Laryngoscope Investigative Otolaryngology最新文献_第4页

Depression Among Patients With Laryngeal Cancer: A Retrospective Cohort Study 喉癌患者抑郁：一项回顾性队列研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-11 DOI: 10.1002/lio2.70325

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.

喉癌的治疗通常会导致语言和吞咽的改变，这可能会导致该患者群体抑郁的发展，并随后影响治疗结果和生存率。本研究旨在确定喉癌患者抑郁的患病率，并确定相关的危险因素。方法使用TriNetX研究网络中的ICD-10编码对喉癌患者进行识别。根据治疗类型（手术与非手术）、年龄、社会经济（SES）危险因素和治疗后副作用对患者进行分层。在控制癌症分期的情况下，分析这些因素对抑郁症发展的影响。结果共确诊喉癌93018例。与整体头颈癌人群相比，这些患者患抑郁症的风险明显更高（RR = 1.15, 95% CI:[1.12, 1.18]）。70岁以下的患者比70岁以上的患者更容易患抑郁症（RR = 1.27, 95% CI:[1.22, 1.33]）。SES危险因素与抑郁风险相关（RR = 2.67, 95% CI:[2.42, 2.97]）。手术治疗的风险高于非手术治疗（RR = 1.54, 95% CI:[1.41, 1.68]）。患有吞咽困难、口干或营养不良等长期并发症的患者患抑郁症的风险增加7.62% （p < 0.01）。结论喉癌患者在治疗后出现抑郁的风险较高。未来的研究评估最佳筛选方案和支持性护理策略可能有助于改善这一人群的精神卫生保健。

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引用次数: 0

Pyriform Plasty as an Adjunct to Septoplasty: A Double-Blind Randomized Trial in Patients With Septal Deviation 梨状成形术辅助鼻中隔成形术：一项针对鼻中隔偏曲患者的双盲随机试验

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-08 DOI: 10.1002/lio2.70324

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.

Level of Evidence

2.

本研究旨在比较鼻中隔偏曲患者在凹侧进行单侧梨形成形术和不进行单侧梨形成形术的最终长期结果。材料与方法2020 - 2023年进行随机临床试验。患者随机分为两组，每组30人。对照组单独行鼻中隔成形术（不行梨状成形术）。干预组采用梨状成形术配合鼻中隔成形术。术前、术后采用鼻腔问卷对患者主观感受进行比较。术后6个月，采用鼻压测量法对患者进行客观评价。结果患者平均年龄37.07±10.39岁。根据鼻流测量法评估，干预组和对照组的气流量分别为791.23±113.14 （cm3/s）和665.44±101.03 （p < 0.001）。干预组抵抗水平为0.20±0.04 (Pa/cm3/s)，对照组抵抗水平为0.23±0.05 (Pa/cm3/s) （p = 0.036）。在评估的症状中，干预组鼻塞明显改善（p = 0.044）。结论虽然鼻中隔成形术通过增加鼻腔气流和降低气流阻力改善了患者的临床状况，但凹侧梨状鼻中隔成形术的效果明显更好。证据级别2。

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引用次数: 0

Patient Self-Recorded Digital Otoscopy in Otology Diagnostics 患者自记录数字耳镜在耳科诊断中的应用。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-12-03 DOI: 10.1002/lio2.70318

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.

Level of Evidence

3.

目的：研究患者自录式数字耳镜（PDO）是否为耳科远程会诊的可靠诊断工具。方法：以实际转诊患者为对象，招募45例耳科门诊患者。患者观看了一段关于使用数字耳镜的教学视频。教程结束后，他们录制了一段关于自己耳朵的短视频。为了进行比较，数字耳镜检查（DO）由耳鼻喉科住院医师执行，患者由耳科医生亲自检查。录音由耳科医生、普通耳鼻喉科医生和耳鼻喉科住院医生进行评估。对录音的质量、远程会诊的有用性、诊断的准确性和观察者对诊断的信心进行了评估。结果：PDO质量平均值为5.2±2.5（平均值±SEM，分值为1-10）。耳鼻喉科住院医师记录的DO （RDO）质量为6.6±2.3（平均值±SEM，评分范围为1-10）。PDO的诊断正确率为48.4%，RDO的诊断正确率为63.5%。不同病理的诊断准确性差异显著。结论：pdo的整体质量虽不如rdo，但仍令人满意。对于某些病理，pdo的诊断准确性与rdo相当，强调自记录DO可用于有局限性的远程会诊。数字耳镜可用于全科医生和护士，以方便耳科远程会诊。证据等级：3。

