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。
{"title":"Infraglottic Edema and Subglottic Stenosis in Tracheostomy-Dependent Children: A Retrospective Cohort Study","authors":"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","doi":"10.1002/lio2.70306","DOIUrl":"https://doi.org/10.1002/lio2.70306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of children who underwent tracheostomy between 2012 and 2022 in a tertiary care children's hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, <i>p</i> = 0.16].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530033","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}
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.
{"title":"Establishing New Pediatric Thresholds for Digits-In-Noise Testing","authors":"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","doi":"10.1002/lio2.70287","DOIUrl":"https://doi.org/10.1002/lio2.70287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>2.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529754","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}
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.
{"title":"Body Mass Index and Hypoglossal Nerve Stimulation Outcomes: A Systematic Review and Meta-Analysis","authors":"Coleton Evans, Benjamin Winters, Sandeep Rao, Sean Kelso, Peter Wickwire","doi":"10.1002/lio2.70305","DOIUrl":"https://doi.org/10.1002/lio2.70305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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/m<sup>2</sup> to those with BMI < 32 kg/m<sup>2</sup>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Review Methods</h3>\u0000 \u0000 <p>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 <i>I</i><sup>2</sup> statistic. Study quality was assessed with the Newcastle–Ottawa Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven studies (<i>n</i> = 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/m<sup>2</sup> group versus < 32 kg/m<sup>2</sup> was 0.87 (95% CI: 0.68–1.11). Between-study heterogeneity was low (<i>Q</i> = 4.11, df = 3, <i>p</i> = 0.25; <i>I</i><sup>2</sup> = 27%), indicating relatively consistent effect estimates across studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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/m<sup>2</sup> achieved meaningful objective and subjective improvements, challenging rigid BMI-based eligibility criteria and supporting individualized candidacy assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530057","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}
Benton Tullis, Jess C. Mace, Conner Massey, Stuart Batterman, Vijay R. Ramakrishnan, Daniel M. Beswick, Zachary M. Soler, Timothy L. Smith, Jeremiah A. Alt, Amarbir S. Gill
Background
Environmental factors, such as air irritants, may play an important role in chronic rhinosinusitis (CRS); however, no studies to date have examined the role of pollen in CRS disease severity. Here, we analyze the effects of pollen exposure on disease-specific and general quality-of-life (QOL) reports.
Methods
Patients were enrolled prospectively across four academic medical centers and completed the 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) surveys at enrollment. Mean annual pollen exposure over a 5-year period before enrollment was obtained from the National Allergy Bureau using residence zip codes. Unadjusted Spearman's correlation coefficients (rs) and 95% confidence intervals (CI) were calculated.
Results
One hundred and three patients were included and 55% had a history of allergy. Higher 5-year mean ragweed pollen exposure correlated with worse presenting SNOT-22 (rs = 0.24; 95% CI: 0.033, 0.42; p = 0.019) and SF-6D scores (rs = −0.21; 95% CI: −0.40, −0.0054; p = 0.039). Higher 5-year weed pollen exposure correlated with worse SNOT-22 scores (rs = 0.20; 95% CI: 0.00054, 0.38; p = 0.043).
Conclusion
This multi-institutional pilot study suggests that weed and ragweed pollen may negatively impact the QOL of patients with CRS, but further studies are needed to confirm these findings.
