Laryngoscope Investigative Otolaryngology最新文献

Objective(s)

Pediatric epistaxis is a common, often non-operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers.

Methods

Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed.

Results

In total, 122 patients were included for analysis. Over a follow-up duration of 20.5 months (IQR 8–36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution (n = 122). Refractory epistaxis was associated with a family history of coagulopathy (p = .007), daily epistaxis episodes (p = .043), and anemia (p <.001). Average direct hospital costs associated with nasal cautery were $187 for in-office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in-office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work-up was $576.

Conclusion

Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care.

Level of Evidence: 4.

Objective

To evaluate the vocal fold histological characteristics during different postnatal periods in rats, especially older rats.

Methods

Sprague–Dawley rats aged 4 days, 4 and 12 weeks, and 12 and 24 months were used for the experiment. Five larynges were obtained for each age and cut into 5-μm consecutive sections. The expression of Ki-67 was assessed using immunohistochemistry to examine cell proliferation. Elastic van Gieson staining was used to detect the collagen and elastin concentrations. The cell type was determined using multicolor immunofluorescence.

Results

Ki-67 was not expressed in the macula flava (MF) of 12-week-, 12-month-, and 24-month-old adults. Collagen fibers in the lamina propria (LP) increased with age. The elastic fiber concentrations in the LP decreased significantly at 24 months (p < .01) but remained stable in the MF. All posterior MF cells showed strong glial fibrillary acidic protein and vimentin-positive reactions with weaker expressions of CD68 and α-smooth muscle actin (α-SMA). The myofibroblasts (α-SMA-positive) and macrophages (CD68-positive) in the LP of the 24-month-old rats were significantly the highest (p < .01).

Conclusion

The extracellular matrix in the LP increases with age, presenting as an increase in collagen with the loss of elastin, which may be due to myofibroblast proliferation. Moreover, the cellular properties or extracellular matrix components of the mature MF in rats are comparable to those in humans.

Objective

To analyze medical device reports (MDR) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events (AEs) in patients implanted with novel active bone conduction hearing implants (BCIs).

Methods

We conducted a search of the FDA MAUDE database on the newest generation of BCIs. Data were collected concerning device malfunctions, patient injuries, factors triggering these incidents, and the subsequent actions taken.

Results

In total, 93 (16.7%) device malfunctions and 465 (83.3%) patient injuries with 358 subsequent interventions were identified, resulting in 558 AEs. Although the absolute AE number per device cannot be identified, the following trends were detected: Among the 494 AEs associated with OSI200, 55 (11.1%) reported device malfunctions and 454 (88.9%) cited patient injuries. Out of the 64 AEs linked to BCI602, 28 (59.4%) were associated with malfunctions, whereas 26 (40.6%) involved patient injuries. The most frequently reported particular AEs for the OSI200 were infection (n = 171, 34.6%), extrusion of the device (n = 107, 21.7%), and pain (n = 51, 10.3%). Conversely, no device output (n = 20, 31.3%) and loss of osseointegration (n = 7, 10.9%) were the most reported AEs for the BCI602. Various AEs led to 214 explanations and 77 revision surgeries. Sixty-seven AEs reported conservative treatment.

Conclusion

The current study provides an overview of the most commonly reported complications with new active BCIs. Although providing an overview, given the limitations of the FDA MAUDE database, our results have to be interpreted with caution.

Level of Evidence

4.

Objective

The objective of this study is to investigate whether conductive hearing loss (CHL) can be differentiated from sensorineural hearing loss in children ages 3–18 using a diotic and antiphasic digits-in-noise (DIN) tablet-based test using existing adult cut-off criteria.

Methods

A blinded multi-institutional prospective cohort of 64 children aged 3–18 scheduled for an audiometric soundbooth evaluation with a pediatric audiologist and a same-day otolaryngologist examination were recruited for the study. Following a conventional audiogram, the subjects underwent diotic (same-phased stimuli) and antiphasic (out-of-phase stimuli) DIN testing on a HearX Samsung Galaxy tablet with over-the-ear headphones, for a total of 128 measurements. DIN test results were compared with soundbooth audiometry using known adult “cut off criteria.”