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引用次数: 0

A Scoping Review of Surgical Interventions for Nasal Valve Obstruction in Facial Paralysis 面瘫鼻瓣膜梗阻手术干预的范围综述

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-27 DOI: 10.1002/lio2.70301

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.

目的本综述的主要目的是确定用于治疗面瘫引起的鼻气道阻塞的各种手术技术，并总结这些技术的可用结果数据。通过Medline （PubMed）和Embase进行文献检索，查找鼻塞和面瘫从成立到2024年4月的临床研究。回顾性分析了面瘫患者鼻瓣膜梗阻手术治疗的相关文献。使用PubMed和Embase进行了搜索。我们检索了82篇描述鼻塞矫正的文章。摘要分析将选择范围缩小到七篇论文。该标准包括对接受手术治疗面瘫引起的鼻塞的患者进行研究，并有主观或客观的结果测量。排除了非面瘫引起的鼻塞的研究。结果阔筋膜悬吊和缝合悬吊分别使鼻翼评分提高21分和31分。主观症状缓解范围从77%到100%，阔筋膜悬吊显示一致的100%改善。并发症发生率最低的是阔筋膜悬吊，为4.3%，最高的是缝合悬吊，为23.5%。阔筋膜修补率为1.5%，缝合悬吊修补率为14.1%。结论面瘫鼻瓣膜梗阻的手术矫正需要特殊的考虑。需要进一步的研究来确定治疗这一独特问题的最安全和最有效的选择。

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引用次数: 0

Complications of Metabolic Dysfunction in Head and Neck Microvascular Reconstruction 头颈部微血管重建中代谢功能障碍的并发症

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-27 DOI: 10.1002/lio2.70290

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.

Level of Evidence

Level 4.

目的了解代谢健康对头颈部肿瘤重建手术成功率的影响及改善预后的作用。方法回顾性队列研究。对2010年至2022年间由单一外科医生进行头颈部微血管重建的患者进行图表回顾。收集了人口统计学、术后并发症和患者的长期预后。根据糖尿病、高血压和BMI的诊断结果将患者分成队列[gt； 25]。合并这三种合并症的患者组成代谢功能障碍（MetD）组，其余患者组成非MetD组。非metd组被分为没有这三种合并症的患者的对照亚队列。比较两组间的结果。术后并发症比较采用学生t检验、卡方检验和Fisher精确检验。926例患者的数据可获得，分布在MetD（91）、非MetD（835）和对照（226）组；BMI越高，患者年龄越大（p < 0.01）。两组患者术后预后无差异。当将MetD与对照组进行比较时，MetD再次显着变老（p < 0.01）， BMI更高（p < 0.01）。虽然MetD组的伤口并发症发生率明显高于对照组（p = 0.02），但两组之间没有其他临床差异。结论：我们的研究表明，在我们的单手术人群中，诊断为高血压、糖尿病和BMI [gt； 25]的患者在头颈部微血管重建后，大多数术后并发症的发生率并没有明显高于没有这些合并症的患者。证据等级4级。

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引用次数: 0

Cannabis Use and Risk of Chronic Rhinosinusitis and Sinus Surgery 大麻使用与慢性鼻窦炎和鼻窦手术的风险

