Ali B. Jafar, Ghabrielle Almeida, Fatima Al Mousawi, Eric Delgado Rendon, Amber U. Luong
Background
Olfactory dysfunction significantly impairs quality of life. Conventional treatments such as corticosteroids and olfactory training offer limited and inconsistent efficacy. Platelet-rich plasma (PRP), a biologically active agent, has shown potential regenerative effects in olfactory neuroepithelium. This study systematically evaluates the efficacy of PRP compared to placebo in improving olfactory function.
Methods
A systematic review and meta-analysis was conducted according to PRISMA guidelines and was registered in PROSPERO (CRD 420251045079). The databases searched included PubMed, Scopus, Embase, Central, and Web of Science. Seven studies (four RCTs, three non-RCTs) involving 789 patients were included. Subjective and objective outcomes were extracted and pooled using a random-effects model. Risk of bias was assessed using ROB-2 and ROBIN-I tools.
Results
PRP was significantly more effective than placebo in improving subjective olfactory scores at 1 month (SMD = 1.16, 95% CI [0.29–2.03], p = 0.009), 3 months (SMD = 0.29, 95% CI [0.07–0.50], p = 0.01), and 12 months (SMD = 1.47, 95% CI [1.06–1.89], p = 0.00001). Objective testing also favored PRP at all timepoints, including 1 month (SMD = 1.55, 95% CI [0.36–2.73], p = 0.01), 3 months (SMD = 0.44, 95% CI [0.05–0.82], p = 0.03), and 12 months (SMD = 2.42, 95% CI [0.35–4.5], p = 0.02). Subgroup analysis showed younger age (< 40 years old) was associated with greater improvements. The safety profile was favorable with no serious adverse events reported.
Conclusion
PRP demonstrates both short- and long-term benefits in olfactory recovery compared to placebo, especially among younger adults. Given the promising results and safety profile, PRP represents a viable treatment option for olfactory dysfunction. Standardization of PRP protocols and further high-quality RCTs need to be further explored.
背景：嗅觉功能障碍显著影响生活质量。常规治疗如皮质类固醇和嗅觉训练的效果有限且不一致。富血小板血浆（PRP）是一种生物活性物质，在嗅觉神经上皮中具有潜在的再生作用。本研究系统地评价了PRP与安慰剂在改善嗅觉功能方面的疗效。方法：根据PRISMA指南进行系统评价和荟萃分析，并在PROSPERO注册（CRD 420251045079）。检索的数据库包括PubMed、Scopus、Embase、Central和Web of Science。纳入7项研究（4项随机对照试验，3项非随机对照试验），涉及789例患者。使用随机效应模型提取并汇总主观和客观结果。使用rob2和ROBIN-I工具评估偏倚风险。结果：PRP在改善1个月（SMD = 1.16, 95% CI [0.29-2.03], p = 0.009）、3个月（SMD = 0.29, 95% CI [0.07-0.50], p = 0.01）和12个月（SMD = 1.47, 95% CI [1.06-1.89], p = 0.00001）的主观嗅觉评分方面明显优于安慰剂。客观检验在所有时间点也支持PRP，包括1个月（SMD = 1.55, 95% CI [0.36-2.73], p = 0.01）、3个月（SMD = 0.44, 95% CI [0.05-0.82], p = 0.03）和12个月（SMD = 2.42, 95% CI [0.35-4.5], p = 0.02）。亚组分析显示年龄更小(结论：与安慰剂相比，PRP在嗅觉恢复方面表现出短期和长期的益处，尤其是在年轻人中。鉴于有希望的结果和安全性，PRP代表了嗅觉功能障碍的可行治疗选择。PRP方案的标准化和更高质量的随机对照试验需要进一步探索。
{"title":"Efficacy of Platelet Rich Plasma Versus Placebo for Improvement in Olfactory Function in Adults With Olfactory Dysfunction: A Systematic Review and Meta-Analysis","authors":"Ali B. Jafar, Ghabrielle Almeida, Fatima Al Mousawi, Eric Delgado Rendon, Amber U. Luong","doi":"10.1002/lio2.70317","DOIUrl":"10.1002/lio2.70317","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Olfactory dysfunction significantly impairs quality of life. Conventional treatments such as corticosteroids and olfactory training offer limited and inconsistent efficacy. Platelet-rich plasma (PRP), a biologically active agent, has shown potential regenerative effects in olfactory neuroepithelium. This study systematically evaluates the efficacy of PRP compared to placebo in improving olfactory function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis was conducted according to PRISMA guidelines and was registered in PROSPERO (CRD 420251045079). The databases searched included PubMed, Scopus, Embase, Central, and Web of Science. Seven studies (four RCTs, three non-RCTs) involving 789 patients were included. Subjective and objective outcomes were extracted and pooled using a random-effects model. Risk of bias was assessed using ROB-2 and ROBIN-I tools.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PRP was significantly more effective than placebo in improving subjective olfactory scores at 1 month (SMD = 1.16, 95% CI [0.29–2.03], <i>p</i> = 0.009), 3 months (SMD = 0.29, 95% CI [0.07–0.50], <i>p</i> = 0.01), and 12 months (SMD = 1.47, 95% CI [1.06–1.89], <i>p</i> = 0.00001). Objective testing also favored PRP at all timepoints, including 1 month (SMD = 1.55, 95% CI [0.36–2.73], <i>p</i> = 0.01), 3 months (SMD = 0.44, 95% CI [0.05–0.82], <i>p</i> = 0.03), and 12 months (SMD = 2.42, 95% CI [0.35–4.5], <i>p</i> = 0.02). Subgroup analysis showed younger age (< 40 years old) was associated with greater improvements. The safety profile was favorable with no serious adverse events reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PRP demonstrates both short- and long-term benefits in olfactory recovery compared to placebo, especially among younger adults. Given the promising results and safety profile, PRP represents a viable treatment option for olfactory dysfunction. Standardization of PRP protocols and further high-quality RCTs need to be further explored.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775969","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}
Basir S. Mansoor, Matthew Zhang, Stephen Chorney, Yann-Fuu Kou, Cynthia S. Wang, Rebecca Brooks, Romaine F. Johnson
Objective
To evaluate the effect of multidisciplinary tracheostomy team (MDT) interventions on emergency department utilization in pediatric patients with tracheostomy.