Results

A logistic regression analysis adjusted for demographics (age, sex) and race was performed to compare CHL determination from DIN testing to CHL determination with soundbooth audiometry. The results showed 50% agreement with a p-value of .753. The determinations based on combined DIN testing agreed with each other 33% of the time and had a p-value of .373. Otologic pathology and age were not predictive of outcome.

Conclusion

This preliminary analysis of DIN testing indicated that DIN and audiometric testing completed in a soundbooth were not significantly predictive of one another in the population of children aged 3–18 when using the adult cut-off criteria for CHL differentiation. Given these findings, further testing is required in children to determine pediatric specific cut-off values.

Objective

Heliox, a mixture of helium and oxygen, has been shown to improve laminar airflow and decrease airway resistance in children. This study aims to describe the outcomes of heliox use in children with respiratory compromise and to identify variables associated with a need for airway surgical intervention.

Methods

A retrospective cohort study of patients who received heliox between 2012 and 2022 at a tertiary care children's hospital.

Results

A hundred and thirty-eight heliox treatments were recorded in 119 children. Twelve patients were excluded. Most (n = 100, 84%) patients had significant comorbidities. On average, patients spent a cumulative mean of 94 ± 187 h on heliox therapy per hospital admission. Patients with croup or asthma without known airway pathology presented at an older age than patients with other indications for heliox therapy (4.0 ± 4.7 vs. 2.2 ± 3.6 years, p = 0.04) and were significantly less likely to have background diseases (n = 14, 52% vs. n = 74, 93%, p < 0.0001). Overall, 51 (47.7%) patients were recommended tracheostomy placement, airway reconstruction, or palliative care. Cumulative use of heliox for more than 47 h was associated with an increased risk of needing tracheostomy or airway reconstruction (odds ratio 6.2, 95% confidence intervals 2.56–14.13, p < 0.0001). In multivariable regression analysis, neuromuscular disease, intracranial neuropathology, and cumulative time of heliox were associated with a need for definitive airway intervention.

Conclusions

Heliox may be used as a temporizing agent in children with upper airway obstruction. The effectiveness of heliox use for more than 47 h in children, especially in the presence of neuromuscular disease and intracranial neuropathology should be reconsidered.

Level of evidence: 4.

Objective

The present study objectived to investigate the influence of Ramadan fasting (RF) on olfactory function.

Methods

Sixty-two participants were included in the current prospective study. The odor threshold and identification performances were determined by using the Connecticut Chemosensory Clinical Research Center (CCCRC) test initially (day 0) and on the first and last day (30th) of RF. Body weight (BW)s were measured initially and at the end of the study. The results were analyzed statistically.

Results

The average of baseline and last-day BWs were 78.38 ± 12.96 and 78.36 ± 12.39 kg, respectively. No significant difference was determined in terms of BWs (p = .932, p > .05). In the evaluation of CCCRC test outcomes, significant differences were observed in the scores of butanol thresholds (p = .0001), odor identification (p = .0001), food-related odors identification (p = .0001), and the number of normosmic individuals (p = .0001) at different times (p < .05). The thresholds scores (p = .0001, p = .0001), the identification scores (p = .0001, p = .0001), food-related odors identification scores (p = .0001, p = .0002), and the number of normomic individuals (p = .001, p = .001) detected on 30th day were significantly higher than on 0th and 1st days; respectively (p < .05). Additionally, the threshold scores (p = .0001), the identification scores (p = .003), food-related odors identification scores (p = .007), and the number of normosmic individuals (p = .018) detected on day 1 were significantly higher than on day 0 (p < .05).

Conclusion

The current study demonstrated that Ramadan fasting enhances the olfactory detection threshold and odor identification scores, significantly improving the identification of food-related odors. The results may indicate that Ramadan fasting improves olfactory performance.

Level of evidence

Level II.

Objective

To identify predictors associated with loss and recovery of smell and taste after COVID-19 infection.

Methods

The Integrated Public Use Microdata Series (IPUMS) 2021 National Health Interview Series (NHIS) database was used to analyze factors associated with loss and recovery of smell and taste in respondents who had a previous COVID-19 infection. Significant variables from univariate analysis were included in a stepwise backward regression model to identify independent predictors.