{"title":"Pollen Exposure and Chronic Rhinosinusitis Quality of Life Disease Severity","authors":"Benton Tullis, Jess C. Mace, Conner Massey, Stuart Batterman, Vijay R. Ramakrishnan, Daniel M. Beswick, Zachary M. Soler, Timothy L. Smith, Jeremiah A. Alt, Amarbir S. Gill","doi":"10.1002/lio2.70309","DOIUrl":"https://doi.org/10.1002/lio2.70309","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Environmental factors, such as air irritants, may play an important role in chronic rhinosinusitis (CRS); however, no studies to date have examined the role of pollen in CRS disease severity. Here, we analyze the effects of pollen exposure on disease-specific and general quality-of-life (QOL) reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients were enrolled prospectively across four academic medical centers and completed the 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) surveys at enrollment. Mean annual pollen exposure over a 5-year period before enrollment was obtained from the National Allergy Bureau using residence zip codes. Unadjusted Spearman's correlation coefficients (<i>r</i><sub><i>s</i></sub>) and 95% confidence intervals (CI) were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and three patients were included and 55% had a history of allergy. Higher 5-year mean ragweed pollen exposure correlated with worse presenting SNOT-22 (<i>r</i><sub><i>s</i></sub> = 0.24; 95% CI: 0.033, 0.42; <i>p</i> = 0.019) and SF-6D scores (<i>r</i><sub><i>s</i></sub> = −0.21; 95% CI: −0.40, −0.0054; <i>p</i> = 0.039). Higher 5-year weed pollen exposure correlated with worse SNOT-22 scores (<i>r</i><sub><i>s</i></sub> = 0.20; 95% CI: 0.00054, 0.38; <i>p</i> = 0.043).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This multi-institutional pilot study suggests that weed and ragweed pollen may negatively impact the QOL of patients with CRS, but further studies are needed to confirm these findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Clinical trial registration ID: NCT02720653 (www.clinicaltrials.gov)</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530064","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}
Nikhil Bellamkonda, Anne Naumer, Luke O. Buchmann, Hilary C. McCrary, Mana Espahbodi, Neil S. Patel
Introduction
The objective of this study was to determine the proportion of patients over the age of 50 who have HNPGL related to an SDH PV.
Methods
Patients seen at a single, tertiary-care academic medical center diagnosed with a new HNPGL over the age of 50 were included and analyzed.
Results
One hundred and eleven individuals (155 tumors) were included. Eighty (72%) patients underwent genetic testing. Twenty-one PVs of known significance were identified (SDHA in 1, SDHB in 11, SDHC in 5, SDHD in 3, and FH in 1). The rate of SDH PVs in the tested group was 25%. The median age in patients with a PV was 60 years (IQR: 54–67) years, compared to 67 years (IQR: 59–71) in those without.
Conclusions
Patients diagnosed with a HNPGL over the age of 50 are still at risk for having an SDH PV. Older patients with HNPGL and their families should still be referred for genetic testing.
{"title":"Succinate Dehydrogenase Pathogenic Variants Among Older Adults With Head and Neck Paragangliomas","authors":"Nikhil Bellamkonda, Anne Naumer, Luke O. Buchmann, Hilary C. McCrary, Mana Espahbodi, Neil S. Patel","doi":"10.1002/lio2.70302","DOIUrl":"10.1002/lio2.70302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The objective of this study was to determine the proportion of patients over the age of 50 who have HNPGL related to an SDH PV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients seen at a single, tertiary-care academic medical center diagnosed with a new HNPGL over the age of 50 were included and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and eleven individuals (155 tumors) were included. Eighty (72%) patients underwent genetic testing. Twenty-one PVs of known significance were identified (<i>SDHA</i> in 1, <i>SDHB</i> in 11, <i>SDHC</i> in 5, <i>SDHD</i> in 3, and <i>FH</i> in 1). The rate of <i>SDH</i> PVs in the tested group was 25%. The median age in patients with a PV was 60 years (IQR: 54–67) years, compared to 67 years (IQR: 59–71) in those without.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients diagnosed with a HNPGL over the age of 50 are still at risk for having an SDH PV. Older patients with HNPGL and their families should still be referred for genetic testing.</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":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514697","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}
Zhaojun Zhu, Felix Johnson, Amir Bolooki, Luca Engelmann, Naglaa Mansour, Andreas Knopf, Elias Scherer, Anna Stenzl, Benedikt Hofauer
Objectives
One method for the reconstruction of the entire soft palate is to use prelaminated radial forearm flaps (PRFFF). In a two-step procedure the back of the flap is first epithelialized with split-skin and subsequently used for soft palate reconstruction. Limited data exist on the perioperative and postoperative course of this technique. In this study, we investigated the perioperative course and postsurgical outcomes of patients who received a PRFF for soft palate reconstruction.
Methods
All patients, who received a PRFFF at our clinics since 2012 were identified retrospectively. The operation was carried out in two stages. The perioperative course, postoperative complications and the functional outcome were recorded by analyzing patient files and operation protocols.
