The obstructive sleep apnea (OSA) syndrome with its various phenotypes, as assessed by the apnea-hypopnea index (AHI), has become a major public health issue. While physicians are regularly faced with a variety of patients with OSA complaints, they may not be aware that OSA in nonobese young adults remains a largely underinvestigated topic. It is hypothesized that, in these subjects, facial bone volumes are smaller than in healthy adults.
Methods
This cross-sectional, nonrandomized, controlled study was designed to compare the 3D cephalometric analysis of bone and craniofacial soft tissues in a group of 23 nonobese apneic (AHI ≥ 15), young (18–35 years) adults and in a control group of 23 nonapneic (AHI < 15) healthy subjects by using cone beam computed tomography (CBCT). All subjects were Caucasian and underwent a sleep examination in the Sleep Clinic of the University Hospital of Liege.
Results
The two groups were comparable except for age and medications. The maxillary bone volume (23.2 ± 4.6 cm3 vs. 24.8 ± 2.9 cm3) and the mandibular bone volume (44.0 ± 6.4 cm3 vs. 46.9 ± 5.2 cm3) adjusted for demographic and biometric characteristics were significantly smaller in OSA subjects than in controls. OSA subjects had also a smaller angle of the maxillary diagonals (95.3 ± 13.9° vs. 106 ± 15.9°) and, at the mandible, a narrower width (90.8 ± 8.0 mm vs. 95.1 ± 5.3 mm), a wider gonial angle (119.9 ± 5.5° vs. 116.5 ± 4.4°), a longer ramus (51.2 ± 6.6 mm vs. 47.3 ± 5.0 mm), and a shorter corpus (74.1 ± 10.3 mm vs. 78.9 ± 5.8 mm) than controls.
Conclusion
Craniofacial structures that most discerned apneic subjects from controls were the maxillary and mandible bone volumes. An overly narrow maxilla and a postero-rotating mandible were also associated with OSA.
Level of Evidence
III.
Registration
NCT06022679.
{"title":"Three-dimensional cone beam computed tomography analysis of craniofacial phenotype in nonobese apneic young adults","authors":"Mathilde Jadoul DDS, Adelin Albert PhD, Nathalie Maes MSc, Robert Poirrier MD, PhD, Anne-Lise Poirrier MD, PhD, Annick Bruwier DDS, PhD","doi":"10.1002/lio2.70061","DOIUrl":"10.1002/lio2.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The obstructive sleep apnea (OSA) syndrome with its various phenotypes, as assessed by the apnea-hypopnea index (AHI), has become a major public health issue. While physicians are regularly faced with a variety of patients with OSA complaints, they may not be aware that OSA in nonobese young adults remains a largely underinvestigated topic. It is hypothesized that, in these subjects, facial bone volumes are smaller than in healthy adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional, nonrandomized, controlled study was designed to compare the 3D cephalometric analysis of bone and craniofacial soft tissues in a group of 23 nonobese apneic (AHI ≥ 15), young (18–35 years) adults and in a control group of 23 nonapneic (AHI < 15) healthy subjects by using cone beam computed tomography (CBCT). All subjects were Caucasian and underwent a sleep examination in the Sleep Clinic of the University Hospital of Liege.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The two groups were comparable except for age and medications. The maxillary bone volume (23.2 ± 4.6 cm<sup>3</sup> vs. 24.8 ± 2.9 cm<sup>3</sup>) and the mandibular bone volume (44.0 ± 6.4 cm<sup>3</sup> vs. 46.9 ± 5.2 cm<sup>3</sup>) adjusted for demographic and biometric characteristics were significantly smaller in OSA subjects than in controls. OSA subjects had also a smaller angle of the maxillary diagonals (95.3 ± 13.9° vs. 106 ± 15.9°) and, at the mandible, a narrower width (90.8 ± 8.0 mm vs. 95.1 ± 5.3 mm), a wider gonial angle (119.9 ± 5.5° vs. 116.5 ± 4.4°), a longer ramus (51.2 ± 6.6 mm vs. 47.3 ± 5.0 mm), and a shorter corpus (74.1 ± 10.3 mm vs. 78.9 ± 5.8 mm) than controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Craniofacial structures that most discerned apneic subjects from controls were the maxillary and mandible bone volumes. An overly narrow maxilla and a postero-rotating mandible were also associated with OSA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>III.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Registration</h3>\u0000 \u0000 <p>NCT06022679.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081639","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}
B. S. Jacey Elliott, Pawan Acharya, Lurdes Queimado, Daniel Zhao, Wesley Greene, Greg Krempl, Rachad Mhawej
Objective
Musculoskeletal symptoms are common among surgical staff and can have long-term implications on health and wellbeing. The purpose of this study is to evaluate the impact of anti-fatigue floor mat on the comfort level of surgical teams during head and neck surgeries lasting ≥ 3 h.
