Given the increasing utilization of biologics in the treatment of CRSwNP, it is important to characterize their adverse events (AEs). This study compares the AE profiles of FDA-approved biologics for CRSwNP when adjusting for potential confounders, such as prescription indication, age, and sex.
Methods
We retrospectively reviewed AEs reported in the FDA Adverse Events Reporting System (FAERS) from 2019Q1 to 2023Q2. AEs were categorized and compared between biologics for comparison of AE type and severity. Chi-square tests compared outcomes between groups and regression modeling identified predictors of a serious adverse event (SAE).
Results
We identified ~79,000 AE logs consisting of ~226,000 individual adverse reactions (IARs). Most dupilumab IARs were dermatologic or administration/medical error related. Most mepolizumab were administration/medical error related or pulmonary. Most omalizumab were pulmonary or dermatologic. Compared to dupilumab, we found that mepolizumab (OR 3.61, 95% CI: 3.29–3.98) and omalizumab (OR 15.33, 95% CI: 13.98–16.81) had a greater odds of a reported AE being an SAE. Though more females reported having any AE, male sex, increasing age, and a prescription indication of asthma were associated with a significantly increased odds of an AE being an SAE.
Conclusion
We found potential predictors associated with SAEs to FDA approved biologics including gender (male > female), age (increasing age), and prescription indication (asthma > asthma + CRSwNP > CRSwNP). This data is important to prescribers educating their patients to potential AEs.
{"title":"FDA-Approved Biologics for CRSwNP: A Five-Year Analysis of the FDA Adverse Event Reporting System","authors":"Radhika Duggal, Mohamad R. Chaaban","doi":"10.1002/lio2.70133","DOIUrl":"https://doi.org/10.1002/lio2.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Given the increasing utilization of biologics in the treatment of CRSwNP, it is important to characterize their adverse events (AEs). This study compares the AE profiles of FDA-approved biologics for CRSwNP when adjusting for potential confounders, such as prescription indication, age, and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed AEs reported in the FDA Adverse Events Reporting System (FAERS) from 2019Q1 to 2023Q2. AEs were categorized and compared between biologics for comparison of AE type and severity. Chi-square tests compared outcomes between groups and regression modeling identified predictors of a serious adverse event (SAE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified ~79,000 AE logs consisting of ~226,000 individual adverse reactions (IARs). Most dupilumab IARs were dermatologic or administration/medical error related. Most mepolizumab were administration/medical error related or pulmonary. Most omalizumab were pulmonary or dermatologic. Compared to dupilumab, we found that mepolizumab (OR 3.61, 95% CI: 3.29–3.98) and omalizumab (OR 15.33, 95% CI: 13.98–16.81) had a greater odds of a reported AE being an SAE. Though more females reported having any AE, male sex, increasing age, and a prescription indication of asthma were associated with a significantly increased odds of an AE being an SAE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found potential predictors associated with SAEs to FDA approved biologics including gender (male > female), age (increasing age), and prescription indication (asthma > asthma + CRSwNP > CRSwNP). This data is important to prescribers educating their patients to potential AEs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272430","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}
Jacquelyn K. Callander, Taylor S. Erickson, Hasan Abdulbaki, Philip V. Theodosopoulos, Manish K. Aghi, Ezequiel D. Goldschmidt, Ivan H. El-Sayed, Jose G. Gurrola II
Objectives
Multiple reconstruction techniques exist to repair defects arising from expanded endonasal approach (EEA) surgeries targeting anterior skull base tumors. These repairs aim to minimize post-operative complications such as cerebrospinal fluid (CSF) leak. In 2022, our group described the “Bow tie” trilayer graft, a repair method that incorporates two layers of a collagen matrix graft stitched to a fat graft. The initial data demonstrated a reduction in the rate of CSF leaks following the adoption of this method. This study evaluates the surgical practice of a single surgeon with access to the trilayer technique and the post-operative outcomes.
Methods
Retrospective chart review encompassing all EEAs to anterior skull base tumors performed by a single otolaryngologist (JGG) from January 2019 to September 2024 at a tertiary care center.
Results
Of 250 cases meeting inclusion criteria, 42 (16.8%) involved bow tie graft reconstruction. Postoperative CSF leaks occurred in 3 subjects (1.2%), with none of these cases involving bow tie grafts. Trilayer grafts were used more frequently in revision cases (p = 0.018) and when intra-operative CSF leaks were encountered (p < 0.0001). There was no difference in average age, sex, BMI, maximum tumor dimension, or the frequency of lumbar drain insertion between the groups with and without trilayer grafts (p > 0.05).
Conclusion
The trilayer graft is an efficient and useful tool in the armamentarium of an anterior skull base surgeon. This technique may decrease rates of postoperative CSF leak with limited additional morbidity. Larger multicenter studies are warranted to validate this potential benefit given the relative rarity of this complication.