Results
A total of 11 patients were enrolled (sex: 9 male, 2 female; age: 58 ± 14, 10/11 squamous cell carcinoma of the soft palate, 1/11 adenoid cystic carcinoma of the soft palate). Postoperative complications occurred in 6/11 patients. Three patients underwent revision surgery. One patient developed postoperatively a central pulmonary embolism leading to a prolonged intensive care unit stay. Flap viability was 100% across all cases and there was no high donor site morbidity in postoperative follow-ups.
Conclusion
The prelaminated radial forearm free flap allows a better physiological reconstruction of the soft palate while showing similar perioperative complication rates compared to the standard radial forearm free flap. In this case series no flap loss occurred, and functional outcomes were satisfactory.
{"title":"Postoperative Outcome of Prelaminated Radial Forearm Free Flap for Soft Palate Reconstruction","authors":"Zhaojun Zhu, Felix Johnson, Amir Bolooki, Luca Engelmann, Naglaa Mansour, Andreas Knopf, Elias Scherer, Anna Stenzl, Benedikt Hofauer","doi":"10.1002/lio2.70299","DOIUrl":"10.1002/lio2.70299","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>One method for the reconstruction of the entire soft palate is to use prelaminated radial forearm flaps (PRFFF). In a two-step procedure the back of the flap is first epithelialized with split-skin and subsequently used for soft palate reconstruction. Limited data exist on the perioperative and postoperative course of this technique. In this study, we investigated the perioperative course and postsurgical outcomes of patients who received a PRFF for soft palate reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients, who received a PRFFF at our clinics since 2012 were identified retrospectively. The operation was carried out in two stages. The perioperative course, postoperative complications and the functional outcome were recorded by analyzing patient files and operation protocols.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 11 patients were enrolled (sex: 9 male, 2 female; age: 58 ± 14, 10/11 squamous cell carcinoma of the soft palate, 1/11 adenoid cystic carcinoma of the soft palate). Postoperative complications occurred in 6/11 patients. Three patients underwent revision surgery. One patient developed postoperatively a central pulmonary embolism leading to a prolonged intensive care unit stay. Flap viability was 100% across all cases and there was no high donor site morbidity in postoperative follow-ups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prelaminated radial forearm free flap allows a better physiological reconstruction of the soft palate while showing similar perioperative complication rates compared to the standard radial forearm free flap. In this case series no flap loss occurred, and functional outcomes were satisfactory.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12598804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496711","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}
Ryan Stepp, Naushin Ali, Areli A. Rodriguez, Ethan Nicklow, Noah Thornton, Adithya Reddy, Hannah Kenny, Patrick S. Cottler, Donald R. Griffin, James J. Daniero
Objectives
Acute laryngeal injury (ALgI) is created as a result of endotracheal tube pressure ulcer formation leading to fibrosis and inflammation. This condition often leads to airway obstruction and voice and swallowing dysfunction. This study demonstrates a reliable animal model of ALgI to reproduce the acute wound process seen clinically, to explore the pathophysiology of this disease process, and to serve as a reproducible injury suitable for the evaluation of therapeutic interventions.
Methods
An ALgI model was developed in New Zealand White rabbits using precise mucosal stripping of the posterior larynx, followed by intubation with an oversized 4.0 endotracheal tube for 1 h to mimic intubation-associated trauma and pressure ischemia. Laryngoscopy and laryngeal harvest were performed 2 weeks post-injury for histologic and immunofluorescent evaluation.
Results
Injured rabbits demonstrated an eightfold increase in posterior glottic thickness (1.57 vs. 0.19 mm in controls; p = 0.0004) and an 11-fold increase in collagen content (1.93 vs. 0.17 mm2; p = 0.005). Collagen subtype analysis revealed a shift toward active collagen within the injured larynx compared to the uninjured, with increased Type III Collagen (69.0% vs. 26.1%; p < 0.0001) and reduced Type I Collagen (27.2% vs. 73.9%; p < 0.0001) in the posterior glottis, consistent with the proliferative phase of wound healing. Collagen fiber alignment analysis demonstrated increased coherency in injured tissues (0.36 vs. 0.21; p = 0.023), indicating early organized collagen formation consistent with scar formation within the posterior glottis.