Methods
This retrospective cohort study analyzed a prospective registry of 364 children who underwent tracheostomy from 2015 to 2023 at a single tertiary pediatric center. The study period encompassed pre-intervention, post-intervention pre-COVID, COVID-19, and post-COVID recovery phases. Primary outcomes were time to ED visits and ED visit frequency, analyzed using parametric survival analysis and mixed-effects negative binomial regression.
Results
Among 364 patients (mean age 3.5 ± 5.4 years; 53% male), MDT implementation was associated with a 50% reduction in ED visit rates (incidence rate ratio 0.50, 95% CI: 0.43–0.57, p < 0.001) during the post-intervention, pre-COVID period. Benefits sustained through COVID (65% reduction) and post-COVID recovery (91% reduction). Time to first ED visit increased significantly across post-intervention periods (post-intervention, pre-COVID: time ratio 1.22, 95% CI: 1.12–1.32, p < 0.001; post-COVID recovery: time ratio 1.25, 95% CI: 1.11–1.40, p < 0.001). During median follow-up of 2.8 years, 1056 of 1842 total encounters (57%) involved ED visits. Respiratory conditions accounted for 34% of ED visits. Hispanic ethnicity (time ratio 0.88, p = 0.003) and respiratory-related visits (time ratio 0.78, p < 0.001) were associated with shorter return intervals but did not affect overall visit frequency.
Conclusion
MDTs were associated with sustained 50% reductions in pediatric ED utilization, with reductions continuing through the COVID-19 pandemic.
Levels of Evidence
3.
目的：评价多学科气管切开术团队（MDT）干预对儿科气管切开术患者急诊科使用率的影响。方法：本回顾性队列研究分析了2015年至2023年在一家三级儿科中心接受气管切开术的364名儿童的前瞻性登记。研究期间包括干预前、干预后、干预前、COVID-19和COVID-19后恢复阶段。主要结局为ED就诊时间和ED就诊频率，采用参数生存分析和混合效应负二项回归进行分析。结果：在364例患者（平均年龄3.5±5.4岁，53%为男性）中，MDT实施与急诊科就诊率降低50%（发病率比0.50,95% CI: 0.43-0.57, p p p p = 0.003）和呼吸相关就诊（时间比0.78,p）相关。结论：MDT与儿科急诊科使用率持续降低50%相关，并在COVID-19大流行期间持续降低。证据等级：3。
{"title":"Multidisciplinary Tracheostomy Teams Reduce Emergency Department Utilization in Pediatric Patients: A Retrospective Cohort Study","authors":"Basir S. Mansoor, Matthew Zhang, Stephen Chorney, Yann-Fuu Kou, Cynthia S. Wang, Rebecca Brooks, Romaine F. Johnson","doi":"10.1002/lio2.70327","DOIUrl":"10.1002/lio2.70327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the effect of multidisciplinary tracheostomy team (MDT) interventions on emergency department utilization in pediatric patients with tracheostomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed a prospective registry of 364 children who underwent tracheostomy from 2015 to 2023 at a single tertiary pediatric center. The study period encompassed pre-intervention, post-intervention pre-COVID, COVID-19, and post-COVID recovery phases. Primary outcomes were time to ED visits and ED visit frequency, analyzed using parametric survival analysis and mixed-effects negative binomial regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 364 patients (mean age 3.5 ± 5.4 years; 53% male), MDT implementation was associated with a 50% reduction in ED visit rates (incidence rate ratio 0.50, 95% CI: 0.43–0.57, <i>p</i> < 0.001) during the post-intervention, pre-COVID period. Benefits sustained through COVID (65% reduction) and post-COVID recovery (91% reduction). Time to first ED visit increased significantly across post-intervention periods (post-intervention, pre-COVID: time ratio 1.22, 95% CI: 1.12–1.32, <i>p</i> < 0.001; post-COVID recovery: time ratio 1.25, 95% CI: 1.11–1.40, <i>p</i> < 0.001). During median follow-up of 2.8 years, 1056 of 1842 total encounters (57%) involved ED visits. Respiratory conditions accounted for 34% of ED visits. Hispanic ethnicity (time ratio 0.88, <i>p</i> = 0.003) and respiratory-related visits (time ratio 0.78, <i>p</i> < 0.001) were associated with shorter return intervals but did not affect overall visit frequency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MDTs were associated with sustained 50% reductions in pediatric ED utilization, with reductions continuing through the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Levels of Evidence</h3>\u0000 \u0000 <p>3.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769697","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}
Ghedak Ansari, Jeanne A. Darbinian, Samuel A. Collazo, Nikolas R. Block-Wheeler, Megan L. Durr
Objective
In adult patients who undergo soft tissue and maxillomandibular advancement (MMA) sleep surgery for obstructive sleep apnea (OSA), we identify preoperative pain diagnoses and postoperative pain medication dispensing patterns by surgery type.