Methods
Over 4 months, we prospectively randomized 34 major (≥ 3 h) head and neck procedures to the use or not of an anti-fatigue floor mat. Anonymous questionnaires measured the comfort levels in different subjects including the surgeons, assistant surgeons, and surgical scrub technicians (n = 57). Subjects completed questionnaires before, immediately after, and one day after surgery. Variables collected included demographics, overall discomfort level, overall energy level, discomfort level in different body parts, number of breaks taken during the case, time since last physical exercise, and frequency of physical exercise. The analysis of variance (ANOVA) technique was used for data analysis.
Results
The group that used anti-fatigue floor mats reported lower increases in discomfort from pre-op to immediately post-op and 24 h post-op compared to the group that did not (p = 0.009 and p < 0.001). Participants who used the mats reported significant lower levels of pain in the ankles and feet, knees, and shoulders immediately post-op compared to participants who did not. Participants who used the mats reported lower increases in discomfort in their back, hips, knees, neck, and shoulders from pre-op to post-op.
Conclusions
Using anti-fatigue floor mats during surgery is an effective and low-cost intervention to decrease the musculoskeletal symptoms experienced by the surgical team.
Level of Evidence
2.
{"title":"Impact of Anti-Fatigue Floor Mat on Surgical Staff Comfort Levels in Head and Neck Surgery Cases","authors":"B. S. Jacey Elliott, Pawan Acharya, Lurdes Queimado, Daniel Zhao, Wesley Greene, Greg Krempl, Rachad Mhawej","doi":"10.1002/lio2.70083","DOIUrl":"10.1002/lio2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Musculoskeletal symptoms are common among surgical staff and can have long-term implications on health and wellbeing. The purpose of this study is to evaluate the impact of anti-fatigue floor mat on the comfort level of surgical teams during head and neck surgeries lasting ≥ 3 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Over 4 months, we prospectively randomized 34 major (≥ 3 h) head and neck procedures to the use or not of an anti-fatigue floor mat. Anonymous questionnaires measured the comfort levels in different subjects including the surgeons, assistant surgeons, and surgical scrub technicians (<i>n</i> = 57). Subjects completed questionnaires before, immediately after, and one day after surgery. Variables collected included demographics, overall discomfort level, overall energy level, discomfort level in different body parts, number of breaks taken during the case, time since last physical exercise, and frequency of physical exercise. The analysis of variance (ANOVA) technique was used for data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The group that used anti-fatigue floor mats reported lower increases in discomfort from pre-op to immediately post-op and 24 h post-op compared to the group that did not (<i>p</i> = 0.009 and <i>p</i> < 0.001). Participants who used the mats reported significant lower levels of pain in the ankles and feet, knees, and shoulders immediately post-op compared to participants who did not. Participants who used the mats reported lower increases in discomfort in their back, hips, knees, neck, and shoulders from pre-op to post-op.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using anti-fatigue floor mats during surgery is an effective and low-cost intervention to decrease the musculoskeletal symptoms experienced by the surgical team.</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 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068856","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}
Granulomatous invasive fungal sinusitis (GIFS) affects immunocompetent individuals. There is ongoing debate over whether surgery, antifungal medication, or a combined approach is the best treatment. This article summarizes reports about GIFS and its management.
