Laryngoscope Investigative Otolaryngology最新文献_第5页

Parent Reports Versus Objective Behavioral Measures in Pediatric Sleep-Disordered Breathing 儿童睡眠呼吸障碍的家长报告与客观行为测量。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-18 DOI: 10.1002/lio2.70312

Daniel C. Fong, Nithya Navarathna, Sophia Uddin, Heather Bortfeld, Sergio Novi, Amal Isaiah

Objective(s)

To determine the association between parent-reported problem behaviors and objectively measured response inhibition in children with sleep-disordered breathing (SDB). Understanding this concordance could facilitate better clinical decision-making, as parent reports often guide treatment decisions despite unclear relationships with objective behavioral measures.

Methods

This prospective observational study was conducted at a tertiary care pediatric otolaryngology clinic from 1/1/24–12/1/2024. Children aged 5–11 years with SDB symptoms were included, while those with clinically significant psychiatric or neurologic disorders were excluded. Parent-reported problem behaviors were measured using the Behavior Rating Inventory of Executive Function (BRIEF), with the inhibit T-score as the primary predictor. The primary outcome was performance on the Flanker Test of Inhibitory Control and Attention, which measures response suppression to irrelevant stimuli while maintaining attention to target stimuli. Relationships between BRIEF scores and Flanker Test performance were assessed using Pearson correlation and linear regression, adjusting for sociodemographic factors.

Results

Among 84 participants (mean age: 93 months [95% CI, 89–98], 56% male), parent-reported inhibitory problems showed a small but statistically significant correlation with response inhibition performance (r = −0.23, p = 0.04) in unadjusted analyses. This relationship was attenuated after adjusting for demographic and socioeconomic factors. Other behavioral domains showed weaker associations. Adjusted R² values ranged 0.14–0.16, indicating parent reports explained minimal variance in objective scores.

Conclusion

Parent-reported behavioral problems showed limited concordance with objective measures of response inhibition in children with SDB. Treatment decisions for pediatric SDB should not rely solely on parent-reported behavioral symptoms, highlighting the need for integrating objective assessments when feasible.

Level of Evidence

3.

目的：探讨睡眠呼吸障碍（SDB）患儿家长报告的问题行为与客观测量的反应抑制的关系。理解这种一致性可以促进更好的临床决策，因为尽管与客观行为测量的关系不明确，但家长报告经常指导治疗决策。方法：本前瞻性观察研究于2024年1月1日至12月1日在某三级儿科耳鼻喉科门诊进行。纳入5-11岁伴有SDB症状的儿童，排除有临床显著精神或神经障碍的儿童。使用执行功能行为评定量表（BRIEF）测量父母报告的问题行为，抑制t分数作为主要预测因子。主要结果是抑制控制和注意的Flanker测试的表现，该测试测量对无关刺激的反应抑制，同时保持对目标刺激的注意。BRIEF分数与Flanker测试成绩之间的关系采用Pearson相关和线性回归进行评估，并对社会人口因素进行调整。结果：在84名参与者中（平均年龄：93个月[95% CI， 89-98]， 56%为男性），未经调整的分析中，父母报告的抑制问题与反应抑制表现有很小但有统计学意义的相关性（r = -0.23, p = 0.04）。在调整了人口和社会经济因素后，这种关系减弱了。其他行为领域表现出较弱的关联。调整后的r2值为0.14-0.16，表明家长报告解释了客观评分的最小方差。结论：父母报告的行为问题与SDB患儿反应抑制的客观测量结果的一致性有限。儿科SDB的治疗决策不应仅仅依赖于父母报告的行为症状，强调在可行的情况下需要整合客观评估。证据等级：3。

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引用次数: 0

High Remission Rate in Eosinophilic Chronic Rhinosinusitis Following More Than Two Years of Dupilumab Therapy Dupilumab治疗2年以上后嗜酸性慢性鼻窦炎的高缓解率

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-18 DOI: 10.1002/lio2.70311

Seiichiro Kamimura, Keisuke Ishitani, Ryota Morozumi, Tatsuya Fujii, Yoshiaki Kitamura

Objective

This study aimed to evaluate the clinical remission rate and changes in medication use in patients with eosinophilic chronic rhinosinusitis (ECRS) treated with dupilumab for > 2 years.