Methods
This retrospective cohort chart review study examines adults who underwent sleep surgery for OSA at an integrated healthcare delivery system (2009–2017). Data obtained from electronic sources included demographics, surgery type, presentation to the emergency department, hospital readmission, and postoperative medication dispensings.
Results
A total of 2287 adult patients were identified. The average age at surgery was 40.8 ± 12.5 years. Surgeries performed included (n, %) uvulopalatopharyngoplasty (1312, 57.3%) tonsillectomy (577, 25.2%), genioglossus muscle advancement (GA) alone or combined with MMA (108, 4.7%) and MMA alone (170, 7.4%), adenoidectomy (60, 2.6%), tongue and palate surgery (54, 2.4%), and tongue reduction (6, 0.3%). A total of 811 (35.5%) had a preoperative pain-related diagnosis, and 336 (14.7%) had a preoperative diagnosis of depression. Of the total cohort, 912 (39.9%) had a preoperative opioid prescription. In our cohort, 91.7% were prescribed outpatient opioid medication postoperatively. This varied by surgery type, with the highest proportion of opioid prescription dispensings observed in the soft tissue surgery group (non-MMA ± GA) and the lowest in the maxillofacial surgery group (MMA ± GA). In contrast, the maxillofacial surgery group had the highest proportion of nonopioid prescriptions dispensed, while the soft tissue surgery group had the lowest.
Conclusions
Non-hypoglossal nerve stimulation (non-HGNS) sleep surgery for OSA is associated with high (nearly 92%) postoperative opioid dispensings. Adult patients undergoing non-HGNS sleep surgery are likely at increased risk of opioid complications given the high prevalence of preoperative opioid use, chronic pain, and depression.
{"title":"Role of Pain in Adults Undergoing Soft Tissue and Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea","authors":"Ghedak Ansari, Jeanne A. Darbinian, Samuel A. Collazo, Nikolas R. Block-Wheeler, Megan L. Durr","doi":"10.1002/lio2.70322","DOIUrl":"10.1002/lio2.70322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In adult patients who undergo soft tissue and maxillomandibular advancement (MMA) sleep surgery for obstructive sleep apnea (OSA), we identify preoperative pain diagnoses and postoperative pain medication dispensing patterns by surgery type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort chart review study examines adults who underwent sleep surgery for OSA at an integrated healthcare delivery system (2009–2017). Data obtained from electronic sources included demographics, surgery type, presentation to the emergency department, hospital readmission, and postoperative medication dispensings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2287 adult patients were identified. The average age at surgery was 40.8 ± 12.5 years. Surgeries performed included (<i>n</i>, %) uvulopalatopharyngoplasty (1312, 57.3%) tonsillectomy (577, 25.2%), genioglossus muscle advancement (GA) alone or combined with MMA (108, 4.7%) and MMA alone (170, 7.4%), adenoidectomy (60, 2.6%), tongue and palate surgery (54, 2.4%), and tongue reduction (6, 0.3%). A total of 811 (35.5%) had a preoperative pain-related diagnosis, and 336 (14.7%) had a preoperative diagnosis of depression. Of the total cohort, 912 (39.9%) had a preoperative opioid prescription. In our cohort, 91.7% were prescribed outpatient opioid medication postoperatively. This varied by surgery type, with the highest proportion of opioid prescription dispensings observed in the soft tissue surgery group (non-MMA ± GA) and the lowest in the maxillofacial surgery group (MMA ± GA). In contrast, the maxillofacial surgery group had the highest proportion of nonopioid prescriptions dispensed, while the soft tissue surgery group had the lowest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Non-hypoglossal nerve stimulation (non-HGNS) sleep surgery for OSA is associated with high (nearly 92%) postoperative opioid dispensings. Adult patients undergoing non-HGNS sleep surgery are likely at increased risk of opioid complications given the high prevalence of preoperative opioid use, chronic pain, and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769691","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}
Sandhya Ganesan, Sharwani Kota, Sana Smaoui, Tyler P. Tufano, Leena Zitoun, Arjun Joshi, Punam Thakkar
Introduction
The treatment of laryngeal cancer often results in alterations of speech and swallowing, which may contribute to the development of depression in this patient population and subsequently affect treatment outcomes and survivorship. This study aims to determine the prevalence of depression in patients with laryngeal cancer and identify contributing risk factors.
Methods
Patients with laryngeal cancer were identified using ICD-10 codes within the TriNetX Research Network. Patients were stratified by treatment type (surgical versus non-surgical), age, socioeconomic (SES) risk factors, and post-treatment side effects. The effect of these factors on the development of depression was analyzed while controlling for cancer stage.