{"title":"Surgical Experience and Validation of the “Bow Tie” Trilayer Graft Technique for Closure of Anterior Skull Base Defects","authors":"Jacquelyn K. Callander, Taylor S. Erickson, Hasan Abdulbaki, Philip V. Theodosopoulos, Manish K. Aghi, Ezequiel D. Goldschmidt, Ivan H. El-Sayed, Jose G. Gurrola II","doi":"10.1002/lio2.70281","DOIUrl":"https://doi.org/10.1002/lio2.70281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Multiple reconstruction techniques exist to repair defects arising from expanded endonasal approach (EEA) surgeries targeting anterior skull base tumors. These repairs aim to minimize post-operative complications such as cerebrospinal fluid (CSF) leak. In 2022, our group described the “Bow tie” trilayer graft, a repair method that incorporates two layers of a collagen matrix graft stitched to a fat graft. The initial data demonstrated a reduction in the rate of CSF leaks following the adoption of this method. This study evaluates the surgical practice of a single surgeon with access to the trilayer technique and the post-operative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective chart review encompassing all EEAs to anterior skull base tumors performed by a single otolaryngologist (JGG) from January 2019 to September 2024 at a tertiary care center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 250 cases meeting inclusion criteria, 42 (16.8%) involved bow tie graft reconstruction. Postoperative CSF leaks occurred in 3 subjects (1.2%), with none of these cases involving bow tie grafts. Trilayer grafts were used more frequently in revision cases (<i>p</i> = 0.018) and when intra-operative CSF leaks were encountered (<i>p</i> < 0.0001). There was no difference in average age, sex, BMI, maximum tumor dimension, or the frequency of lumbar drain insertion between the groups with and without trilayer grafts (<i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The trilayer graft is an efficient and useful tool in the armamentarium of an anterior skull base surgeon. This technique may decrease rates of postoperative CSF leak with limited additional morbidity. Larger multicenter studies are warranted to validate this potential benefit given the relative rarity of this complication.</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 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273026","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}
Wesley L. Cai, Vanessa Helou, Matthew E. Spector, José P. Zevallos, Angela L. Mazul, Kevin J. Contrera
<p>Head and neck cancer (HNC) remains a significant health concern, with an estimated 71,000 new cases expected in the United States (US) in 2024 [<span>1</span>]. The COVID-19 pandemic altered healthcare delivery, causing a 10% drop in overall cancer incidence in the US in 2020 compared to 2019 [<span>2</span>]. While prior studies have examined pandemic-related incidence disruptions during the pandemic [<span>3</span>], the specific trajectory of HNC incidence following the pandemic warrants further investigation. Understanding these trends is essential for optimizing cancer screening and delivery in future public health crises. This study aims to provide insights into HNC incidence trends during and after the COVID-19 pandemic.</p><p>This National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry, updated on April 17, 2024, was used [<span>4</span>]. Age-adjusted incidence data (per 100,000 people) were extracted based on ICD-O-3 codes for lip, tongue anterior, gum, floor of mouth, palate excluding soft and uvula, buccal mucosa, mouth other, major salivary glands, nasopharynx, oropharynx, hypopharynx, pharynx and oral cavity other, nasal cavity and paranasal sinuses, sinus other, and larynx cancers. No institutional review board approval or informed consent was required as the data is publicly available and de-identified. Data on “localized,” “regional,” and “distant” disease was obtained using the SEER Combined Summary Stage (2004+) variable, with staging based on organ site.</p><p>Age-adjusted incidence rates were obtained, and data were selected by sex, race, and origin, and combined summary stage. Annual percent change (APC) was calculated using the average change in lower and upper confidence intervals of incidence rates. Data analysis was conducted using R 4.4.0 with data.table, ggplot2, ggrepel packages. Plots were visualized using ggplot2.</p><p>In 2021, there were 28,154 new HNC cases, resulting in an incidence rate of 14.6 new cases per 100,000 individuals. From 2020 to 2021, incidence increased by 14.0%, corresponding to an APC of +4.5%. This follows a decline from 2019 to 2020, with an APC of −6.9% (Figure 1A). The largest increases by anatomical site from 2020 to 2021 were observed in “sinus other” (+30.7%), “floor of mouth” (+21.2%), “gum” (+20.6%), and “buccal mucosa” (+17.9%) (Figure 1B).</p><p>The APC trends were consistent across racial groups, showing a decline in 2020 followed by an increase in 2021. The largest increase occurred in Asian American and Pacific Islander (AAPI) (+16.0%), followed by Hispanics (+14.1%), non-Hispanic Whites (+11.4%), and non-Hispanic Blacks (NHB) (+10.4%). Examining the data by sex, increases were + 10.3% in females and +11.8% in males.</p><p>Of the 28,154 new cases, 9202 (32.7%) were local, 13,832 (49.1%) were regional, and 3458 (12.3%) were distant. The incidence of all three stages increased from 2020 to 2021. The largest APC rise was in localized cases (+23.0%), fo