Methods

This retrospective study included 19 patients with ECRS who received dupilumab therapy for > 2 years. The nasal polyp, Lund–Mackay on sinus CT, and SNOT-22 scores were assessed at baseline, 3 months, 1 year, and at the final evaluation. Remission was defined as sustained fulfillment of specific clinical and endoscopic criteria for at least 12 months. The use of concomitant medications was also assessed.

Results

Polyp score significantly improved from 6.1 ± 0.6 at baseline to 0.68 ± 1.2 at final evaluation. SNOT-22 scores decreased from 42.8 ± 20.0 to 14.1 ± 10.2. Clinical remission was achieved in 15 patients (79%). The remaining four patients did not meet the remission criteria because of persistent olfactory dysfunction or nasal obstruction. Significant reductions in the use of oral corticosteroids, drop-type intranasal corticosteroids, nasal spray corticosteroids, leukotriene receptor antagonists, and inhaled corticosteroids were also observed.

Conclusion

Dupilumab therapy for > 2 years resulted in a high clinical remission rate and reduced the need for concomitant medications in patients with ECRS. Persistent olfactory dysfunction is the main reason for non-remission, indicating the need for further therapeutic strategies in such refractory cases.

Level of Evidence

3.

目的：本研究旨在评估dupilumab治疗慢性嗜酸性鼻窦炎（ECRS）患者治疗bb50 - 2年的临床缓解率和用药变化。方法：本回顾性研究包括19例接受dupilumab治疗的ECRS患者，治疗时间为50 ~ 2年。在基线、3个月、1年和最终评估时评估鼻息肉、鼻窦CT隆德-麦凯和SNOT-22评分。缓解被定义为持续满足特定的临床和内镜标准至少12个月。同时还评估了伴随药物的使用情况。结果：息肉评分由基线时的6.1±0.6分显著改善至最终评估时的0.68±1.2分。SNOT-22评分由42.8±20.0降至14.1±10.2。15例患者（79%）达到临床缓解。其余4例患者因持续嗅觉功能障碍或鼻塞未达到缓解标准。口服糖皮质激素、滴入型鼻内糖皮质激素、鼻喷雾糖皮质激素、白三烯受体拮抗剂和吸入糖皮质激素的使用也显著减少。结论：在ECRS患者中，Dupilumab治疗bbb - 2年导致了较高的临床缓解率，并减少了对伴随药物的需求。持续性嗅觉功能障碍是不缓解的主要原因，这表明需要进一步的治疗策略来治疗这些难治性病例。证据等级：3。

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引用次数: 0

Efficacy of Over-the-Counter Cerumen Removal Devices: A Randomized Trial 非处方耵聍清除装置的疗效：一项随机试验。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-18 DOI: 10.1002/lio2.70313

William E. Kamm, McKenzie M. Tolan, Catherine L. Kennedy, Janet S. Choi, Schelomo Marmor, Meredith E. Adams

Objective

Consumer interest in ear hygiene has created an industry worth $2 billion, offering tools claiming to assist in cerumen removal. In this study, we aimed to compare the efficacy of self-operated over-the-counter (OTC) cerumen removal devices.

Methods

A community-based, prospective randomized trial was conducted at the Driven to Discover Research Facility at the Minnesota State Fair. A total of 529 adults aged ≥ 18 years were prospectively recruited; 149 met inclusion criteria for randomization to one of four OTC cerumen removal devices (cotton swab control, irrigator, powered and non-powered spiral tools). Cerumen burden and complications were evaluated via video-otoscopy by otolaryngologists before and after self-use of the assigned device using an objective grading system. Surveys on cerumen removal practices and consumer attitudes were completed. Group sociodemographic, survey, and cerumen burden data were compared between groups.

Results

Of 147 randomized trial participants with moderate to excessive cerumen in at least one ear (mean age 49 years, 48% female), 130 (88%) showed no improvement or worsening of cerumen burden grade following device use. There was no significant difference in the efficacy of the four OTC cerumen removal device groups. Observed complications included medial displacement of cerumen (17%), pain or discomfort (n = 7, 5%) and canal trauma (1%). While some participants would consider purchasing (29%) or recommending the device they used to others (27%), their preferred price point ($10–$20) was lower than the market price for all devices except cotton swabs.

Conclusion

Commonly used OTC cerumen removal devices did not result in a meaningful reduction of cerumen burden when used by the public and did not show superiority to cotton swabs. While it is unknown if device efficacy would improve with repeated use and familiarization, these findings do not currently support routine use of OTC cerumen removal devices for removal of excess cerumen.