Results
Briefly, 93,018 patients with laryngeal cancer were identified. These patients had a significantly higher risk of depression compared to the overall head and neck cancer population (RR = 1.15, 95% CI: [1.12, 1.18]). Patients under 70 were more likely to develop depression than those over 70 (RR = 1.27, 95% CI: [1.22, 1.33]). SES risk factors were associated with over double the risk of depression (RR = 2.67, 95% CI: [2.42, 2.97]). Surgical treatment conferred a higher risk than non-surgical treatment modalities (RR = 1.54, 95% CI: [1.41, 1.68]). Patients who experienced long-term complications such as dysphagia, xerostomia, or malnutrition had a 7.62% increased risk of depression (p < 0.01).
Conclusions
Patients with laryngeal cancer face a uniquely high risk of developing post-treatment depression. Future studies evaluating optimal screening protocols and supportive care strategies may help improve mental health care in this population.
{"title":"Depression Among Patients With Laryngeal Cancer: A Retrospective Cohort Study","authors":"Sandhya Ganesan, Sharwani Kota, Sana Smaoui, Tyler P. Tufano, Leena Zitoun, Arjun Joshi, Punam Thakkar","doi":"10.1002/lio2.70325","DOIUrl":"https://doi.org/10.1002/lio2.70325","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The treatment of laryngeal cancer often results in alterations of speech and swallowing, which may contribute to the development of depression in this patient population and subsequently affect treatment outcomes and survivorship. This study aims to determine the prevalence of depression in patients with laryngeal cancer and identify contributing risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with laryngeal cancer were identified using ICD-10 codes within the TriNetX Research Network. Patients were stratified by treatment type (surgical versus non-surgical), age, socioeconomic (SES) risk factors, and post-treatment side effects. The effect of these factors on the development of depression was analyzed while controlling for cancer stage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Briefly, 93,018 patients with laryngeal cancer were identified. These patients had a significantly higher risk of depression compared to the overall head and neck cancer population (RR = 1.15, 95% CI: [1.12, 1.18]). Patients under 70 were more likely to develop depression than those over 70 (RR = 1.27, 95% CI: [1.22, 1.33]). SES risk factors were associated with over double the risk of depression (RR = 2.67, 95% CI: [2.42, 2.97]). Surgical treatment conferred a higher risk than non-surgical treatment modalities (RR = 1.54, 95% CI: [1.41, 1.68]). Patients who experienced long-term complications such as dysphagia, xerostomia, or malnutrition had a 7.62% increased risk of depression (<i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with laryngeal cancer face a uniquely high risk of developing post-treatment depression. Future studies evaluating optimal screening protocols and supportive care strategies may help improve mental health care in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739606","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}
Matin Ghazizadeh, Behrouz Barati, Mohammad Moini, Homeira Mansurzadeh
Introduction
The study was designed to compare the final long-term outcomes of septoplasty with and without unilateral pyriform plasty on the concave side in patients with septal deviation.
Materials and Methods
A randomized clinical trial was conducted from 2020 to 2023. Patients were randomly divided into two groups of 30. The control group underwent septoplasty alone (without pyriform plasty). Septoplasty with pyriform plasty was performed for the intervention group. The patient's subjective feelings were compared using the NOSE questionnaire pre- and post-operatively. Six months after surgery, the patients were evaluated objectively using rhinomanometry.
Results
The mean age of the patients was 37.07 ± 10.39 years. Based on the rhinomanometry evaluation, the amounts of airflow in the intervention and control groups were 791.23 ± 113.14 (cm3/s) and 665.44 ± 101.03 (p < 0.001), respectively. Also, the resistance level was 0.20 ± 0.04 (Pa/cm3/s) in the intervention group and 0.23 ± 0.05 (Pa/cm3/s) in the control group (p = 0.036). Among evaluated symptoms, significant improvement in nasal obstruction was detected in the intervention group (p = 0.044).
Conclusion
Although septoplasty improved the patient's clinical condition by increasing nasal airflow and decreasing airflow resistance, septoplasty with pyriform plasty on the concave side significantly resulted in more favorable outcomes.
{"title":"Pyriform Plasty as an Adjunct to Septoplasty: A Double-Blind Randomized Trial in Patients With Septal Deviation","authors":"Matin Ghazizadeh, Behrouz Barati, Mohammad Moini, Homeira Mansurzadeh","doi":"10.1002/lio2.70324","DOIUrl":"https://doi.org/10.1002/lio2.70324","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The study was designed to compare the final long-term outcomes of septoplasty with and without unilateral pyriform plasty on the concave side in patients with septal deviation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A randomized clinical trial was conducted from 2020 to 2023. Patients were randomly divided into two groups of 30. The control group underwent septoplasty alone (without pyriform plasty). Septoplasty with pyriform plasty was performed for the intervention group. The patient's subjective feelings were compared using the NOSE questionnaire pre- and post-operatively. Six months after surgery, the patients were evaluated objectively using rhinomanometry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of the patients was 37.07 ± 10.39 years. Based on the rhinomanometry evaluation, the amounts of airflow in the intervention and control groups were 791.23 ± 113.14 (cm<sup>3</sup>/s) and 665.44 ± 101.03 (<i>p</i> < 0.001), respectively. Also, the resistance level was 0.20 ± 0.04 (Pa/cm<sup>3</sup>/s) in the intervention group and 0.23 ± 0.05 (Pa/cm<sup>3</sup>/s) in the control group (<i>p</i> = 0.036). Among evaluated symptoms, significant improvement in nasal obstruction was detected in the intervention group (<i>p</i> = 0.044).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although septoplasty improved the patient's clinical condition by increasing nasal airflow and decreasing airflow resistance, septoplasty with pyriform plasty on the concave side significantly resulted in more favorable outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>2.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739581","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}
Erik Appelberg, Sanna Viitasalo, Saku Tapani Sinkkonen
Objectives
To study whether patient self-recorded digital otoscopy (PDO) is a reliable diagnostic tool in otologic remote consultations.