Conclusions
The model offers a robust platform for studying the acute pathogenesis of laryngeal injury and for testing the treatment options in the management of ALgI.
Level of Evidence
3.
目的：急性喉损伤（ALgI）是由于气管内管压性溃疡形成导致纤维化和炎症而产生的。这种情况通常会导致气道阻塞、声音和吞咽功能障碍。本研究展示了一种可靠的ALgI动物模型，可以再现临床所见的急性伤口过程，探索该疾病过程的病理生理学，并可作为一种可重复性损伤，适用于评估治疗干预措施。方法：采用精确剥除后喉粘膜的方法，建立新西兰大白兔ALgI模型，然后用大号4.0气管内插管1 h，模拟插管相关创伤和压力缺血。损伤后2周进行喉镜检查和喉部切除，进行组织学和免疫荧光评估。结果：损伤家兔声门后厚度增加了8倍（1.57比0.19 mm, p = 0.0004），胶原含量增加了11倍（1.93比0.17 mm2, p = 0.005）。胶原亚型分析显示，与未损伤的喉部相比，受损喉部的活性胶原向活性胶原转移，III型胶原增加（69.0%比26.1%;p p p = 0.023），表明早期有组织的胶原形成与后声门内瘢痕形成一致。结论：该模型为研究喉损伤的急性发病机制和测试喉损伤的治疗方案提供了一个强大的平台。证据等级：3。
{"title":"Development of a Clinically Relevant Rabbit Model of Acute Laryngeal Injury","authors":"Ryan Stepp, Naushin Ali, Areli A. Rodriguez, Ethan Nicklow, Noah Thornton, Adithya Reddy, Hannah Kenny, Patrick S. Cottler, Donald R. Griffin, James J. Daniero","doi":"10.1002/lio2.70298","DOIUrl":"10.1002/lio2.70298","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Acute laryngeal injury (ALgI) is created as a result of endotracheal tube pressure ulcer formation leading to fibrosis and inflammation. This condition often leads to airway obstruction and voice and swallowing dysfunction. This study demonstrates a reliable animal model of ALgI to reproduce the acute wound process seen clinically, to explore the pathophysiology of this disease process, and to serve as a reproducible injury suitable for the evaluation of therapeutic interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An ALgI model was developed in New Zealand White rabbits using precise mucosal stripping of the posterior larynx, followed by intubation with an oversized 4.0 endotracheal tube for 1 h to mimic intubation-associated trauma and pressure ischemia. Laryngoscopy and laryngeal harvest were performed 2 weeks post-injury for histologic and immunofluorescent evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Injured rabbits demonstrated an eightfold increase in posterior glottic thickness (1.57 vs. 0.19 mm in controls; <i>p</i> = 0.0004) and an 11-fold increase in collagen content (1.93 vs. 0.17 mm<sup>2</sup>; <i>p</i> = 0.005). Collagen subtype analysis revealed a shift toward active collagen within the injured larynx compared to the uninjured, with increased Type III Collagen (69.0% vs. 26.1%; <i>p</i> < 0.0001) and reduced Type I Collagen (27.2% vs. 73.9%; <i>p</i> < 0.0001) in the posterior glottis, consistent with the proliferative phase of wound healing. Collagen fiber alignment analysis demonstrated increased coherency in injured tissues (0.36 vs. 0.21; <i>p</i> = 0.023), indicating early organized collagen formation consistent with scar formation within the posterior glottis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The model offers a robust platform for studying the acute pathogenesis of laryngeal injury and for testing the treatment options in the management of ALgI.</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":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12587430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460418","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}