Methods
Eight search engines, gray literature, and review articles were searched. Two independent reviewer groups screened the eligibility of articles. An independent reviewer solved disagreements. Exclusion criteria included non-English language reports, papers with unavailable full-texts, reviews, publications before 1980, and studies lacking information about GIFS management.
Results
Of the 279 identified articles, 41 studies were included (n = 89 patients). Sinonasal GIFS with skull-base/intracranial extension was associated with an increase in mortality (p = 0.002, OR = 14.083; 95% CI = 1.753–113.157). Treatment was associated with an 87.2% remission rate (p < 0.001, OR = 7.818; 95% CI = 4.502–13.576); a combined medical and surgical approach had a 74.2% recovery rate. Of surgical interventions, the highest recovery rates were associated with endoscopic debulking (52.5%), extensive surgical debulking (32.5%), and open sinonasal approach (15%, p = 0.132). The utilization of voriconazole was associated with higher recovery rates, but this was not significant (76.9 vs. 56%, p = 0.548).
Conclusion
Sinonasal GIFS with skull-base/intracranial extension is associated with higher mortality rates. The superiority of the endoscopic debulking and voriconazole protocol in managing these cases warrants further investigation.
Level of Evidence
Level 4.
{"title":"Systematic Review of Granulomatous Invasive Fungal Sinusitis Management","authors":"Abdulsalam Baqays, Sarah Almutawa, Razan Alsabti, Luluh Alsughayer, Sandra Campbell, Nassr Almaflehi, Hussain Albaharana, Saad Alsaleh","doi":"10.1002/lio2.70086","DOIUrl":"10.1002/lio2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Granulomatous invasive fungal sinusitis (GIFS) affects immunocompetent individuals. There is ongoing debate over whether surgery, antifungal medication, or a combined approach is the best treatment. This article summarizes reports about GIFS and its management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eight search engines, gray literature, and review articles were searched. Two independent reviewer groups screened the eligibility of articles. An independent reviewer solved disagreements. Exclusion criteria included non-English language reports, papers with unavailable full-texts, reviews, publications before 1980, and studies lacking information about GIFS management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 279 identified articles, 41 studies were included (<i>n</i> = 89 patients). Sinonasal GIFS with skull-base/intracranial extension was associated with an increase in mortality (<i>p</i> = 0.002, OR = 14.083; 95% CI = 1.753–113.157). Treatment was associated with an 87.2% remission rate (<i>p</i> < 0.001, OR = 7.818; 95% CI = 4.502–13.576); a combined medical and surgical approach had a 74.2% recovery rate. Of surgical interventions, the highest recovery rates were associated with endoscopic debulking (52.5%), extensive surgical debulking (32.5%), and open sinonasal approach (15%, <i>p</i> = 0.132). The utilization of voriconazole was associated with higher recovery rates, but this was not significant (76.9 vs. 56%, <i>p</i> = 0.548).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sinonasal GIFS with skull-base/intracranial extension is associated with higher mortality rates. The superiority of the endoscopic debulking and voriconazole protocol in managing these cases warrants further investigation.</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 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048414","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}
Ahmed Saleem, Jonas Philteos, Shayanne Lajud, Ashok Jethwa, Carissa Thomas, Christopher M. L. K. Yao, David P. Goldstein, Kevin P. Higgins
Background
The main technique for identification of free flap perforator vessels is Doppler sonography, which is not always accurate, user dependent and affected by the patient's body habitus.
Methods
Adult patients undergoing head and neck resection and free flap reconstruction at two academic institutions were enrolled. Doppler sonography was used to identify perforators, and were marked using a skin marker. The donor site was cooled down for 3 min using a sterile iced saline bag. FLIR-ONE (FLIR Systems Inc., Wilsonville, OR) camera was used to assess for “hot spots” during a 3–5 min period of re-warming as a surrogate for cutaneous blood flow. The distance between the Doppler signal location, and the “hot spot” was recorded. The position of the perforator was then identified intraoperatively and the distances between the surgical position, the Doppler and “hot spot” were recorded.