Methods
Based on real-life referrals, 45 otologic outpatients were recruited. The patients were shown an instructional video on the use of a digital otoscope. After the tutorial, they recorded a short video of their ears. For comparison, digital otoscopy (DO) was performed by an ENT resident, and the patient was examined in person by an otologist. The recordings were evaluated by otologists, general otolaryngologists and ENT residents. The recordings were evaluated for their quality, usefulness in remote consultations, diagnostic accuracy, and observers' confidence in setting the diagnosis.
Results
The average PDO quality was 5.2 ± 2.5 (mean ± SEM; scale of 1–10). The ENT resident recorded DO (RDO) quality was 6.6 ± 2.3 (mean ± SEM; scale of 1–10). The diagnosis was correct in 48.4% of the PDO cases and in 63.5% of the RDO cases. The diagnostic accuracy varied significantly across different pathologies.
Conclusions
The overall quality of PDOs is satisfactory, although inferior to that of RDOs. The diagnostic accuracy of PDOs was comparable to that of RDOs for certain pathologies, highlighting that self-recorded DO may be used for remote consultations with limitations. Digital otoscopes could be used by general practitioners and nurses to facilitate otologic remote consultations.
{"title":"Patient Self-Recorded Digital Otoscopy in Otology Diagnostics","authors":"Erik Appelberg, Sanna Viitasalo, Saku Tapani Sinkkonen","doi":"10.1002/lio2.70318","DOIUrl":"10.1002/lio2.70318","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To study whether patient self-recorded digital otoscopy (PDO) is a reliable diagnostic tool in otologic remote consultations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Based on real-life referrals, 45 otologic outpatients were recruited. The patients were shown an instructional video on the use of a digital otoscope. After the tutorial, they recorded a short video of their ears. For comparison, digital otoscopy (DO) was performed by an ENT resident, and the patient was examined in person by an otologist. The recordings were evaluated by otologists, general otolaryngologists and ENT residents. The recordings were evaluated for their quality, usefulness in remote consultations, diagnostic accuracy, and observers' confidence in setting the diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average PDO quality was 5.2 ± 2.5 (mean ± SEM; scale of 1–10). The ENT resident recorded DO (RDO) quality was 6.6 ± 2.3 (mean ± SEM; scale of 1–10). The diagnosis was correct in 48.4% of the PDO cases and in 63.5% of the RDO cases. The diagnostic accuracy varied significantly across different pathologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The overall quality of PDOs is satisfactory, although inferior to that of RDOs. The diagnostic accuracy of PDOs was comparable to that of RDOs for certain pathologies, highlighting that self-recorded DO may be used for remote consultations with limitations. Digital otoscopes could be used by general practitioners and nurses to facilitate otologic remote consultations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>3.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679225","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}
Raj Patel, Daaren Bukhari, Sullivan Smith, Luis Rubio, Amy Pittman
Objective
The main objective of this scoping review was to identify various surgical techniques used to treat nasal airway obstruction Caused by facial paralysis and summarize available outcome data for these techniques.
Data Sources
A literature search was conducted using Medline (PubMed) and Embase to find clinical studies on nasal obstruction and facial paralysis from their inception to April 2024.
Review Methods
Literature was reviewed for studies that investigated the surgical treatment for nasal valve obstruction in patients experiencing facial paralysis. A search was conducted using PubMed and Embase. The search yielded 82 articles that described nasal obstruction correction. Abstract analysis narrowed the selection to seven papers. The criteria entailed studies that described patients undergoing surgical intervention in treating nasal obstruction due to facial paralysis and had subjective or objective outcome measures. Any study that addressed nasal obstruction not caused by facial paralysis was excluded.
Results
Fascia lata sling and suture suspension improved NOSE scores by 21 and 31 points, respectively. Subjective symptom relief ranged from 77% to 100%, with fascia lata sling showing consistent 100% improvement. Complication rates were lowest with fascia lata sling, at 4.3%, and highest with suture suspension, at 23.5%. Revision rates were 1.5% for fascia lata and 14.1% for suture suspension.
Conclusions
Surgical correction of nasal valve obstruction in facial paralysis requires unique considerations. Further studies are necessary to determine the safest and most effective options for treating this unique problem.