Level of Evidence

Level II, randomized controlled trial.

目的：消费者对耳部卫生的兴趣创造了一个价值20亿美元的产业，提供声称有助于去除耳垢的工具。在本研究中，我们旨在比较自行操作的非处方（OTC）耵聍清除装置的疗效。方法：在明尼苏达州博览会的驱动发现研究机构进行了一项基于社区的前瞻性随机试验。前瞻性招募529名年龄≥18岁的成年人；149例符合随机纳入标准，随机选择四种非处方耵聍清除装置（棉签对照、灌水器、电动和非电动螺旋工具）之一。耳鼻喉科医生在自行使用指定设备前后通过视频耳镜评估耳垢负担和并发症，并采用客观评分系统。完成了有关耵聍清除方法和消费者态度的调查。组间社会人口学、调查和耳垢负担数据进行比较。结果：147名至少有一只耳朵有中度至重度耳垢的随机试验参与者（平均年龄49岁，48%为女性），130名（88%）在使用器械后没有显示耳垢负担等级的改善或恶化。四组非处方耵聍清除器的疗效无显著差异。观察到的并发症包括耵聍内侧移位（17%）、疼痛或不适（7.5%）和肛管创伤（1%）。虽然一些参与者会考虑购买（29%）或向其他人推荐他们使用的设备（27%），但他们喜欢的价格点（10- 20美元）低于除棉签外所有设备的市场价格。结论：常用的OTC耵聍清除器在公众使用时并没有显著减少耵聍负担，也没有表现出棉签的优越性。虽然尚不清楚器械的功效是否会随着反复使用和熟悉而提高，但这些发现目前并不支持常规使用OTC耵聍去除装置来去除多余的耵聍。证据水平：II级，随机对照试验。

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引用次数: 0

Impact of Anticoagulation Therapy on Healthcare Utilization in Patients With Epistaxis 抗凝治疗对鼻出血患者医疗保健利用的影响。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-18 DOI: 10.1002/lio2.70307

Boston Andersen, Alec Kadrie, Meghana Chanamolu, M. Boyd Gillespie

Objective

Epistaxis can occur in individuals on anticoagulants, raising concerns about the potential impact on healthcare utilization. This retrospective analysis aims to compare measures of healthcare utilization of two cohorts: adult epistaxis patients without anticoagulant use compared to adult epistaxis patients on anticoagulants.

Methods

A retrospective analysis using TriNetX datasets from 2014 to 2024 compared the outcomes of two cohorts: cohort 1 (18,550 patients) named “Epistaxis without Anticoagulation > 18 years” and cohort 2 (9530 patients) named “Epistaxis with Anticoagulation > 18 years”. The populations were matched for demographics, leaving 5480 in each cohort. The following outcomes were measured: subsequent hospital care, Emergency Department (ED) services, hospital observation services, diagnostic radiology procedures of the chest, surgical procedures on the respiratory system, surgical procedures on accessory sinuses, and post-op control of nasal hemorrhage posterior or anterior.

Results

Analyses show Cohort 2 at an increased risk for subsequent hospital care (RR 5.99 [4.31–8.33]), ED services (RR 2.70 [2.39–3.03]), hospital observation services (RR 3.00 [1.81–4.98]), and diagnostic radiology procedures of the chest (RR 3.92 [3.25–4.74]). There was a significant increase in the number of ED services required by cohort 2 (p = 0.019). Cohort 1 was more likely to need control of anterior nasal hemorrhage using simple (p < 0.001) and complex (p < 0.001) methods.

Conclusion

This analysis highlights the potential impact of anticoagulation therapy on healthcare utilization in the management of epistaxis and underscores the importance of careful monitoring and appropriate management strategies for this patient population.

Level of Evidence

IV.