<div> <section> <h3> Objective</h3> <p>Mastering otosclerosis surgery is challenging, especially in low-prevalence Asian populations. This study defines the learning curve for a single surgeon's first 100 consecutive CO<sub>2</sub> laser-assisted stapedotomies by analyzing audiometric and complication outcomes. Despite widespread descriptions of laser-assisted stapes surgery, there is a paucity of data examining the learning process in low-incidence, low-volume regions like East Asia. We aim to characterize the unique challenges and surgical adaptations required in such an environment.</p> </section> <section> <h3> Methods</h3> <p>A retrospective review of 100 primary stapedotomy cases was performed. The proficiency changepoint was identified using Bayesian and cumulative sum (CUSUM) analyses based on success (postoperative air-bone gap [ABG] ≤ 10 dB and no significant bone-conduction deterioration). Audiometric outcomes—including postoperative ABG, achievement of “Negative ABGe” (postoperative air conduction superior to preoperative bone conduction), and change in high-tone bone conduction—were compared between the pre-proficiency (cases 1–30) and post-proficiency (cases 31–100) phases.</p> </section> <section> <h3> Results</h3> <p>A proficiency changepoint was robustly identified at 30 cases. Subsequently, outcomes improved significantly: mean postoperative ABG decreased from 12.1 dB to 5.2 dB (<i>p</i> < 0.001), and the success rate (ABG ≤ 10 dB) increased from 53.3% to 91.4%. The rate of achieving a Negative ABGe surged from 3.3% to 50.0% (<i>p</i> < 0.001). The mean change in high-tone bone conduction also shifted from −0.3 to +6.1 dB of overclosure (<i>p</i> < 0.001). All major complications occurred within the initial 30 cases.</p> </section> <section> <h3> Conclusion</h3> <p>For CO<sub>2</sub> laser-assisted stapedotomy, proficiency significantly improves after approximately 30 cases. This study uniquely highlights how surgical mastery develops under conditions of limited disease prevalence and restricted training exposure. The findings suggest that even in low-volume environments, structured experience enables not only consistent ABG closure but also meaningful gains in patient-centered outcomes such as Negative ABGe and cochlear preservation. Our results advocate for simulation-enhanced education strategies tailored to resource-constrained surgical contexts.</p> </section> <section> <h3> Level of Evidence</h3> <p>4.</p>
目的：掌握耳硬化手术是具有挑战性的，特别是在低患病率的亚洲人群中。本研究通过分析听力学和并发症结果，定义了单个外科医生前100例连续CO2激光镫骨切除术的学习曲线。尽管对激光辅助镫骨手术有广泛的描述，但在东亚等低发病率、低容量地区，研究学习过程的数据却很缺乏。我们的目标是描述在这样的环境中所需要的独特挑战和手术适应。方法：对100例原发性镫骨切除术病例进行回顾性分析。基于手术成功（术后气骨间隙[ABG]≤10 dB且无明显骨传导恶化），使用贝叶斯和累积和（CUSUM）分析确定熟练度变化点。比较熟练前（病例1-30）和熟练后（病例31-100）阶段的听力学结果，包括术后ABG、“阴性ABGe”（术后空气传导优于术前骨传导）和高音调骨传导的变化。结果：熟练程度变化点在30例中得到了明确的确定。随后，结果显著改善：术后平均ABG从12.1 dB降至5.2 dB （p pp）。结论：对于CO2激光辅助镫骨切开术，熟练程度在大约30例后显著提高。这项研究独特地强调了在有限的疾病患病率和有限的培训暴露条件下，外科掌握如何发展。研究结果表明，即使在低容量的环境中，结构化的经验不仅可以使ABG闭合一致，而且在以患者为中心的结果（如ABGe阴性和耳蜗保存）方面也有意义的收获。我们的研究结果提倡为资源受限的外科环境量身定制模拟强化教育策略。证据等级：4。
{"title":"Learning Curve for CO2 Laser Stapedotomy: A Single-Surgeon Experience in South Korea","authors":"Dong Woo Nam, Hyoungwon Jeon, Ja-Won Koo","doi":"10.1002/lio2.70294","DOIUrl":"10.1002/lio2.70294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Mastering otosclerosis surgery is challenging, especially in low-prevalence Asian populations. This study defines the learning curve for a single surgeon's first 100 consecutive CO<sub>2</sub> laser-assisted stapedotomies by analyzing audiometric and complication outcomes. Despite widespread descriptions of laser-assisted stapes surgery, there is a paucity of data examining the learning process in low-incidence, low-volume regions like East Asia. We aim to characterize the unique challenges and surgical adaptations required in such an environment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review of 100 primary stapedotomy cases was performed. The proficiency changepoint was identified using Bayesian and cumulative sum (CUSUM) analyses based on success (postoperative air-bone gap [ABG] ≤ 10 dB and no significant bone-conduction deterioration). Audiometric