Results
A total of 28 patients were included. For all flap types, FLIR thermal imaging measurements consistently tended to be closer to the surgical site compared to Doppler ultrasound. In anterolateral thigh flaps (n = 20), thoracodorsal artery perforator flaps (n = 5), and fibula osteocutaneous flaps (n = 3), absolute mean differences ranged from 0.62 to 1.33 cm, with trends favoring FLIR. While paired t-tests did not reach statistical significance, both methods correlated with intraoperatively identified skin perforators, and distances generally ranged between 0 and 2 cm.
Conclusion
We demonstrate that a smartphone-based thermal imaging system has the potential to serve as an adjunct for identifying flap perforators, with the possibility of reducing operative times and minimizing patient morbidity.
Level of Evidence
Level 3.
背景：游离皮瓣穿支血管的主要识别技术是多普勒超声，但多普勒超声并不总是准确的、依赖于使用者和受患者身体习惯的影响。方法：选取在两所学术机构接受头颈部切除术和游离皮瓣重建的成年患者。多普勒超声用于识别穿支，并使用皮肤标记进行标记。用无菌冰盐水袋冷却供体部位3分钟。fliri - one （FLIR Systems Inc., Wilsonville， OR）相机在3-5分钟的重新加热期间作为皮肤血流量的替代品，用于评估“热点”。记录多普勒信号位置与“热点”之间的距离。术中确定穿支位置，记录手术位置、多普勒和“热点”之间的距离。结果：共纳入28例患者。对于所有皮瓣类型，与多普勒超声相比，FLIR热成像测量始终倾向于更接近手术部位。在股前外侧皮瓣（n = 20）、胸背动脉穿支皮瓣（n = 5）和腓骨骨皮皮瓣（n = 3）中，绝对平均差异范围为0.62至1.33 cm，趋势倾向于FLIR。虽然配对t检验没有达到统计学意义，但两种方法都与术中识别的皮肤穿孔相关，距离通常在0到2厘米之间。结论：我们证明了基于智能手机的热成像系统有潜力作为识别皮瓣穿支的辅助工具，有可能减少手术时间并最大限度地减少患者的发病率。证据等级：三级。
{"title":"Smartphone Thermal Imaging as an Adjunct to Identify Free Flap Perforators and Assisting Flap Design: A Pilot Study","authors":"Ahmed Saleem, Jonas Philteos, Shayanne Lajud, Ashok Jethwa, Carissa Thomas, Christopher M. L. K. Yao, David P. Goldstein, Kevin P. Higgins","doi":"10.1002/lio2.70081","DOIUrl":"10.1002/lio2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The main technique for identification of free flap perforator vessels is Doppler sonography, which is not always accurate, user dependent and affected by the patient's body habitus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients undergoing head and neck resection and free flap reconstruction at two academic institutions were enrolled. Doppler sonography was used to identify perforators, and were marked using a skin marker. The donor site was cooled down for 3 min using a sterile iced saline bag. FLIR-ONE (FLIR Systems Inc., Wilsonville, OR) camera was used to assess for “hot spots” during a 3–5 min period of re-warming as a surrogate for cutaneous blood flow. The distance between the Doppler signal location, and the “hot spot” was recorded. The position of the perforator was then identified intraoperatively and the distances between the surgical position, the Doppler and “hot spot” were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 28 patients were included. For all flap types, FLIR thermal imaging measurements consistently tended to be closer to the surgical site compared to Doppler ultrasound. In anterolateral thigh flaps (<i>n</i> = 20), thoracodorsal artery perforator flaps (<i>n</i> = 5), and fibula osteocutaneous flaps (<i>n</i> = 3), absolute mean differences ranged from 0.62 to 1.33 cm, with trends favoring FLIR. While paired <i>t</i>-tests did not reach statistical significance, both methods correlated with intraoperatively identified skin perforators, and distances generally ranged between 0 and 2 cm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We demonstrate that a smartphone-based thermal imaging system has the potential to serve as an adjunct for identifying flap perforators, with the possibility of reducing operative times and minimizing patient morbidity.</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 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014038","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}
John R. de Almeida, Katrina Hueniken, Michael Xie, Eric Monteiro, Gelareh Zadeh, Aristotelis Kalyvas, Patrick Gullane, Carl Snyderman, Eric Wang, Paul Gardner, Dan Fliss, Barak Ringel, Ziv Gil, Shorook Na'ara, Eng Ooi, David Goldstein, Ian Witterick
Objectives
The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches.