{"title":"A Scoping Review of Surgical Interventions for Nasal Valve Obstruction in Facial Paralysis","authors":"Raj Patel, Daaren Bukhari, Sullivan Smith, Luis Rubio, Amy Pittman","doi":"10.1002/lio2.70301","DOIUrl":"https://doi.org/10.1002/lio2.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The main objective of this scoping review was to identify various surgical techniques used to treat nasal airway obstruction Caused by facial paralysis and summarize available outcome data for these techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>A literature search was conducted using Medline (PubMed) and Embase to find clinical studies on nasal obstruction and facial paralysis from their inception to April 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Review Methods</h3>\u0000 \u0000 <p>Literature was reviewed for studies that investigated the surgical treatment for nasal valve obstruction in patients experiencing facial paralysis. A search was conducted using <i>PubMed</i> and <i>Embase</i>. The search yielded 82 articles that described nasal obstruction correction. Abstract analysis narrowed the selection to seven papers. The criteria entailed studies that described patients undergoing surgical intervention in treating nasal obstruction due to facial paralysis and had subjective or objective outcome measures. Any study that addressed nasal obstruction not caused by facial paralysis was excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fascia lata sling and suture suspension improved NOSE scores by 21 and 31 points, respectively. Subjective symptom relief ranged from 77% to 100%, with fascia lata sling showing consistent 100% improvement. Complication rates were lowest with fascia lata sling, at 4.3%, and highest with suture suspension, at 23.5%. Revision rates were 1.5% for fascia lata and 14.1% for suture suspension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Surgical correction of nasal valve obstruction in facial paralysis requires unique considerations. Further studies are necessary to determine the safest and most effective options for treating this unique problem.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619144","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}
Grace Zhang, Nicholas Hutchins, Siddhant Tripathi, Eric Wong, Jack Garcia, Abigail Haslinger, Eugene Cho, Yash Patil
Objective
To understand how metabolic health influences surgical success and improves prognostication in head and neck cancer reconstruction.
Methods
Retrospective cohort study. Chart review was performed on patients that underwent head and neck microvascular reconstruction by a single surgeon between 2010 and 2022. Demographic, postoperative complications, and long-term patient outcomes were collected. Patients were divided into cohorts based on the diagnosis of DM, hypertension, and BMI > 25. Those with all three comorbidities constituted the metabolic dysfunction (MetD) cohort, while the remainder group constituted the non-MetD cohort. The non-MetD group was divided into a control sub-cohort of patients with none of the three comorbidities. Outcomes were compared between groups. Postoperative complications were compared using student's t-test, chi-square test, and Fisher Exact Test.
Results
Data was available for 926 patients distributed in MetD (91), non-MetD (835), and the control (226) cohorts; the MetD was significantly older (p < 0.01) with a higher BMI (p < 0.01). There were no differences in postoperative outcomes between the two cohorts. When comparing the MetD to the control, the MetD was again significantly older (p < 0.01) with a higher BMI (p < 0.01). Although the MetD had a significantly greater incidence of wound complications (p = 0.02) compared to the control, there were no other clinical differences between the two groups.
Conclusion
Our study showed that within our single-surgeon population, patients with diagnosed hypertension, DM, and BMI > 25 did not experience a significantly greater incidence of most postoperative complications compared to patients without those co-morbidities after head and neck microvascular reconstruction.
{"title":"Complications of Metabolic Dysfunction in Head and Neck Microvascular Reconstruction","authors":"Grace Zhang, Nicholas Hutchins, Siddhant Tripathi, Eric Wong, Jack Garcia, Abigail Haslinger, Eugene Cho, Yash Patil","doi":"10.1002/lio2.70290","DOIUrl":"https://doi.org/10.1002/lio2.70290","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand how metabolic health influences surgical success and improves prognostication in head and neck cancer reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study. Chart review was performed on patients that underwent head and neck microvascular reconstruction by a single surgeon between 2010 and 2022. Demographic, postoperative complications, and long-term patient outcomes were collected. Patients were divided into cohorts based on the diagnosis of DM, hypertension, and BMI > 25. Those with all three comorbidities constituted the metabolic dysfunction (MetD) cohort, while the remainder group constituted the non-MetD cohort. The non-MetD group was divided into a control sub-cohort of patients with none of the three comorbidities. Outcomes were compared between groups. Postoperative complications were compared using student's <i>t</i>-test, chi-square test, and Fisher Exact Test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data was available for 926 patients distributed in MetD (91), non-MetD (835), and the control (226) cohorts; the MetD was significantly older (<i>p</i> < 0.01) with a higher BMI (<i>p</i> < 0.01). There were no differences in postoperative outcomes between the two cohorts. When comparing the MetD to the control, the MetD was again significantly older (<i>p</i> < 0.01) with a higher BMI (<i>p</i> < 0.01). Although the MetD had a significantly greater incidence of wound complications (<i>p</i> = 0.02) compared to the control, there were no other clinical differences between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study showed that within our single-surgeon population, patients with diagnosed hypertension, DM, and BMI > 25 did not experience a significantly greater incidence of most postoperative complications compared to patients without those co-morbidities after head and neck microvascular reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level 4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619141","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}
Austin J. Lee, Michael W. Liu, David C. Kaelber, Mohamad R. Chaaban
Objective
While cannabis' link to asthma is well-studied, its impact on CRS is less clear. This study explores the association between cannabis use and rates of new-onset chronic rhinosinusitis (CRS), chronic rhinosinusitis with nasal polyps (CRSwNP), and functional endoscopic sinus surgery (FESS) rates.