outcomes—including postoperative ABG, achievement of “Negative ABGe” (postoperative air conduction superior to preoperative bone conduction), and change in high-tone bone conduction—were compared between the pre-proficiency (cases 1–30) and post-proficiency (cases 31–100) phases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A proficiency changepoint was robustly identified at 30 cases. Subsequently, outcomes improved significantly: mean postoperative ABG decreased from 12.1 dB to 5.2 dB (<i>p</i> < 0.001), and the success rate (ABG ≤ 10 dB) increased from 53.3% to 91.4%. The rate of achieving a Negative ABGe surged from 3.3% to 50.0% (<i>p</i> < 0.001). The mean change in high-tone bone conduction also shifted from −0.3 to +6.1 dB of overclosure (<i>p</i> < 0.001). All major complications occurred within the initial 30 cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For CO<sub>2</sub> laser-assisted stapedotomy, proficiency significantly improves after approximately 30 cases. This study uniquely highlights how surgical mastery develops under conditions of limited disease prevalence and restricted training exposure. The findings suggest that even in low-volume environments, structured experience enables not only consistent ABG closure but also meaningful gains in patient-centered outcomes such as Negative ABGe and cochlear preservation. Our results advocate for simulation-enhanced education strategies tailored to resource-constrained surgical contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 ","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12587434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460436","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}
Layth R. Alkhani, Yusef Qazi, Siddhant Suri Dhawan, Paraag R. Bhatt, Christopher J. Shin, Tarik F. Massoud
Objective
Thickness of torus tubarius (TT) surface mucosa overhanging the Eustachian tube (ET) ostium, and mucosa covering the posterior aspects of bilateral inferior turbinates (ITs) are potentially pertinent to ET balloon tuboplasty. Whether TT and IT mucosal thickness is fixed or varies cyclically is potentially important in therapeutic planning but remains unknown. We establish normative MRI morphometrics for mucosa of TTs, posterior ITs (post-ITs), and anterior ITs (ant-ITs) in healthy subjects, and test the hypothesis that post-IT and TT mucosal thickness may vary during the nasal cycle akin to known changes in ant-ITs.
Methods
We retrospectively selected 60 subjects with normal nasopharynx MRIs, and measured maximal contrast-enhancing mucosal thickness for bilateral TTs, post-ITs, and ant-ITs. We conceived a novel indirect test for nasal cycle variations by computing likelihood ratio (LR) statistics comparing unimodal versus bimodal Gaussian distributions of left–right mucosal thickness differences, with significance assessed using bootstrapped p values. We validated this test by confirming detection of known nasal cycling in ant-ITs, and then applied it to assess potential cycling in TTs and post-ITs. Significance was set at p < 0.05.
Results
Mean maximal mucosal thicknesses for TTs, post-ITs, and ant-ITs were 3.1 ± 0.8, 7.6 ± 1.9, and 4.5 ± 1.3 mm, respectively. LR testing revealed significant cyclical variations in ant-ITs (LR = 4.599; p = 0.021), thus validating our methodology for inferring nasal cycling. There was no mucosal cycling for TTs (LR = −0.801; p = 0.728) or post-ITs (LR = −1.208; p = 0.799).
Conclusion
TT and post-IT mucosa unlikely exhibit nasal cycle variations. Single MRI views of TTs and post-ITs would suffice for assessment during pre-interventional planning of ET procedures.
Level of Evidence
4.