目的：鼻出血可发生在使用抗凝剂的个体中，引起对医疗保健利用的潜在影响的关注。本回顾性分析旨在比较两个队列的医疗保健利用措施：未使用抗凝血剂的成人鼻出血患者与使用抗凝血剂的成人鼻出血患者。方法：回顾性分析2014年至2024年TriNetX数据集，比较两个队列的结果：队列1（18550例）命名为“无抗凝血bb0 18年”，队列2（9530例）命名为“鼻出血合并抗凝血bb1 18年”。在人口统计学上进行了匹配，每个队列中留下5480人。测量了以下结果：随后的医院护理、急诊科（ED）服务、医院观察服务、胸部放射诊断程序、呼吸系统手术程序、副鼻窦手术程序以及术后后或前鼻出血的控制。结果：分析显示队列2后续住院治疗的风险增加（RR 5.99[4.31-8.33]），急诊科服务（RR 2.70[2.39-3.03]），医院观察服务（RR 3.00[1.81-4.98]），胸部放射诊断程序（RR 3.92[3.25-4.74]）。队列2所需的ED服务数量显著增加（p = 0.019）。结论：该分析强调了抗凝治疗对鼻出血治疗中医疗保健利用的潜在影响，并强调了对这一患者群体进行仔细监测和适当管理策略的重要性。证据等级：四级。

{"title":"Impact of Anticoagulation Therapy on Healthcare Utilization in Patients With Epistaxis","authors":"Boston Andersen, Alec Kadrie, Meghana Chanamolu, M. Boyd Gillespie","doi":"10.1002/lio2.70307","DOIUrl":"10.1002/lio2.70307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Epistaxis can occur in individuals on anticoagulants, raising concerns about the potential impact on healthcare utilization. This retrospective analysis aims to compare measures of healthcare utilization of two cohorts: adult epistaxis patients without anticoagulant use compared to adult epistaxis patients on anticoagulants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis using TriNetX datasets from 2014 to 2024 compared the outcomes of two cohorts: cohort 1 (18,550 patients) named “Epistaxis without Anticoagulation > 18 years” and cohort 2 (9530 patients) named “Epistaxis with Anticoagulation > 18 years”. The populations were matched for demographics, leaving 5480 in each cohort. The following outcomes were measured: subsequent hospital care, Emergency Department (ED) services, hospital observation services, diagnostic radiology procedures of the chest, surgical procedures on the respiratory system, surgical procedures on accessory sinuses, and post-op control of nasal hemorrhage posterior or anterior.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analyses show Cohort 2 at an increased risk for subsequent hospital care (RR 5.99 [4.31–8.33]), ED services (RR 2.70 [2.39–3.03]), hospital observation services (RR 3.00 [1.81–4.98]), and diagnostic radiology procedures of the chest (RR 3.92 [3.25–4.74]). There was a significant increase in the number of ED services required by cohort 2 (<i>p</i> = 0.019). Cohort 1 was more likely to need control of anterior nasal hemorrhage using simple (<i>p</i> < 0.001) and complex (<i>p</i> < 0.001) methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This analysis highlights the potential impact of anticoagulation therapy on healthcare utilization in the management of epistaxis and underscores the importance of careful monitoring and appropriate management strategies for this patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12624485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Artificial Intelligence in Laryngeal Cancer Management: Enhancing Guidelines or Redefining Standards? 人工智能在喉癌管理中的应用：强化指南还是重新定义标准？

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-17 DOI: 10.1002/lio2.70296

Rogério Aparecido Dedivitis, Mario Augusto Ferrari de Castro, Leandro Luongo Matos, Daniel Araki Ribeiro, Bruno Pelison Duarte, Luiz Paulo Kowalski

Objective

To evaluate the accuracy of artificial intelligence (AI) in establishing clinical decision-making in the treatment of advanced laryngeal cancer.

Methods

A structured question was elaborated for each of the seven recommendations chosen. Each Large Language Model (LLM) platform answered the questions. The Claude platform identified the differences between the guidelines and the responses generated and three specialists evaluated the impact of such differences.

Results

Of the 28 analyzed responses, 22 (78.6%) demonstrated content similarity with existing guidelines. Two responses showed that guidelines contained significantly more comprehensive content, three responses from LLMs provided additional content not demonstrated in the guidelines, and one response showed direct disagreement with established guidelines.

Conclusion

There was a 78.6% overlap in responses between guideline recommendations and LLMs. Therefore, while AI holds promise for transforming guideline creation, its integration into clinical practice must be carefully evaluated to ensure that it complements, rather than replaces, established expert-driven protocols.

Level of Evidence

4.