Study Type and Design
Prospective Review.
Methods
Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses.
Results
A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, p < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, p = 0.004; 5.8 vs. −1.1, p = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, p = 0.009), as well as endocrine (mean difference = 8.3, p = 0.011), neurologic (mean difference = 8.3, p = 0.012), visual (mean difference = 7.9; p = 0.032), financial (mean difference = 9.7, p = 0.03), and spiritual domain scores (mean difference = 4.0, p = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group.
Conclusions
Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required.
{"title":"Multi-Institutional Comparison of Quality of Life Between Open Versus Endoscopic Skull Base Approaches","authors":"John R. de Almeida, Katrina Hueniken, Michael Xie, Eric Monteiro, Gelareh Zadeh, Aristotelis Kalyvas, Patrick Gullane, Carl Snyderman, Eric Wang, Paul Gardner, Dan Fliss, Barak Ringel, Ziv Gil, Shorook Na'ara, Eng Ooi, David Goldstein, Ian Witterick","doi":"10.1002/lio2.70082","DOIUrl":"10.1002/lio2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Type and Design</h3>\u0000 \u0000 <p>Prospective Review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, <i>p</i> < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, <i>p</i> = 0.004; 5.8 vs. −1.1, <i>p</i> = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, <i>p</i> = 0.009), as well as endocrine (mean difference = 8.3, <i>p</i> = 0.011), neurologic (mean difference = 8.3, <i>p</i> = 0.012), visual (mean difference = 7.9; <i>p</i> = 0.032), financial (mean difference = 9.7, <i>p</i> = 0.03), and spiritual domain scores (mean difference = 4.0, <i>p</i> = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV evidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014392","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}
Emily A. Janio, Cori Walker, Eliza Steere, Aaron T. Seaman, Natoshia Askelson, Nitin A. Pagedar
Objective
The incidence of human papillomavirus (HPV)-related oropharyngeal cancers has increased such that they are now the most prevalent HPV-related cancer. In 2020, the Food and Drug Administration (FDA) expanded the indication for Gardasil-9 to include the prevention of oropharyngeal and other head and neck cancers caused by selected HPV types, but uptake remains low. Otolaryngology office interactions may provide opportunities to increase uptake, given the relevance of HPV to clinical practice. This study explored the feasibility of recommending HPV vaccination in otolaryngology clinics.
Methods
Participants were recruited between February to June of 2022 from the alumni of the residency and fellowship training programs at the University of Iowa Hospitals and Clinics. Participant interviews comprised open-ended questions pertaining to otolaryngologists' attitudes toward HPV vaccination recommendation. Interview recordings were transcribed, coded, and analyzed for themes.
Results
Participants were willing to respond if patients asked about the HPV vaccine, although a common attitude toward vaccine discussions was that they were a pediatrician's responsibility. One barrier to recommending HPV vaccination was providers' concern that discussing the vaccine when not directly relevant to the patient's chief complaint could result in patient frustration. Nevertheless, participants endorsed the feasibility of discussing the vaccine during follow-up visits after the patient's needs had been addressed or via the distribution of educational materials to patients.
Conclusion
Otolaryngologists do not currently identify recommending HPV vaccine uptake as their clinical responsibility. While such recommendations may not be feasible in every patient encounter, there could be a role for this in the appropriate clinical scenario. These findings can be used to inform interventions aimed at recommending the vaccine in otolaryngology clinics.