Methods
The TriNetX Analytics Research Network was queried for adults ≥ 18 years old, stratified into cannabis user and non-user cohorts based on electronic health record data from January 2012 to December 2019. Separate cohorts of patients with pre-existing CRS—with and without cannabis use—were analyzed to evaluate associations with FESS. Primary outcomes were relative risks of new-onset CRS and CRSwNP encounter diagnosis and FESS 1, 2, and 5 years after initial cannabis use diagnosis.
Results
After 1:1 propensity score matching, cohorts analyzing CRS and CRSwNP included 73,091 patients each. Cannabis use was associated with reduced risk of unspecified CRS at 1 year (aRR = 0.87, 95% CI 0.80–0.95), 2 years (aRR = 0.84, 95% CI 0.78–0.90), and 5 years (aRR = 0.83, 95% CI 0.78–0.87). There was no difference in risk of CRSwNP at any timepoints. For FESS outcomes, matched cohorts included 5591 patients with pre-existing CRS; cannabis users had lower risk at 1 year (aRR = 0.67, 95% CI 0.47–0.96), 2 years (aRR = 0.64, 95% CI 0.46–0.88), and 5 years (aRR = 0.69, 95% CI 0.52–0.91).
Conclusions
Patients with cannabis use demonstrated significantly reduced risks in new-onset diagnoses of CRS and FESS compared to non-users. Further studies are warranted to examine the cause of this relationship.
Level of Evidence
4.
虽然大麻与哮喘的关系已被充分研究，但其对CRS的影响尚不清楚。本研究探讨了大麻使用与新发慢性鼻窦炎（CRS）、慢性鼻窦炎伴鼻息肉（CRSwNP）和功能性内窥镜鼻窦手术（FESS）发生率之间的关系。方法根据2012年1月至2019年12月的电子健康记录数据，对TriNetX分析研究网络中≥18岁的成年人进行查询，分为大麻使用者和非大麻使用者队列。对既往存在crs的患者（有和没有使用大麻）进行单独队列分析，以评估与FESS的关系。主要结局是首次使用大麻诊断后1、2和5年新发CRS和CRSwNP遭遇诊断和FESS的相对风险。结果经1:1倾向评分匹配后，分析CRS和CRSwNP的队列各纳入73091例患者。大麻使用与1年（aRR = 0.87, 95% CI 0.80-0.95）、2年（aRR = 0.84, 95% CI 0.78-0.90）和5年（aRR = 0.83, 95% CI 0.78-0.87）发生未指定CRS的风险降低相关。在任何时间点CRSwNP的风险均无差异。对于FESS结果，匹配队列包括5591例既往CRS患者；大麻使用者在1年（aRR = 0.67, 95% CI 0.47-0.96）、2年（aRR = 0.64, 95% CI 0.46-0.88）和5年（aRR = 0.69, 95% CI 0.52-0.91）时的风险较低。结论与非大麻使用者相比，大麻使用者在新发CRS和FESS诊断中的风险显著降低。有必要进一步研究这种关系的原因。证据级别4。
{"title":"Cannabis Use and Risk of Chronic Rhinosinusitis and Sinus Surgery","authors":"Austin J. Lee, Michael W. Liu, David C. Kaelber, Mohamad R. Chaaban","doi":"10.1002/lio2.70320","DOIUrl":"https://doi.org/10.1002/lio2.70320","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>While cannabis' link to asthma is well-studied, its impact on CRS is less clear. This study explores the association between cannabis use and rates of new-onset chronic rhinosinusitis (CRS), chronic rhinosinusitis with nasal polyps (CRSwNP), and functional endoscopic sinus surgery (FESS) rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The TriNetX Analytics Research Network was queried for adults ≥ 18 years old, stratified into cannabis user and non-user cohorts based on electronic health record data from January 2012 to December 2019. Separate cohorts of patients with pre-existing CRS—with and without cannabis use—were analyzed to evaluate associations with FESS. Primary outcomes were relative risks of new-onset CRS and CRSwNP encounter diagnosis and FESS 1, 2, and 5 years after initial cannabis use diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 1:1 propensity score matching, cohorts analyzing CRS and CRSwNP included 73,091 patients each. Cannabis use was associated with reduced risk of unspecified CRS at 1 year (aRR = 0.87, 95% CI 0.80–0.95), 2 years (aRR = 0.84, 95% CI 0.78–0.90), and 5 years (aRR = 0.83, 95% CI 0.78–0.87). There was no difference in risk of CRSwNP at any timepoints. For FESS outcomes, matched cohorts included 5591 patients with pre-existing CRS; cannabis users had lower risk at 1 year (aRR = 0.67, 95% CI 0.47–0.96), 2 years (aRR = 0.64, 95% CI 0.46–0.88), and 5 years (aRR = 0.69, 95% CI 0.52–0.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with cannabis use demonstrated significantly reduced risks in new-onset diagnoses of CRS and FESS compared to non-users. Further studies are warranted to examine the cause of this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619191","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}
Matthew Zhang, Basir Mansoor, Marlaine Frelier, Cynthia Wang, Yann-Fuu Kou, Stephen R Chorney, Romaine Johnson
Objectives
To develop and validate a risk stratification model for postoperative dysphagia in pediatric cardiac surgery patients, focusing on factors relevant to otolaryngologic assessment and implications for Otolaryngology management.