目的：评价人工智能（AI）在晚期喉癌治疗中制定临床决策的准确性。方法：对所选择的七个建议中的每一个都详细阐述了一个结构化问题。每个大型语言模型（LLM）平台都回答了这些问题。克劳德平台确定了指南和产生的反应之间的差异，三位专家评估了这种差异的影响。结果：在分析的28份回复中，22份（78.6%）显示内容与现有指南相似。两个回复显示指南包含了更全面的内容，三个来自法学硕士的回复提供了指南中未展示的额外内容，一个回复显示了对既定指南的直接异议。结论：指南建议与llm的应答有78.6%的重叠。因此，尽管人工智能有望改变指南的制定，但必须仔细评估其与临床实践的整合，以确保它是对现有专家驱动的协议的补充，而不是取代。证据等级：4。

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引用次数: 0

Use of Superficial Temporal Vessels in Reconstructive Oral and Maxillofacial Surgery With Vascularized Free Flaps Among “Frozen Neck” Patients 颞浅血管在“冰冻颈部”患者血管化皮瓣重建口腔颌面外科中的应用。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-17 DOI: 10.1002/lio2.70283

Pei-Yi Lin, Cheng-Ri Jin, Hong-Feng Li, Shu-Ming Liu, Jie Zhang, Xiao-Ming Lyu, Ming-Wei Huang

Background

This study aimed to evaluate the feasibility of using superficial temporal vessels as recipient vessels for vascularized free flap reconstruction in “frozen neck” patients following radiotherapy for head and neck cancer (HNC).

Methods

Between February 2022 and November 2024, 16 patients underwent vascularized free flap reconstruction by using superficial temporal vessels at Peking University School and Hospital of Stomatology. Among them, anterolateral thigh flap (ALT, n = 5), radial forearm free flap (RFFF, n = 1), deep circumflex iliac artery microvascular free flap (DCIA, n = 8), and superficial iliac circumflex artery perforator flap (SCIP, n = 2) were utilized. Intraoperative vessel identification, flap survival, and postoperative complications were assessed.

Results

All patients attained optimal surgical outcomes. During the mean follow-up period of 9 months, all flaps survived with absence of major procedure-related morbidity.

Conclusion

Superficial temporal vessels offer a safe, reliable approach for vascularized free flap reconstruction in challenging “frozen neck” cases, providing an effective alternative in oral-maxillofacial reconstruction.

Level of Evidence

4.

背景：本研究旨在探讨应用颞浅血管作为受体血管用于头颈癌（HNC）放疗后“冰冻颈部”患者带血管游离皮瓣重建的可行性。方法：于2022年2月至2024年11月在北京大学附属口腔医院行颞浅血管带血管游离皮瓣重建16例。其中，采用股前外侧皮瓣（ALT, n = 5）、前臂桡骨游离皮瓣（RFFF, n = 1）、旋髂深动脉微血管游离皮瓣（DCIA, n = 8）、旋髂浅动脉穿支皮瓣（SCIP, n = 2）。评估术中血管识别、皮瓣存活及术后并发症。结果：所有患者均获得最佳手术效果。在平均9个月的随访期间，所有皮瓣均存活，无重大手术相关并发症。结论：颞浅血管为具有挑战性的“冰冻颈部”病例提供了一种安全可靠的带血管游离皮瓣重建方法，为口腔颌面部重建提供了一种有效的选择。证据等级：4。

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引用次数: 0

Impact of Balance and Dizziness Problems on Falls in Older Adults: The Longitudinal AGES-Reykjavik Study 平衡和头晕问题对老年人跌倒的影响：纵向AGES-Reykjavik研究。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-17 DOI: 10.1002/lio2.70266

Chuan-Ming Li, Howard J. Hoffman, Bryan K. Ward, Charles C. Della Santina, Mary Frances Cotch, May S. Chiu, Katalin G. Losonczy, Christa L. Themann, Lenore J. Launer, Kristin Siggeirsdottir, Palmi V. Jonsson, Vilmundur Gudnason, Hannes Petersen

Objective

To investigate the impact of balance and dizziness problems (BDP) and other risk factors on falls in a longitudinal, population-based cohort of older adults.

Methods

The Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS I) 2002–2006 examined 5764 adults aged 66–98. Five years later, 3316 surviving subjects were reexamined in AGES-RS II. Participants were asked about BDP, falls, usual activities, and health conditions. BDP symptoms during the past 12 months included: vertigo (spinning/moving sensation); floating/spacey sensation; light-headedness (no moving sensation); near fainting (presyncope) or fainting (syncope); blurred vision with head movement (oscillopsia); and feeling off-balance/unsteady. Clinical assessments included hand grip and leg strength plus steps and time to walk 6 m.

