Laryngoscope Investigative Otolaryngology最新文献

Background and Objective

Septoplasty and turbinate reduction surgery (STR) is hypothesized to affect pulmonary function by modifying airway dynamics. This study investigates the impact of STR-mediated improvements in nasal patency on pulmonary function tests (PFTs).

Methods

In a prospective analysis, 37 adult patients undergoing STR were enrolled. Peak nasal inspiratory flow (PNIF) and PFT parameters, including forced expiratory flow at 25% (FEF25) and 75% of forced vital capacity (FEF75) and forced expiratory flow between 25 and 75% of the pulmonary volume (FEF25–75), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1), were measured before and after surgery.

Results

Significant improvements were observed in PNIF (p < .001). Additionally, significant improvements in peripheral airway function occurred, as measured by FEF25, FEF25-75, and FEF75 (p < .05), suggesting reduced airway resistance after STR. Notably, a significant positive correlation was found between the change in PNIF (∆PNIF) and the change in various PFT measurements (∆PFT) (p < .05). FVC and FEV1 did not show significant changes.

Conclusions

These findings suggest that improving nasal patency through STR can affect lower airway resistance, potentially benefiting patients with nasal obstruction. The observed positive correlation between ∆PNIF and ∆PFT warrants further investigation into the underlying mechanism.

Level of evidence

Level III.

Objective

To investigate the impact of music on patient tolerance during office-based laryngeal surgery (OBLS).

Methods

All patients undergoing OBLS between February 2024 to June 2024 were invited to participate in this study. They were divided into two subgroups, those with music in the background during surgery and those without. Following surgery, all patients were asked to fill IOWA tolerance score and the VAS for discomfort ranging from 0 to 10, with 0 indicating no discomfort and 10 indicating maximum discomfort.

Results

A total of 87 patients undergoing 95 office-based laryngeal surgeries (OBLS) were included, with a mean age of 54.7 years and a male-to-female ratio of 1.5. The most common procedure was blue laser therapy (45.3%), followed by vocal fold injection (29.5%). The mean IOWA tolerance score was 2.02. Patients who listened to music during OBLS showed a significantly higher mean IOWA tolerance score compared to those without music (2.48 vs. 1.55; p < .001). Significant differences persisted when stratified by procedure type. Additionally, the mean VAS score for discomfort was lower with music (2.27 vs. 4.21; p = .001), with a significant difference noted for laser therapy (p = .004).

Conclusion

The results of this investigation indicate that music has a positive effect on procedural tolerance in OBLS. Participants who underwent OBLS with music in the background had significantly higher tolerance score and less discomfort than those who had no music in the background. Music can be used as a safe nonpharmacologic modality to reduce stress and improve patient tolerance in awake OBLS.

Level of Evidence

2.

Objectives

Although various stapedotomy and stapedectomy techniques exist, anchoring the piston can be challenging. We present a novel surgical approach for treating congenital stapes malformations with an atypical facial nerve trajectory.

Methods

This is a case of a 7-year-old boy presenting with bilateral conductive hearing loss. Prior attempts at tympanoplasty had proven unsuccessful in improving his hearing. Presurgical imaging studies revealed an unusual anatomical configuration, with the facial nerve positioned inferior to the oval window. This anatomical variation precluded the use of conventional prosthesis-anchoring techniques typically employed in stapedotomies. Thus, we devised an innovative approach, opting to anchor the prosthesis to the short process of the incus.

Results

This novel technique circumvented the atypical course of the facial nerve, allowing for successful reconstruction of the ossicular chain. The patient demonstrated an acceptable improvement (30 dB gain) in hearing 1-year post-surgery, with no reported complications.

Conclusion

This case underscores the critical importance of adapting surgical techniques to address the unique anatomical challenges that may arise in the context of congenital ear malformations. It also highlights the potential of the short process of the incus as a viable alternative anchoring site for stapes prostheses, thereby improving the outcomes of such complex cases. This technique not only restored the patient's hearing but also contributed valuable insights into the management of similar cases, potentially improving the quality of life for individuals with rare and challenging anatomical variations.

Level of evidence

5.

Objective(s)

To evaluate the otolaryngology surgical capacity in Harare, Zimbabwe by analyzing procedural volumes across four hospitals, one private and three public, from 2019 to 2022.

Methods

A retrospective review of hand-written surgical case logs was conducted at Harare Eye, Ear, Nose, and Throat Institute (HEENT), Parirenyatwa Group of Hospitals (PGH), Sally Mugabe Children's Hospital (SMCH), and Sally Mugabe Adult's Hospital (SMAH). Patient age and surgical intervention for all otolaryngology surgeries performed in the operating room from 2019 to 2022 were recorded. Procedures were categorized into six groups: head and neck malignancy, laryngeal surgery, oropharyngeal surgery, otologic surgery, rhinology/sinus surgery, and other. Data were analyzed using descriptive statistics to identify trends in surgical volume and types of procedures across hospitals.

