this model feature may be used by trainees to optimize technique. This novel model presents an affordable, portable, and easily replicable tool to enhance FNL simulation and training.

目的评估一种新型3d打印模型的实用性，该模型包含用户导向的头部位置调整，用于柔性光纤鼻咽镜（FNL）训练和模拟。方法：本概念验证研究利用基于ct的3d打印气道模型，允许调整头部前伸、屈曲和伸展，并伴有口咽形状的相关解剖变化。颈部屈曲和寰枢关节伸展（“嗅探位”）代表喉部可视化的最佳头部位置（OHP），由主治耳鼻喉科医师确定。在FNL试验中，受训者模拟患者对头部调整的指导，并被要求指出他们感知到的OHP。采用基于基准标记的图像分析方法，对受训者的OHP进行标准化拍照，并按训练水平进行比较。调查评估了实习生的经验。结果共有26名医学生和住院医师（PGY-1 ~ PGY-4）完成了FNL试验。老年居民（R3+）在选择OHP时几乎没有变化。中级学习者（R1-R2）表现出最大的OHP变异，但最终OHP在参与者之间没有显著差异。在10分制的李克特量表中，受训者将体位调整的帮助程度评为8±1.80。结论头部位置机动性提高了保真度和FNL训练体验。使用该模型，所有培训级别的参与者都能够实现与经验丰富的从业人员相当的ohp。具有中等经验的人的OHP变异性较大，这表明该模型特征可被学员用于优化技术。这种新颖的模型提供了一种负担得起的、便携式的、易于复制的工具，以增强FNL的模拟和训练。

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引用次数: 0