Laryngoscope Investigative Otolaryngology最新文献_第5页

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

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。

{"title":"Parent Reports Versus Objective Behavioral Measures in Pediatric Sleep-Disordered Breathing","authors":"Daniel C. Fong, Nithya Navarathna, Sophia Uddin, Heather Bortfeld, Sergio Novi, Amal Isaiah","doi":"10.1002/lio2.70312","DOIUrl":"10.1002/lio2.70312","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective(s)</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 <i>T</i>-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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>r</i> = −0.23, <i>p</i> = 0.04) in unadjusted analyses. This relationship was attenuated after adjusting for demographic and socioeconomic factors. Other behavioral domains showed weaker associations. Adjusted <i>R</i><sup>2</sup> values ranged 0.14–0.16, indicating parent reports explained minimal variance in objective scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>3.</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/PMC12624483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557524","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

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。

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引用次数: 0