Methods
Analysis of 174 pediatric patients undergoing cardiac surgery at a tertiary care center between January 1, 2022 and December 31, 2023. Logistic regression was used to develop a risk score based on preoperative and intraoperative factors. Patients were categorized into low, moderate, and high-risk groups for dysphagia requiring Otolaryngology consultation. Secondary outcomes included impaired vocal fold mobility.
Results
Of 174 patients, postoperative dysphagia necessitating Otolaryngology evaluation was identified in 102 (58.6%) children. The final predictive model included age at surgery (OR, 0.80; 95% CI, 0.72–0.90; p < 0.001), cardiopulmonary bypass duration (OR, 1.73; 95% CI, 1.23–2.45; p = 0.002), and high-risk complex procedures (e.g., Norwood) (OR, 6.49; 95% CI, 2.70–15.61; p < 0.001). Model discrimination was good (AUC 0.82). Predicted risk categories showed distinct dysphagia rates among the cohort: low-risk (24.7% of the cohort, with 30.2% experiencing dysphagia), moderate-risk (31.6%, with 38.2% experiencing dysphagia), and high-risk (43.7%, with 89.5% experiencing dysphagia). Among high-risk patients, 70.6% exhibited impaired vocal fold mobility at long-term follow-up.
Conclusion
This Otolaryngology-focused risk stratification model identifies pediatric cardiac surgery patients at high risk for postoperative dysphagia and associated impaired vocal fold mobility. Early identification of this population can aid consultation and therapeutic interventions like injection laryngoplasty.
Level of Evidence
Level 3.
目的建立并验证小儿心脏手术患者术后吞咽困难的风险分层模型，重点关注耳鼻喉科评估的相关因素以及耳鼻喉科管理的意义。方法对2022年1月1日至2023年12月31日在某三级保健中心接受心脏手术的174例儿科患者进行分析。采用Logistic回归方法根据术前和术中因素制定风险评分。患者被分为低、中、高风险组，需要耳鼻喉科会诊。次要结果包括声带活动能力受损。结果174例患者中，102例（58.6%）患儿术后出现吞咽困难，需要进行耳鼻喉科检查。最终的预测模型包括手术年龄（OR, 0.80; 95% CI, 0.72-0.90; p < 0.001）、体外循环持续时间（OR, 1.73; 95% CI, 1.23-2.45; p = 0.002）和高危复杂手术（如诺伍德手术）（OR, 6.49; 95% CI, 2.70-15.61; p < 0.001）。模型判别良好（AUC 0.82）。预测的风险类别在队列中显示出不同的吞咽困难发生率：低风险（24.7%的队列，30.2%的队列出现吞咽困难）、中风险（31.6%，38.2%的队列出现吞咽困难）和高风险（43.7%，89.5%的队列出现吞咽困难）。在高风险患者中，70.6%的患者在长期随访中表现出声带活动障碍。结论：该以耳鼻喉科为中心的风险分层模型确定了儿童心脏手术患者术后吞咽困难和相关声带活动障碍的高风险。早期识别这一人群可以帮助咨询和治疗干预，如注射喉部成形术。证据等级3级。
{"title":"An Otolaryngology-Focused Risk Stratification for Postoperative Dysphagia in Pediatric Cardiac Surgery","authors":"Matthew Zhang, Basir Mansoor, Marlaine Frelier, Cynthia Wang, Yann-Fuu Kou, Stephen R Chorney, Romaine Johnson","doi":"10.1002/lio2.70316","DOIUrl":"https://doi.org/10.1002/lio2.70316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop and validate a risk stratification model for postoperative dysphagia in pediatric cardiac surgery patients, focusing on factors relevant to otolaryngologic assessment and implications for Otolaryngology management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Analysis of 174 pediatric patients undergoing cardiac surgery at a tertiary care center between January 1, 2022 and December 31, 2023. Logistic regression was used to develop a risk score based on preoperative and intraoperative factors. Patients were categorized into low, moderate, and high-risk groups for dysphagia requiring Otolaryngology consultation. Secondary outcomes included impaired vocal fold mobility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 174 patients, postoperative dysphagia necessitating Otolaryngology evaluation was identified in 102 (58.6%) children. The final predictive model included age at surgery (OR, 0.80; 95% CI, 0.72–0.90; <i>p</i> < 0.001), cardiopulmonary bypass duration (OR, 1.73; 95% CI, 1.23–2.45; <i>p</i> = 0.002), and high-risk complex procedures (e.g., Norwood) (OR, 6.49; 95% CI, 2.70–15.61; <i>p</i> < 0.001). Model discrimination was good (AUC 0.82). Predicted risk categories showed distinct dysphagia rates among the cohort: low-risk (24.7% of the cohort, with 30.2% experiencing dysphagia), moderate-risk (31.6%, with 38.2% experiencing dysphagia), and high-risk (43.7%, with 89.5% experiencing dysphagia). Among high-risk patients, 70.6% exhibited impaired vocal fold mobility at long-term follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This Otolaryngology-focused risk stratification model identifies pediatric cardiac surgery patients at high risk for postoperative dysphagia and associated impaired vocal fold mobility. Early identification of this population can aid consultation and therapeutic interventions like injection laryngoplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level 3.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619002","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}
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