{"title":"A Qualitative Study of Attitudes Toward HPV Vaccine Recommendation in Otolaryngology Clinics","authors":"Emily A. Janio, Cori Walker, Eliza Steere, Aaron T. Seaman, Natoshia Askelson, Nitin A. Pagedar","doi":"10.1002/lio2.70085","DOIUrl":"10.1002/lio2.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The incidence of human papillomavirus (HPV)-related oropharyngeal cancers has increased such that they are now the most prevalent HPV-related cancer. In 2020, the Food and Drug Administration (FDA) expanded the indication for Gardasil-9 to include the prevention of oropharyngeal and other head and neck cancers caused by selected HPV types, but uptake remains low. Otolaryngology office interactions may provide opportunities to increase uptake, given the relevance of HPV to clinical practice. This study explored the feasibility of recommending HPV vaccination in otolaryngology clinics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were recruited between February to June of 2022 from the alumni of the residency and fellowship training programs at the University of Iowa Hospitals and Clinics. Participant interviews comprised open-ended questions pertaining to otolaryngologists' attitudes toward HPV vaccination recommendation. Interview recordings were transcribed, coded, and analyzed for themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants were willing to respond if patients asked about the HPV vaccine, although a common attitude toward vaccine discussions was that they were a pediatrician's responsibility. One barrier to recommending HPV vaccination was providers' concern that discussing the vaccine when not directly relevant to the patient's chief complaint could result in patient frustration. Nevertheless, participants endorsed the feasibility of discussing the vaccine during follow-up visits after the patient's needs had been addressed or via the distribution of educational materials to patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Otolaryngologists do not currently identify recommending HPV vaccine uptake as their clinical responsibility. While such recommendations may not be feasible in every patient encounter, there could be a role for this in the appropriate clinical scenario. These findings can be used to inform interventions aimed at recommending the vaccine in otolaryngology clinics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014391","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}
Posttonsillectomy hemorrhage (PTH) is a common and potentially life-threatening complication in pediatric tonsillectomy. Early identification and prediction of PTH are of great significance. Currently, there are very few tools available for clinicians to accurately assess the risk of PTH. This study aimed to develop and validate a predictive model for secondary PTH.
Methods
A retrospective analysis was conducted on 492 individuals who underwent tonsillectomy or tonsillotomy in Children's Hospital of Soochow University from July 1st, 2015 to December 31th, 2023. The study population was randomly divided into the training set and the validation set at a ratio of 7:3. Univariate logistic regression analysis was used to screen features. Multivariate logistic regression and seven machine learning algorithms were used to construct predictive models. Discrimination, calibration, and clinical utility were used to compare the predictive performance. The SHapley Additive exPlanation (SHAP) method was used to interpret the results of the best-performing model.
Results
One multivariate logistic regression model and seven machine learning models were constructed. The XGBoost model yielded the best performance in the validation set. The SHAP method ranked the features of the XGBoost model based on their importance and provided both global and local explanations of the model.
Conclusion
This study established a machine learning-based predictive model for secondary PTH, which may enable clinicians to accurately assess the risk of secondary PTH in children.
{"title":"A Predictive Model for Secondary Posttonsillectomy Hemorrhage in Pediatric Patients: An 8-Year Retrospective Study","authors":"Yuting Ge, Wenchuan Chang, Lixiao Xie, Yan Gao, Yue Xu, Huie Zhu","doi":"10.1002/lio2.70080","DOIUrl":"10.1002/lio2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Posttonsillectomy hemorrhage (PTH) is a common and potentially life-threatening complication in pediatric tonsillectomy. Early identification and prediction of PTH are of great significance. Currently, there are very few tools available for clinicians to accurately assess the risk of PTH. This study aimed to develop and validate a predictive model for secondary PTH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 492 individuals who underwent tonsillectomy or tonsillotomy in Children's Hospital of Soochow University from July 1st, 2015 to December 31th, 2023. The study population was randomly divided into the training set and the validation set at a ratio of 7:3. Univariate logistic regression analysis was used to screen features. Multivariate logistic regression and seven machine learning algorithms were used to construct predictive models. Discrimination, calibration, and clinical utility were used to compare the predictive performance. The SHapley Additive exPlanation (SHAP) method was used to interpret the results of the best-performing model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One multivariate logistic regression model and seven machine learning models were constructed. The XGBoost model yielded the best performance in the validation set. The SHAP method ranked the features of the XGBoost model based on their importance and provided both global and local explanations of the model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study established a machine learning-based predictive model for secondary PTH, which may enable clinicians to accurately assess the risk of secondary PTH in children.</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 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014390","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}
Ce Wu MD, Zhiyu Qi MD, Jiahong Chen MD, Xudong Yan MD, PhD, Shunke Li MD, Lin Wang MD, Longgang Yu MD, PhD, Yan Jiang MD, PhD
Introduction
Systemic inflammatory and nutritional markers are associated with the prognosis of various cancers. However, their association with sinonasal squamous cell carcinoma (SNSCC) prognosis remains unclear. This study aimed to identify systemic inflammatory and nutritional markers associated with the postoperative prognosis of patients with SNSCC and to clarify the clinical value of these markers.