目的：耳咽管（ET）口悬垂的管环（TT）表面粘膜厚度和覆盖双侧下鼻甲（ITs）后侧面的粘膜厚度可能与耳咽管球囊成形术有关。TT和IT粘膜厚度是固定的还是周期性变化的，在治疗计划中具有潜在的重要意义，但仍不清楚。我们在健康受试者中建立了TTs、ITs后部（后ITs）和ITs前部（抗ITs）粘膜的规范MRI形态计量学，并验证了后it和TT粘膜厚度可能在鼻循环中发生变化的假设，类似于已知的抗ITs变化。方法：我们回顾性地选择了60名正常鼻咽部mri的受试者，并测量了双侧TTs，后its和抗its的最大对比增强粘膜厚度。我们通过计算似然比（LR）统计量，比较左右粘膜厚度差异的单峰和双峰高斯分布，设想了一种新的鼻周期变化的间接检验，并使用自举p值评估显著性。我们通过确认在抗its中检测到已知的鼻腔循环来验证该测试，然后将其应用于评估tt和后its的潜在循环。结果：TTs组、后its组和抗its组的平均最大粘膜厚度分别为3.1±0.8、7.6±1.9和4.5±1.3 mm。LR测试显示抗its显著的周期性变化（LR = 4.599; p = 0.021），从而验证了我们推断鼻腔循环的方法。TTs组（LR = -0.801; p = 0.728）和its后组（LR = -1.208; p = 0.799）未见粘膜循环。结论：TT和it后粘膜不可能出现鼻循环变化。TTs和post-ITs的单一MRI视图足以在介入前计划ET手术时进行评估。证据等级：4。
{"title":"Gaussian Mixture Modeling of MRI-Derived Torus Tubarius and Inferior Turbinate Mucosal Morphometrics: Implications for Nasal Cycling and Eustachian Tube Interventions","authors":"Layth R. Alkhani, Yusef Qazi, Siddhant Suri Dhawan, Paraag R. Bhatt, Christopher J. Shin, Tarik F. Massoud","doi":"10.1002/lio2.70295","DOIUrl":"10.1002/lio2.70295","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Thickness of torus tubarius (TT) surface mucosa overhanging the Eustachian tube (ET) ostium, and mucosa covering the posterior aspects of bilateral inferior turbinates (ITs) are potentially pertinent to ET balloon tuboplasty. Whether TT and IT mucosal thickness is fixed or varies cyclically is potentially important in therapeutic planning but remains unknown. We establish normative MRI morphometrics for mucosa of TTs, posterior ITs (post-ITs), and anterior ITs (ant-ITs) in healthy subjects, and test the hypothesis that post-IT and TT mucosal thickness may vary during the nasal cycle akin to known changes in ant-ITs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively selected 60 subjects with normal nasopharynx MRIs, and measured maximal contrast-enhancing mucosal thickness for bilateral TTs, post-ITs, and ant-ITs. We conceived a novel indirect test for nasal cycle variations by computing likelihood ratio (LR) statistics comparing unimodal versus bimodal Gaussian distributions of left–right mucosal thickness differences, with significance assessed using bootstrapped <i>p</i> values. We validated this test by confirming detection of known nasal cycling in ant-ITs, and then applied it to assess potential cycling in TTs and post-ITs. Significance was set at <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean maximal mucosal thicknesses for TTs, post-ITs, and ant-ITs were 3.1 ± 0.8, 7.6 ± 1.9, and 4.5 ± 1.3 mm, respectively. LR testing revealed significant cyclical variations in ant-ITs (LR = 4.599; <i>p</i> = 0.021), thus validating our methodology for inferring nasal cycling. There was no mucosal cycling for TTs (LR = −0.801; <i>p</i> = 0.728) or post-ITs (LR = −1.208; <i>p</i> = 0.799).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TT and post-IT mucosa unlikely exhibit nasal cycle variations. Single MRI views of TTs and post-ITs would suffice for assessment during pre-interventional planning of ET procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12587432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460459","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}
Alexander Szymczak, Ben Hirsch, Ashley Young, Rachel D. Yoon, Taher Valika, Jonathan Ida, Saied Ghadersohi, Inbal Hazkani
Background
Patients with severe Bronchopulmonary dysplasia (BPD) are prone to upper airway complications due to their need for prolonged intubation, early tracheostomy placement, and chronic high-pressure ventilation. This study examines structural changes over time in tracheostomy-dependent BPD patients compared to those without BPD.
Methods
A retrospective cohort study of children who underwent tracheostomy at an age less than 6 months at a tertiary-care children's hospital between January 2012 and December 2022.