Results

A total of 2626 procedures were recorded: 1470 at HEENT, 377 at PGH, 625 at SMCH, and 154 at SMAH. Of these, 39.5% were performed on pediatric patients and 60.5% on adult patients. The most common procedures were adenotonsillectomy/adenoidectomy/tonsillectomy (38.9%), diagnostic endoscopies (10.4%), and endoscopic sinus surgery (8.3%). HEENT performed the highest volume and widest range of procedures. HEENT had higher surgical volumes across all groups of procedure, except for laryngeal surgery.

Conclusion

This study found disparities in otolaryngology surgical capacity between a private hospital, HEENT, and three public tertiary hospitals—SMCH, SMAH, and PGH, the largest hospital in the country—in Harare, Zimbabwe. Additionally, it highlights areas for targeted interventions in capacity building. This study establishes a foundation for understanding otolaryngologic surgical capacity in the country, supporting international collaboration, guiding future research, and serving as a model for similar assessments in other LMICs.

Level of evidence

Level VI.

Introduction

H-index is a widely used metric quantifying a researcher's productivity and impact based on an author's publications and citations. Though convenient to calculate, h-index fails to incorporate collaborations and interrelationships between physicians into its assessment of academic impact, leading to limited insight into grouped networks. We present social network analysis as a tool to measure relationships between physicians and quantify their academic impact.

Methods

A bibliometric multicenter analysis was conducted on physician faculty from 129 US ACGME accredited otolaryngology programs who have publications with a physician co-author in the field. Using web searches, 2494 physician faculty were identified. Scopus IDs, h-indices, and publication data for these physicians were identified using multiple Elsevier APIs queried in December 2023. Publications with multiple otolaryngology physician co-authors were included. Network and sub network maps were generated using Gephi and analyzed with custom R scripts. Centrality measures (degree, PageRank, betweenness centralities) quantified collaboration propensity. Non-parametric correlation analysis between centrality measures and h-index was conducted. Sankey diagrams were plotted using ggplot2.

Results

A co-authorship network of 2259 physicians was constructed. Physicians were visualized as nodes with collaborations as links. Centrality measures correlated strongly with h-index (h-index vs. degree centrality: r² = 0.62, h-index vs. PageRank: r² = 0.55, h-index vs. betweenness centrality: r² = 0.55; p < .0001). Analysis revealed novel insights into physician network structure, identifying 14 communities primarily populated by single subspecialties with varied node density.

Conclusion

Social network analysis showed moderate correlation between social connectedness measures and h-index, supporting its use in measuring academic impact. In otolaryngology, collaborative interactions within the academic community are strongly shaped by sub-specialty affiliation and academic institution.

Objective

Endoscopic arytenoid abduction lateropexy (EAAL) is a minimally invasive surgical technique for the immediate management of bilateral vocal fold palsy (BVFP). Specifically, it achieves a stable and adequate airway by lateralizing the arytenoid cartilage without resecting laryngeal structures. Thus, this study evaluated the effect of EAAL on swallowing in cases of BVFP.

Methods

The participants consisted of 17 adult patients (15 female, 2 male) who underwent unilateral EAAL for BVFP. Swallowing function was evaluated by using the fiberoptic endoscopic evaluation of swallowing (FEES) on the 6th postoperative day and in the 6th postoperative month. The results were assessed by using the pharyngeal residue severity scale (PRSS) and the modified penetration-aspiration scale (mPAS). Additionally, the M.D. Anderson Dysphagia Inventory (MDADI) questionnaire was self-administered during the 6th postoperative month.

Results

Overall, 16 of the 17 patients demonstrated normal swallowing function during the early and late postoperative periods. Moreover, one patient experienced mild fluid aspiration early on, but initially managed it with dietary adjustments and eventually resolved it with a head flexion compensatory maneuver. There was no significant deterioration in swallowing-related quality of life according to the MDADI assessments.

Conclusion

Based on this evaluation of unilateral EAAL, our results confirmed that this procedure is not only a reliable solution for BVFP from the perspective of respiratory function and phonation but also in terms of swallowing quality.

Level of Evidence

4.

Objectives

While it is known that surgical costs continue to rise in the United States, there is little information about the specific underlying factors for this variation in many common procedures. This study investigates the influence of geographic location and hospital demographics on hospital cost and postoperative outcomes in adult patients undergoing total thyroidectomy (TT).

Methods

The National Inpatient Sample was queried for patients who underwent primary TT between 2016 and 2017. Multivariable analyses were conducted to determine estimates and odds ratios (OR) between various hospital factors and total cost, prolonged length of stay (LOS), and non-home discharge. Reference categories were small bed-size and Northeast region.

Results

A weighted total of 16,880 patients with mean age of 50.6 years were included. Most patients were female (73.8%), White (57.0%), and treated at Southern (32.4%), large bed-size (65.1%), and urban teaching (82.7%) hospitals. Medium and large bed-size hospitals were associated with a 6.5% (p < .001) and 7.5% (p < .001) reduction in TT cost, respectively. TT cost was greatest in the West, associated with a 32.4% increase (p < .001). Patients in the Midwest (OR 1.366, p = .011) had prolonged LOS, whereas patients treated in the Midwest (OR 0.436, p < .001), South (OR 0.438, p < .001), and West (OR 0.502, p < .001) had lower odds of non-home discharge.