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-27 DOI: 10.1002/lio2.70320

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。

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引用次数: 0

An Otolaryngology-Focused Risk Stratification for Postoperative Dysphagia in Pediatric Cardiac Surgery 以耳鼻喉科为中心的儿科心脏手术术后吞咽困难风险分层

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-26 DOI: 10.1002/lio2.70316

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。

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引用次数: 0

Predictive Value of Blood Eosinophil Ratio for Risk Stratification in Patients With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps 嗜酸性慢性鼻窦炎合并鼻息肉患者血嗜酸性粒细胞比值对危险分层的预测价值

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-22 DOI: 10.1002/lio2.70300

Ting Zuo, Jianwei Wang, Ying Chen, Hongfei Zhao, Yan Hao, Hang Yu, Yu Zhang, Xicheng Song

Background

Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) is associated with severe symptoms and poor outcomes, but the diagnostic criteria remain elusive. The objective of this study is to identify preoperative predictors of ECRSwNP using multiple diagnostic thresholds and to propose a clinically actionable risk stratification model.

Methods

A retrospective analysis was conducted on 1081 CRSwNP patients who underwent endoscopic sinus surgery. Receiver operating characteristic (ROC) curves were generated to predict ECRSwNP based on clinical features and identify reliable predictors.

Results

Both the blood eosinophil count and ratio were identified as indicators for predicting ECRSwNP. The ratio exhibited the strongest correlation with that of tissue (r = 0.401, p < 0.001). The optimal blood eosinophil ratio cutoffs exhibited variability according to tissue-based criteria, ranging from 2.65% to 4.65%. For blood eosinophil ratios, thresholds of 2.65% (for > 10% tissue ratio) and 3.85% (for > 27% tissue ratio) exhibited divergent predictive profiles: the former yielded high positive predictive value (PPV = 79.87%), while the latter yielded high negative predictive value (NPV = 84.39%). To reconcile conflicting PPV/NPV profiles between thresholds, we defined a threshold of 3.25% (median between 2.65% and 3.85%). Patients could be divided into a group with a low risk(LR-ECRSwNP) for being defined as ECRSwNP and another group with a high risk(HR-ECRSwNP), of which the median values with interquartile ranges (IQRs) were 15.20 (2.20, 31.50)/HPF and 12.06 (1.84, 21.77)% tissue eosinophils for the low risk group and 30.67 (16.53, 77.90)/HPF and 23.92 (14.09, 45.66)% tissue eosinophils for the high risk group. The HR-ECRSwNP demonstrated significantly higher tissue eosinophil counts and ratios than the LR-ECRSwNP (p < 0.001).

Conclusion

Blood eosinophil ratio ≥ 3.25% identifies CRSwNP patients at high risk for eosinophilic inflammation, providing a preoperative stratification tool. While correlations between blood and tissue eosinophils were moderate, this threshold balances sensitivity and specificity across heterogeneous diagnostic criteria.

背景嗜酸性慢性鼻窦炎伴鼻息肉（ECRSwNP）与严重症状和不良预后相关，但诊断标准尚不明确。本研究的目的是通过多个诊断阈值确定ECRSwNP的术前预测因素，并提出临床可操作的风险分层模型。方法对1081例行鼻内镜手术的CRSwNP患者进行回顾性分析。生成受试者工作特征（ROC）曲线，根据临床特征预测ECRSwNP并确定可靠的预测因子。结果血嗜酸性粒细胞计数和比值均可作为预测ECRSwNP的指标。该比值与组织的相关性最强（r = 0.401, p < 0.001）。根据组织标准，最佳血嗜酸性粒细胞比例临界值在2.65%至4.65%之间存在差异。对于血嗜酸性粒细胞比率，2.65%（组织比例为10%）和3.85%（组织比例为27%）的阈值具有不同的预测特征：前者具有较高的阳性预测值（PPV = 79.87%），而后者具有较高的阴性预测值（NPV = 84.39%）。为了调和阈值之间相互冲突的PPV/NPV分布，我们将阈值定义为3.25%（中位数为2.65%至3.85%）。将患者分为低危组（LR-ECRSwNP）和高危组（HR-ECRSwNP），其中低危组组织嗜酸性粒细胞中位数（IQRs）为15.20 (2.20,31.50)/HPF和12.06(1.84,21.77)%，高危组组织嗜酸性粒细胞中位数为30.67 (16.53,77.90)/HPF和23.92(14.09,45.66)%。HR-ECRSwNP的组织嗜酸性粒细胞计数和比值明显高于LR-ECRSwNP （p < 0.001）。结论血嗜酸性粒细胞比值≥3.25%的CRSwNP患者存在嗜酸性粒细胞性炎症的高风险，可作为术前分层的工具。虽然血液和组织嗜酸性粒细胞之间的相关性是中等的，但这个阈值平衡了不同诊断标准的敏感性和特异性。