Materials and methods
Data from 129 patients with SNSCC were included. The optimal prognostic systemic inflammatory and nutritional markers were identified using the area under the curve. The prognostic value was evaluated using COX regression and subgroup analyses; a nomogram was built based on these data.
Results
The advanced lung cancer inflammation index (ALI) and systemic immune-inflammatory index (SII) had higher prognostic values than the other indices; their cut-off values were 27.80 and 791.35, respectively. The nomogram included tumor stage, ALI, and tumor primary site; the calibration and decision curves indicated that the model had good clinical value.
Conclusion
The ALI and SII have potential prognostic value for postoperative patients with SNSCC. The nomogram constructed in this study could be used as a tool to assist physicians in making clinical decisions.
{"title":"Prognostic value of inflammation and nutritional indicators for sinonasal squamous cell carcinoma: A single-center retrospective study","authors":"Ce Wu MD, Zhiyu Qi MD, Jiahong Chen MD, Xudong Yan MD, PhD, Shunke Li MD, Lin Wang MD, Longgang Yu MD, PhD, Yan Jiang MD, PhD","doi":"10.1002/lio2.70046","DOIUrl":"10.1002/lio2.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Systemic inflammatory and nutritional markers are associated with the prognosis of various cancers. However, their association with sinonasal squamous cell carcinoma (SNSCC) prognosis remains unclear. This study aimed to identify systemic inflammatory and nutritional markers associated with the postoperative prognosis of patients with SNSCC and to clarify the clinical value of these markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>Data from 129 patients with SNSCC were included. The optimal prognostic systemic inflammatory and nutritional markers were identified using the area under the curve. The prognostic value was evaluated using COX regression and subgroup analyses; a nomogram was built based on these data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The advanced lung cancer inflammation index (ALI) and systemic immune-inflammatory index (SII) had higher prognostic values than the other indices; their cut-off values were 27.80 and 791.35, respectively. The nomogram included tumor stage, ALI, and tumor primary site; the calibration and decision curves indicated that the model had good clinical value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The ALI and SII have potential prognostic value for postoperative patients with SNSCC. The nomogram constructed in this study could be used as a tool to assist physicians in making clinical decisions.</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 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013603","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}
Hamad F. Alrabiah, Nawaf Alqarni, Nuha Alrajhi, Aban Basfar, Tamer A. Mesallam, Mohamed Farahat, Khalid H. Malki
Objectives
This study aimed to translate and validate the Cough Severity Index (CSI) into Arabic (A-CSI) and to evaluate its validity and reliability among patients with chronic cough.
Methods
This cross-sectional descriptive questionnaire-based validation study was conducted at two tertiary hospitals in Riyadh, Saudi Arabia, between December 2023 and August 2024. The CSI was translated from English into Arabic using the forward-backward method. Its reliability was assessed using Cronbach's alpha and test–retest reliability. Its construct validity was assessed using exploratory factor analysis (EFA), and its internal consistency was assessed using Cronbach's alpha. Its discriminant validity was determined using the Mann–Whitney U test, and its reproducibility was evaluated using the intraclass correlation coefficient (ICC).