Conclusion

There is geographic variation in both costs and outcomes of TT. Although Northeastern hospitals had the lowest costs for TT, they were associated with the greatest odds for non-home discharge.

Level of evidence: IV

Introduction

Castleman disease (CD) refers to a heterogeneous group of lymphoproliferative disorders, which rarely involves the larynx. Our goal in this study is to elucidate the clinical presentation, diagnostic techniques, and treatment methods of laryngeal CD through a scoping review and the addition of a new case.

Methods

Due to limited existing literature, we employed a mixed methodology for review. First, we searched Google Scholar using terms related to laryngeal CD. Subsequently, we screened abstracts using Covidence, drawing from databases such as PubMed, Science Direct, ProQuest, and EMBASE. We shortlisted studies for data extraction, focusing on clinical presentations, diagnostics, and treatment methodologies. Finally, we described our additional case.

Results

Scoping review revealed five qualifying laryngeal CD articles. Presenting symptoms included dysphagia, hoarseness, and dyspnea. Diagnosis was always established through histopathologic analysis. Management included local excision or radiotherapy. In our additional case, a 71-year-old male with known CD presented with neck swelling, dysphagia, and dysphonia. Exam revealed lymphoid laryngeal and supraglottic hyperplasia and edema. Laryngeal symptoms improved with medical management of CD.

Discussion

Given the rarity of laryngeal CD, its identification and management can be a challenge. Practitioners should be aware of characteristic points in a CD patient's history, physical exam, imaging, and biopsies. Local excision of obstructive lymphoid tissue and radiation are the best-supported therapies. This study aims to build toward improvements in accurate diagnosis and appropriate treatment for laryngeal CD.

Objectives

This study aimed to investigate the histological and ultrastructural features of the elastic cartilage at the tip of the vocal process in the arytenoid cartilage, which is essential for laryngeal biomechanics.

Methods

Five larynges, including the vocal folds and epiglottis, were examined using transmission electron microscopy. The elastic cartilage at the tip of the vocal process was compared to the epiglottic cartilage within the same larynx to elucidate structural differences.

Results

The elastic cartilage at the vocal process tip consisted of chondrocytes, elastic fibers, collagen fibrils, and ground substances. Chondrocytes in the vocal process were smaller and not distinctly isolated in cartilage cavities (lacunae), unlike those in the epiglottis. Cytoplasmic analysis showed abundant free ribosomes and well-developed granular endoplasmic reticula, often with dilated cisternae. Amorphous materials were synthesized at the periphery of the cytoplasm and secreted through vesicles. The cartilage matrices were composed of elastic fibers, collagen fibrils, microfibrils, and proteoglycans. The density of elastic fibers was notably higher where elaunin fibers predominated. Collagen fibrils were thin, randomly oriented, and did not form thick bundles. Microfibrils formed delicate three-dimensional networks with other extracellular matrix components. And proteoglycan granules were located in the interstitial spaces among other cartilage matrix components and attached to them.

Conclusions

The unique structural features of the elastic cartilage at the tip of vocal process, when compared to the epiglottic cartilage, suggest a specialized functional role in maintaining the flexibility and resilience required for vocal fold adduction and abduction during phonation and other laryngeal functions.

Level of evidence: NA

Objective

To identify differences in timing of exposure and demographic characteristics between medical students who did and did not consider Otolaryngology as a career choice.

Methods

This cross-sectional study involved developing and distributing a survey by an interdisciplinary team to assess exposure to Otolaryngology and individual consideration of pursuing Otolaryngology. The survey was administered electronically to third- and fourth-year medical students at a single medical school, with a small monetary incentive for completion. Descriptive statistics, Fisher's exact tests, and logistic regression models were used for analysis.

Results

A total of 172 survey responses were collected out of 374 third- and fourth-year medical students (46%). A total of 74 (43.0%) respondents considered Otolaryngology during medical school. Exposure to Otolaryngology prior to medical school was significantly associated with choosing Otolaryngology (71.4%) compared to those who lacked exposure (28.6%) (p = .048). There was no significant gender difference among students who considered Otolaryngology (p = .537). However, our results showed significant differences between those who considered Otolaryngology by race (p = .003). Black/African American (OR = 0.11, 95% CI 0.01–0.99; p = .049) and Hispanic or Latino (OR = 0.14, 95% CI 0.03–0.65; p = .012) were less likely to consider Otolaryngology when compared to those identifying as White when adjusted for exposure prior to medical school.

Conclusions

Our results showed that early exposure and demographic background impact a student's decision to consider Otolaryngology as a career. These findings highlight the need for robust recruitment initiatives. Avenues like pipeline and mentorship programs are recommended to recruit and attract diverse applicants to Otolaryngology.

Level of Evidence

3