Results

During the past 12 months in AGES-RS II, BDP prevalence was 40.1% (males 35.2%, females 43.7%) and the prevalence of falling was 23.0% (males 20.9%, females 24.8%). BDP increased steps and time to walk 6 m. BDP increased the risk of falls (adjusted prevalence ratio [PR] = 1.53; 95% confidence interval [CI]: 1.34–1.76 for AGES-RS I, PR = 1.77, 95% CI: 1.55–2.03 for AGES-RS II). The prevalence of ≥ 2 falls was 8.9% (15.6% with BDP vs. 4.4% without BDP). Among those who fell ≥ 2 times, 70.4% reported BDP in the past 12 months. Additional risk of falling was associated with fear/panic attacks, memory loss, hearing loss, and other health conditions.

Conclusion

BDP are common in older adults and associated with 50% to 80% increased risk of falling and even greater risk of falling ≥ 2 times. Quantitative estimates are provided for contributing factors that further increase the risk of falls.

Level of Evidence

2 (prospective cohort study).

目的：探讨平衡和头晕问题（BDP）和其他危险因素对老年人跌倒的影响。方法：年龄，基因/环境易感性-雷克雅未克研究（ags - rs I） 2002-2006对5764名年龄在66-98岁之间的成年人进行了调查。5年后，3316名幸存的受试者在AGES-RS II中重新接受检查。参与者被问及BDP、跌倒、日常活动和健康状况。过去12个月BDP症状包括：眩晕（旋转/移动感觉）；浮动/史派西的感觉;头晕（没有移动感觉）；接近晕厥（晕厥前期）或晕厥（晕厥）；视力模糊伴头部运动（示波器减退）；感觉失去平衡/不稳定。临床评估包括握力和腿部力量以及步行6米的步数和时间。结果：过去12个月，ags - rs II患者BDP患病率为40.1%（男性35.2%，女性43.7%），下降患病率为23.0%（男性20.9%，女性24.8%）。BDP增加了步行6米的步数和时间。BDP增加了跌倒的风险（调整患病率比[PR] = 1.53； age - rs I的95%置信区间[CI]: 1.34-1.76， age - rs II的PR = 1.77, 95% CI: 1.55-2.03）。≥2次跌倒的患病率为8.9% （BDP患者为15.6%，无BDP患者为4.4%）。在下降≥2次的患者中，70.4%的患者在过去12个月内报告了BDP。额外的跌倒风险与恐惧/惊恐发作、记忆丧失、听力丧失和其他健康状况有关。结论：BDP在老年人中很常见，与跌倒风险增加50% - 80%相关，跌倒≥2次的风险甚至更大。对进一步增加跌倒风险的因素提供了定量估计。证据等级：2（前瞻性队列研究）。

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引用次数: 0

Infraglottic Edema and Subglottic Stenosis in Tracheostomy-Dependent Children: A Retrospective Cohort Study 气管造瘘依赖儿童的声门下狭窄和完全性水肿：一项回顾性队列研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-14 DOI: 10.1002/lio2.70306

Rhea Verma, Alexander Szymczak, Ashley Young, Steven Tomasi, Rachel L. Schappacher, Sara K. Perry, Rachel D. Yoon, Saied Ghadersohi, Taher Valika, Jonathan Ida, Inbal Hazkani

Objective

Infraglottic edema secondary to swelling of the conus elasticus is a common observation in children after tracheostomy. We sought to describe the natural course of infra-glottic edema as seen at first direct laryngoscopy and bronchoscopy (DLB) and explore its association with developing subglottic stenosis (SGS) in tracheostomy-dependent children.

Methods

A retrospective cohort study of children who underwent tracheostomy between 2012 and 2022 in a tertiary care children's hospital.