Results

Of the 3844 individuals who answered yes to having contracted COVID-19, 51.1% and 48.9% reported losing smell and taste, respectively. 95.7% recovered smell and 97% recovered taste. Predictors associated with higher odds of reporting a loss of smell included younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.98–0.99), female sex (OR 1.38; CI 1.17–1.63), use of e-cigarettes (OR 1.59; CI 1.25–2.02), and Mexican ethnicity (OR 1.61; CI 1.22–2.11). Predictors of taste loss were younger age (OR 0.98; CI 0.98–0.99), female sex (OR 1.31; CI 1.08–1.58), and higher BMI (OR 1.02; CI 1.00–1.04). Female sex was associated with decreased odds of reporting a recovery of smell (OR 0.74; CI 0.59–0.92) and taste (OR 0.54; CI 0.42–0.69). Black/African American race (OR 1.44; CI 1.03–2.03) and non-Mexican Hispanic ethnicities (OR 1.55; CI 1.02–2.34) were associated with an increased likelihood of reporting the recovery of smell.

Conclusion

Various factors may be associated with the loss and recovery of smell and taste after COVID-19 infections. Clinicians may use this information to better counsel patients with these symptoms.

Level of evidence

4.

Objective

Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features.

Methods

Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre- and post-treatment VHI-10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality.

Results

One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty-five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty-five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI-10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post-treatment, (p < .001). 57/111 patients reported high voice demand professions or recreational activities. The average self-reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in-office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%).

Conclusions

In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs.

Level of evidence

Level 3: Retrospective cohort study.

Objective

The objective of this study is to assess disparities in adherence to swallowing therapy for clinically diagnosed oropharyngeal dysphagia (OD) patients.

Methods

Analysis was conducted on data from 600 patients with OD and confirmed impairments in swallowing safety and/or efficiency on a videofluoroscopic swallow study. Patients were classified based on their adherence to treatment sessions, defined as the number of swallow treatment sessions attended. The outcome of treatment adherence was categorized into two groups: those who attended fewer than 50% of the prescribed treatment sessions and those who attended 50% or more of the sessions. Continuous variables were presented as mean ± standard deviation or median ± interquartile range. Categorical variables were compared using Pearson chi-square tests and Fisher's exact test when appropriate. Univariable and multivariable binary logistic regression models were employed to identify factors associated with successful adherence.

Results

Approximately 79% adhered to swallowing treatment. We found no significant relationship between adherence and age, sex, race, ethnicity, primary language, marital status, insurance status, occupation, median income, distance, education, OD severity, and diagnosis year (p > 0.05). We found no covariables to be significant predictors to swallowing treatment nonadherence in both univariable and multivariable binary regression models (p > 0.05).

Conclusion

The variables analyzed in this study were not significantly associated with nonadherence to swallow therapy. Nevertheless, our study still addressed an important knowledge gap and future studies would benefit from exploring other relevant socioeconomic and disease-related factors.

Level of evidence

Level 4.

Objectives

Recently, a set of consensus criteria and near-consensus criteria for the evaluation of chronic rhinosinusitis (CRS) disease control was identified by an international multidisciplinary panel of key stakeholders. The objective of this study is to evaluate patient perspectives on these disease control criteria.

Methods

This is a qualitative phenomenological study using constant comparative methodology. Twenty-one one-on-one interviews, ranging from 6 to 15 min and based on a standardized semi-structured script, with CRS patients from diverse backgrounds were performed. The authors analyzed transcripts of the interviews to identify recurrent themes in patient responses. Conclusions were drawn based on these themes.

Results

All participants agreed with the consensus criteria (overall symptom severity, nasal obstruction severity, patients' self-assessed CRS control, and need for CRS-related oral corticosteroids), and most participants agreed with near-consensus criteria (nasal endoscopy, smell loss and nasal drainage severities, impairment of day-to-day activities, and overall quality of life) identified by the international multidisciplinary panel. Some patients disagreed with inclusion of smell loss due to common etiologies—such as post-viral or iatrogenic causes—that would not necessarily be an indicator of active sinonasal inflammation. One theme that emerged was the need for a facial pain/pressure criterion to be added.

Conclusions

CRS patients overwhelmingly affirmed recently described consensus and near-consensus criteria for CRS disease control with the caveat that a question asking about facial pain/pressure should be included as well. Recently, identified consensus criteria for CRS disease control should be interpreted within the context of patient perspectives.