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引用次数: 0

Nerve Branch Diameter as an Indicator of Motor Function in Extralaryngeal Branches of the Recurrent Laryngeal Nerve During Thyroidectomy 神经分支直径作为甲状腺切除术中喉返神经喉外分支运动功能的指标

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-22 DOI: 10.1002/lio2.70269

Ja Kyung Lee, Eunji Kim, Yoon Kong, Seungho Lee, Woochul Kim, Hyeong Won Yu, Su-jin Kim, Young Jun Chai, June Young Choi, Kyu Eun Lee

Objective

Preserving the recurrent laryngeal nerve (RLN) is a critical aspect of thyroidectomy, as its injury can significantly impair voice function. However, surgeons frequently encounter branched RLNs, which occur in 10.1%–42.9% of cases. This anatomical variation can be particularly challenging for novice surgeons, as identifying and preserving the motor branch requires precision.

Methods

Of 239 patients who received bilateral axillo-breast approach robotic total thyroidectomy from December 2023 to January 2025, patients with extralaryngeal RLN branch were retrospectively evaluated using video recordings. The function of RLN branches was determined using intraoperative neuromonitoring (IONM). Branch diameter and branching distance to the laryngeal entry point (LEP) were measured on captured surgical images using ImageJ software, referencing a 1.3 mm monopolar hook tip. Sensory branches were further classified by insertion site (LEP vs. non-LEP).

Results

Among 293 RLNs at risk, 31 (10.6%) showed extralaryngeal branching. Most nerves were double-branched (27/31). Motor branches were significantly thicker than sensory branches (1.47 ± 0.34 mm vs. 1.02 ± 0.28 mm, p < 0.001). Of 34 sensory branches, 13 inserted into the LEP and 21 into non-laryngeal structures. LEP-inserting sensory branches were thicker (1.19 ± 0.22 mm vs. 0.93 ± 0.22 mm, p = 0.01) and branched closer to the LEP (17.77 ± 6.15 mm vs. 26.44 ± 7.71 mm, p = 0.001).

Conclusion

Branch diameter correlates with motor function in RLN branches. In the absence of IONM, thickness and branching location may help surgeons distinguish motor from sensory branches and preserve vocal function.

Level of Evidence

Level 4.

目的保护喉返神经是甲状腺切除术的重要内容，喉返神经损伤会严重损害声带功能。然而，外科医生经常遇到分支性rln，发生率为10.1%-42.9%。这种解剖变异对外科新手来说尤其具有挑战性，因为识别和保存运动分支需要精度。方法对2023年12月至2025年1月行双侧腋窝-乳房入路机器人甲状腺全切除术的239例患者进行录像回顾性评价。术中神经监测（IONM）测定RLN分支功能。参考1.3 mm单极钩尖，使用ImageJ软件测量手术图像上的分支直径和到喉入口点（LEP）的分支距离。感觉分支按插入部位进一步分类（LEP与非LEP）。结果293例危险RLNs中，31例（10.6%）出现咽外分支。大多数神经为双支（27/31）。运动分支明显厚于感觉分支（1.47±0.34 mm比1.02±0.28 mm, p < 0.001）。在34个感觉分支中，有13个进入喉外结构，21个进入喉外结构。插入LEP的感觉分支较粗（1.19±0.22 mm比0.93±0.22 mm, p = 0.01），分支更靠近LEP（17.77±6.15 mm比26.44±7.71 mm, p = 0.001）。结论RLN分支直径与运动功能相关。在缺乏IONM的情况下，厚度和分支位置可以帮助外科医生区分运动分支和感觉分支，并保持声带功能。证据等级4级。