Results

A total of 255 children (mean age 3.5 ± 5.3 years) were enrolled, of whom 150 met inclusion criteria. Infraglottic edema was observed in 74 patients (49.3%) at first DLB, performed a median of 1.7 months after tracheostomy. Patients with edema were significantly younger at the time of tracheostomy and more likely to be ventilator-dependent due to bronchopulmonary dysplasia. Thirty patients (20%) developed SGS within 12–24 months of follow-up. On univariable analysis, factors associated with increased odds of developing SGS included the presence of infraglottic edema at first DLB, gestational age, age at tracheostomy, and medical comorbidities; no significant association between SGS and other variables was identified in multivariable analysis; however, the adjusted odds ratio suggested a 94% increase in odds of developing SGS in patients with infraglottic edema [OR 1.94, p = 0.16].

Conclusions

Infraglottic edema is a common early finding after pediatric tracheostomy. While none of the variables of interest were associated with the development of SGS, the comparatively higher odds of SGS in patients with infraglottic edema suggest a potential link that warrants further investigation in prospective studies.

Level of Evidence

4.

目的儿童气管切开术后继发于弹性圆锥肿胀的膨胀性水肿较为常见。我们试图描述首次直接喉镜检查和支气管镜检查（DLB）所见的声门下水肿的自然过程，并探讨其与气管造瘘依赖儿童发生声门下狭窄（SGS）的关系。方法对2012 - 2022年在某三级儿童医院行气管切开术的患儿进行回顾性队列研究。结果共纳入255例儿童，平均年龄（3.5±5.3）岁，其中150例符合纳入标准。74例（49.3%）患者在气管切开术后中位时间为1.7个月的首次DLB患者中观察到房颤性水肿。水肿患者在气管切开术时明显更年轻，并且由于支气管肺发育不良更容易依赖呼吸机。30例（20%）患者在随访12-24个月内发生SGS。在单变量分析中，与发生SGS的几率增加相关的因素包括：首次DLB时是否存在房颤性水肿、胎龄、气管切开术年龄和医疗合并症；在多变量分析中，SGS与其他变量无显著相关性；然而，调整后的优势比显示，骶髂水肿患者发生SGS的几率增加94% [OR 1.94, p = 0.16]。结论小儿气管切开术后常见的早期症状是室性水肿。虽然所有的变量都与SGS的发展无关，但在声带膨大性水肿患者中，SGS的相对较高的几率表明有潜在的联系，值得在前瞻性研究中进一步调查。证据级别4。

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引用次数: 0

Establishing New Pediatric Thresholds for Digits-In-Noise Testing 建立新的儿科数字噪声检测阈值

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-14 DOI: 10.1002/lio2.70287

Morgan McBride, Allyson Dunlap, Siva Chinnadurai, Brianne B. Roby, Andrew Redmann, Abby C. Meyer, Luke Jakubowski, Hannah Herd, Rebecca Maher, Chelsea Kimlinger, Madeline Poland, Michael Finch, Asitha D. L. Jayawardena

Objective

To determine if specific pediatric diagnostic criteria exist to determine the presence of conductive hearing loss (CHL) digits in noise (DIN) tablet testing in children.

Methods

One hundred forty nine children aged 3–18 underwent a conventional audiogram, followed by an otolaryngologist examination and tablet-based digits in noise (DIN) testing. DIN testing consisted of diotic (same-phased stimuli) and antiphasic (out-of-phase stimuli) digits-in-noise testing on a HearX Samsung Galaxy tablet with over-the-ear headphones, for a total of 298 measurements. Children were included if they could repeat the numbers 1–10 in English, and excluded if they could not complete testing or could not tolerate ear-level examination.

Results

The signal-to-noise ratios of all participants were correlated with the hearing diagnosis determined by sound booth audiometric evaluation. Two unique parameters were identified that allowed us to identify conductive hearing loss (CHL) in the pediatric population with a high positive predictive value (76% and 95%) and acceptable specificity (81% and 98%), but poor sensitivity (39% and 22%).

Conclusion

Pediatric DIN testing did not delineate CHL from NH as cleanly as adult data. Trends were noted, but improvements need to be made to sensitivity prior to utilizing DIN as a screening tool for pediatric CHL.

Level of Evidence

2.