Results
Data were collected from 100 participants, 50 with chronic cough and 50 healthy controls. The mean age was 41.56 ± 14.28 years in the chronic cough group and 35.48 ± 10.02 years in the healthy control group. The A-CSI exhibited high reproducibility (ICC = 0.896) and excellent internal consistency (Cronbach's alpha = 0.966). EFA identified three factors explaining 66.41% of the variance, with all items having communalities > 0.3. The A-CSI exhibited significant discriminant validity between the chronic cough and healthy control groups (p < 0.001).
Conclusion
The A-CSI is a reliable and valid tool for assessing chronic cough in Arabic-speaking patients, making it suitable for both clinical practice and research.
{"title":"Validity and Reliability of the Arabic Cough Severity Index","authors":"Hamad F. Alrabiah, Nawaf Alqarni, Nuha Alrajhi, Aban Basfar, Tamer A. Mesallam, Mohamed Farahat, Khalid H. Malki","doi":"10.1002/lio2.70074","DOIUrl":"10.1002/lio2.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to translate and validate the Cough Severity Index (CSI) into Arabic (A-CSI) and to evaluate its validity and reliability among patients with chronic cough.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional descriptive questionnaire-based validation study was conducted at two tertiary hospitals in Riyadh, Saudi Arabia, between December 2023 and August 2024. The CSI was translated from English into Arabic using the forward-backward method. Its reliability was assessed using Cronbach's alpha and test–retest reliability. Its construct validity was assessed using exploratory factor analysis (EFA), and its internal consistency was assessed using Cronbach's alpha. Its discriminant validity was determined using the Mann–Whitney <i>U</i> test, and its reproducibility was evaluated using the intraclass correlation coefficient (ICC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data were collected from 100 participants, 50 with chronic cough and 50 healthy controls. The mean age was 41.56 ± 14.28 years in the chronic cough group and 35.48 ± 10.02 years in the healthy control group. The A-CSI exhibited high reproducibility (ICC = 0.896) and excellent internal consistency (Cronbach's alpha = 0.966). EFA identified three factors explaining 66.41% of the variance, with all items having communalities > 0.3. The A-CSI exhibited significant discriminant validity between the chronic cough and healthy control groups (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The A-CSI is a reliable and valid tool for assessing chronic cough in Arabic-speaking patients, making it suitable for both clinical practice and research.</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 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014160","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}
Raymond J. So AB, Luu V. Pham MD, David W. Eisele MD, Kevin Motz MD
Objectives
Hypoglossal nerve stimulation (HGNS) is a promising surgical option for patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure therapy (CPAP). Efficacy studies for HGNS stimulation largely focus on the apnea–hypopnea index and/or oxygen desaturation index. This study's objective was to show the physiological effects of HGNS stimulation on upper airway patency, airflow, and treatment effect during polysomnography (PSG) testing.
Analysis of on–off periods of HGNS therapy during PSG allows for a concise assessment of HGNS efficacy. The presence of inspiratory flow limitation and subsequent apneas or hypopneas upon turning off HGNS stimulation with restoration of stable, unobstructed breathing upon resuming HGNS stimulation indicates a positive treatment effect related to HGNS therapy. Despite the respiratory-sensing capacity of the Inspire HGNS device, desynchrony of stimulation and inspiration is observed. Desynchrony yields partially captured inspiratory cycles, allowing for assessment of HGNS effect on an individual breath.
Conclusion
Night-to-night and intranight variability in OSA severity makes assessing the effect of HGNS complex. Strategic testing protocols during postoperative PSG can provide critical insight into the effect of this therapy on upper airway obstruction during sleep. On–off periods of stimulation provide a concise assessment of the effect of HGNS on preventing upper airway collapse and help to account for night-to-night and intranight variability. Respiratory desynchrony associated with HGNS therapy exists. Observing partially-stimulated inspiratory cycles allow for assessment of HGNS's effect on a single breath.
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