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引用次数: 0

Nasal Septal Perforation and Hereditary Hemorrhagic Telangiectasia: Evolution in Management 鼻中隔穿孔和遗传性出血性毛细血管扩张：治疗的演变

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-21 DOI: 10.1002/lio2.70315

Stephen F. Bansberg, Trenton House, Devyani Lal, Michael J. Marino, Cullen M. Taylor, Amar Miglani

Objectives

To review septal perforation management and outcomes in patients with hereditary hemorrhagic telangiectasia (HHT).

Methods

Collection and presentation of patient demographic, perforation size, and prior perforation and HHT treatment data over a 20-year period. Symptom and quality of life treatment outcomes were determined using the Nasal Obstruction Symptom Evaluation (NOSE)-Perf scale and the 5-Factor Glasgow Inventory (GBI-5F), respectively, in patients treated since 2017.

Results

Nine patients met study criteria. Mean (range) age was 64.4 (52–80) years and seven were biological males. Mean (range) perforation length and height were 1.9 (1.2–2.6) and 1.4 (1.0–1.8) cm. Four patients were treated with a customized septal button, one with posterior septal resection, and four with endonasal bilateral mucosal flap repair supported with an interposition graft. The button prostheses were well tolerated and the surgical closures successful at 8–60 months postoperatively. Subjective responses in the first three patients, and NOSE-Perf with GBI-5F scores in the latter six patients, demonstrated symptom and quality of life improvement for all patients. Perforation repair patients demonstrated substantial improvement in mean GBI-5F subdomain scores for quality of life, self-confidence, and social involvement and all have undergone sodium tetradecyl sclerotherapy injection postoperatively without re-perforation.

Conclusion

Symptom and quality of life improvement can be achieved in HHT patients with a perforation using customized septal buttons, posterior septal resection, or bilateral flap surgical repair. Surgical closure combined with injection sclerotherapy is feasible with a low risk of re-perforation and represents an effective treatment strategy in selected patients.

Level of Evidence

4.

目的探讨遗传性出血性毛细血管扩张症（HHT）患者鼻中隔穿孔的治疗及预后。方法收集和介绍20年来患者人口统计学、穿孔大小、既往穿孔和HHT治疗数据。2017年以来接受治疗的患者分别使用鼻塞症状评估(NOSE)-Perf量表和5因素格拉斯哥量表（GBI-5F）来确定症状和生活质量治疗结果。结果9例患者符合研究标准。平均（范围）年龄为64.4岁（52 ~ 80岁），男性7例。平均（范围）穿孔长度和高度分别为1.9（1.2-2.6）和1.4 (1.0-1.8)cm。4例患者采用定制的间隔钮扣，1例采用后间隔切除术，4例采用间置移植物支持的双侧鼻内粘膜瓣修复。钮扣假体耐受性良好，术后8-60个月手术闭合成功。前3名患者的主观反应和后6名患者的GBI-5F评分显示，所有患者的症状和生活质量都有所改善。穿孔修复患者在生活质量、自信心和社会参与方面的平均GBI-5F亚域评分有显著改善，并且所有患者术后均接受了十四烷基钠硬化治疗注射，无再次穿孔。结论采用定制化鼻中隔钮扣、后鼻中隔切除术或双侧皮瓣手术修复可改善HHT穿孔患者的症状和生活质量。手术缝合联合注射硬化治疗是可行的，再穿孔的风险低，在选定的患者中是一种有效的治疗策略。证据级别4。

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引用次数: 0