目的确定是否存在特定的儿科诊断标准来确定儿童在噪声（DIN）片剂检测中是否存在传导性听力损失（CHL）。方法149例3 ~ 18岁儿童行常规听力学检查、耳鼻喉科检查和片式指指噪声（DIN）检测。DIN测试包括在戴耳式耳机的HearX三星Galaxy平板电脑上进行双相（同相刺激）和反相（异相刺激）数字噪声测试，共进行298次测量。能够用英语重复数字1-10的儿童被纳入，不能完成测试或不能忍受耳级检查的儿童被排除在外。结果所有受试者的信噪比均与听力学评价确定的听力诊断相关。我们确定了两个独特的参数，使我们能够在儿科人群中识别传导性听力损失（CHL），具有较高的阳性预测值（76%和95%）和可接受的特异性（81%和98%），但灵敏度较差（39%和22%）。结论儿童DIN检测不能像成人数据那样清晰地区分CHL和NH。趋势已被注意到，但在使用DIN作为儿童CHL筛查工具之前，需要提高敏感性。证据级别2。

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引用次数: 0

Body Mass Index and Hypoglossal Nerve Stimulation Outcomes: A Systematic Review and Meta-Analysis 身体质量指数和舌下神经刺激的结果：一项系统回顾和荟萃分析

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology

Pub Date : 2025-11-13 DOI: 10.1002/lio2.70305

Coleton Evans, Benjamin Winters, Sandeep Rao, Sean Kelso, Peter Wickwire

Objective

This systematic review and meta-analysis evaluated how body mass index (BMI) influences surgical outcomes of hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea (OSA), specifically comparing patients with BMI ≥ 32 kg/m² to those with BMI < 32 kg/m².

Data Sources

PubMed, Embase, and Scopus were searched from January 2014 to April 2025 for prospective and retrospective cohort studies or case–control studies reporting HGNS outcomes stratified by BMI.

Review Methods

Following PRISMA guidelines, data were extracted on study design, demographics, baseline apnea–hypopnea index (AHI), and postoperative outcomes. Surgical success was defined using Sher or modified Sher criteria. Random-effects meta-analysis was performed using the DerSimonian and Laird method. Fixed-effect inverse-variance weights were first calculated, and between-study heterogeneity was quantified using Cochran's Q statistic and expressed as the I² statistic. Study quality was assessed with the Newcastle–Ottawa Scale.

Results

Seven studies (n = 1572) were included in the qualitative synthesis; four were included in the meta-analysis. Qualitative findings were mixed, with some studies reporting poorer outcomes at higher BMI and others showing no difference. The pooled odds ratio for treatment success in the BMI ≥ 32 kg/m² group versus < 32 kg/m² was 0.87 (95% CI: 0.68–1.11). Between-study heterogeneity was low (Q = 4.11, df = 3, p = 0.25; I² = 27%), indicating relatively consistent effect estimates across studies.

Conclusion

Elevated BMI was associated with a nonsignificant trend toward lower HGNS surgical success, but outcomes were broadly consistent across studies. Many patients with BMI ≥ 32 kg/m² achieved meaningful objective and subjective improvements, challenging rigid BMI-based eligibility criteria and supporting individualized candidacy assessment.

目的本系统综述和荟萃分析评价体重指数（BMI）对舌下神经刺激（HGNS）治疗阻塞性睡眠呼吸暂停（OSA）手术效果的影响，特别比较BMI≥32 kg/m2和BMI≤32 kg/m2的患者。从2014年1月至2025年4月，检索PubMed、Embase和Scopus，以报告按BMI分层的HGNS结果的前瞻性和回顾性队列研究或病例对照研究。根据PRISMA指南，提取研究设计、人口统计学、基线呼吸暂停低通气指数（AHI）和术后结果的数据。手术成功的定义采用Sher或修改后的Sher标准。随机效应荟萃分析采用DerSimonian和Laird方法。首先计算固定效应反方差权值，采用Cochran’s Q统计量量化研究间异质性，并用I2统计量表示。采用纽卡斯尔-渥太华量表评估研究质量。结果7项研究（n = 1572）纳入定性综合；其中4例纳入meta分析。定性研究结果好坏参半，一些研究报告高BMI的结果较差，而另一些研究则没有发现差异。BMI≥32 kg/m2组与BMI≤32 kg/m2组治疗成功的合并优势比为0.87 （95% CI: 0.68-1.11）。研究间异质性较低（Q = 4.11, df = 3, p = 0.25; I2 = 27%），表明研究间的效应估计相对一致。结论：BMI升高与HGNS手术成功率降低的趋势不显著相关，但各研究的结果大致一致。许多BMI≥32 kg/m2的患者获得了有意义的客观和主观改善，挑战了严格的基于BMI的资格标准，并支持个性化的候选资格评估。

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引用次数: 0