Results
A total of 82 patients underwent tracheostomy at an age of less than 6 months, of which 42 (51.2%) had BPD. Patients with BPD were older at the time of tracheostomy (4.44 vs. 3.36 months, p = 0.012) and had a younger gestational age (26.5 vs. 37.0 weeks, p < 0.001). Additionally, patients with BPD had higher rates of mechanical ventilation (42/42 vs. 24/40, p = 0.0018) and a greater number of days intubated prior to tracheostomy (92 vs. 21, p < 0.001). The median follow-up period for all patients was 28.8 months [IQR = 36.8]. BPD infants were more likely to develop subglottic stenosis (30/42 vs. 16/40, p = 0.0082), glottic edema (32/42 vs. 19/40, p = 0.0074), require laryngotracheal reconstruction (16/42 vs. 5/40, p = 0.0095) and get decannulated (21/42 vs. 8/40, p = 0.0045) compared to infants without BPD.
Conclusions
Tracheostomy-dependent infants with BPD had higher rates of glottic edema, subglottic stenosis, and laryngotracheal reconstruction but were more likely to be decannulated. These findings suggest that, despite increased airway pathology, tracheostomy is a safe and effective intervention in this population, with outcomes comparable to other pediatric cohorts.
Level of Evidence
4.
背景：重度支气管肺发育不良（BPD）患者由于需要长时间插管、早期气管造口和长期高压通气，容易发生上呼吸道并发症。本研究考察了依赖气管造口术的BPD患者与非BPD患者的结构变化。方法：对2012年1月至2022年12月间在一家三级儿童医院接受气管切开术的6个月以下儿童进行回顾性队列研究。结果：82例患者年龄小于6个月行气管切开术，其中42例（51.2%）为BPD。BPD患者当时旧的气管造口术(4.44和3.36个月,p = 0.012),年轻的胎龄(26.5 vs 37.0周,p p = 0.0018)和更多的天插管前气管造口术(92 vs . 21, p p = 0.0082),声门的水肿(32/42和19/40,p = 0.0074),需要喉气管的重建(16/42和5/40,p = 0.0095), decannulated(21/42和8/40,p = 0.0045),而对婴儿没有桶。结论：气管造瘘依赖的BPD患儿声门水肿、声门下狭窄和喉气管重建的发生率较高，但更有可能断开气管管。这些发现表明，尽管气道病理增加，气管切开术在这一人群中是一种安全有效的干预措施，其结果与其他儿科队列相当。证据等级：4。
{"title":"Tracheal Structural Changes in Tracheostomy-Dependent Children With Bronchopulmonary Dysplasia","authors":"Alexander Szymczak, Ben Hirsch, Ashley Young, Rachel D. Yoon, Taher Valika, Jonathan Ida, Saied Ghadersohi, Inbal Hazkani","doi":"10.1002/lio2.70293","DOIUrl":"10.1002/lio2.70293","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with severe Bronchopulmonary dysplasia (BPD) are prone to upper airway complications due to their need for prolonged intubation, early tracheostomy placement, and chronic high-pressure ventilation. This study examines structural changes over time in tracheostomy-dependent BPD patients compared to those without BPD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of children who underwent tracheostomy at an age less than 6 months at a tertiary-care children's hospital between January 2012 and December 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 82 patients underwent tracheostomy at an age of less than 6 months, of which 42 (51.2%) had BPD. Patients with BPD were older at the time of tracheostomy (4.44 vs. 3.36 months, <i>p</i> = 0.012) and had a younger gestational age (26.5 vs. 37.0 weeks, <i>p</i> < 0.001). Additionally, patients with BPD had higher rates of mechanical ventilation (42/42 vs. 24/40, <i>p</i> = 0.0018) and a greater number of days intubated prior to tracheostomy (92 vs. 21, <i>p</i> < 0.001). The median follow-up period for all patients was 28.8 months [IQR = 36.8]. BPD infants were more likely to develop subglottic stenosis (30/42 vs. 16/40, <i>p</i> = 0.0082), glottic edema (32/42 vs. 19/40, <i>p</i> = 0.0074), require laryngotracheal reconstruction (16/42 vs. 5/40, <i>p</i> = 0.0095) and get decannulated (21/42 vs. 8/40, <i>p</i> = 0.0045) compared to infants without BPD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tracheostomy-dependent infants with BPD had higher rates of glottic edema, subglottic stenosis, and laryngotracheal reconstruction but were more likely to be decannulated. These findings suggest that, despite increased airway pathology, tracheostomy is a safe and effective intervention in this population, with outcomes comparable to other pediatric cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12587431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460461","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}
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