{"title":"Head and Neck Cancer Incidence in the United States Following the Onset of COVID-19 Pandemic","authors":"Wesley L. Cai, Vanessa Helou, Matthew E. Spector, José P. Zevallos, Angela L. Mazul, Kevin J. Contrera","doi":"10.1002/lio2.70226","DOIUrl":"https://doi.org/10.1002/lio2.70226","url":null,"abstract":"<p>Head and neck cancer (HNC) remains a significant health concern, with an estimated 71,000 new cases expected in the United States (US) in 2024 [<span>1</span>]. The COVID-19 pandemic altered healthcare delivery, causing a 10% drop in overall cancer incidence in the US in 2020 compared to 2019 [<span>2</span>]. While prior studies have examined pandemic-related incidence disruptions during the pandemic [<span>3</span>], the specific trajectory of HNC incidence following the pandemic warrants further investigation. Understanding these trends is essential for optimizing cancer screening and delivery in future public health crises. This study aims to provide insights into HNC incidence trends during and after the COVID-19 pandemic.</p><p>This National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry, updated on April 17, 2024, was used [<span>4</span>]. Age-adjusted incidence data (per 100,000 people) were extracted based on ICD-O-3 codes for lip, tongue anterior, gum, floor of mouth, palate excluding soft and uvula, buccal mucosa, mouth other, major salivary glands, nasopharynx, oropharynx, hypopharynx, pharynx and oral cavity other, nasal cavity and paranasal sinuses, sinus other, and larynx cancers. No institutional review board approval or informed consent was required as the data is publicly available and de-identified. Data on “localized,” “regional,” and “distant” disease was obtained using the SEER Combined Summary Stage (2004+) variable, with staging based on organ site.</p><p>Age-adjusted incidence rates were obtained, and data were selected by sex, race, and origin, and combined summary stage. Annual percent change (APC) was calculated using the average change in lower and upper confidence intervals of incidence rates. Data analysis was conducted using R 4.4.0 with data.table, ggplot2, ggrepel packages. Plots were visualized using ggplot2.</p><p>In 2021, there were 28,154 new HNC cases, resulting in an incidence rate of 14.6 new cases per 100,000 individuals. From 2020 to 2021, incidence increased by 14.0%, corresponding to an APC of +4.5%. This follows a decline from 2019 to 2020, with an APC of −6.9% (Figure 1A). The largest increases by anatomical site from 2020 to 2021 were observed in “sinus other” (+30.7%), “floor of mouth” (+21.2%), “gum” (+20.6%), and “buccal mucosa” (+17.9%) (Figure 1B).</p><p>The APC trends were consistent across racial groups, showing a decline in 2020 followed by an increase in 2021. The largest increase occurred in Asian American and Pacific Islander (AAPI) (+16.0%), followed by Hispanics (+14.1%), non-Hispanic Whites (+11.4%), and non-Hispanic Blacks (NHB) (+10.4%). Examining the data by sex, increases were + 10.3% in females and +11.8% in males.</p><p>Of the 28,154 new cases, 9202 (32.7%) were local, 13,832 (49.1%) were regional, and 3458 (12.3%) were distant. The incidence of all three stages increased from 2020 to 2021. The largest APC rise was in localized cases (+23.0%), fo","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70226","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272431","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}
Khang Win Vu, Martha Watson, Abdallah Attia, Ahmed Abdelmaksoud, Manal S. Fawzy, Eman A. Toraih
Objective
To compare short-term complications and long-term survival outcomes between surgical and non-surgical treatments for oropharyngeal cancer.
Methods
We conducted a large-scale retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data from 154,494,403 patients across 128 healthcare organizations. After applying inclusion criteria and propensity score matching, we compared 2413 surgical patients with 2413 non-surgical patients. Primary outcomes included short-term complications at 6 months (dysphagia, gastrostomy tube placement, tracheostomy, respiratory complications) and 5-year all-cause mortality.
Results
At 6 months post-treatment, surgical patients showed higher rates of dysphagia (46.83% vs. 40.61%, RR = 1.15, 95% CI: 1.08–1.23) and respiratory complications (6.30% vs. 3.69%, RR = 1.71, 95% CI: 1.32–2.21). Non-surgical patients experienced increased rates of gastrostomy tube placement (17.86% vs. 6.09%, RR = 0.34, 95% CI: 0.29–0.41) and tracheostomy (7.34% vs. 3.61%, RR = 0.49, 95% CI: 0.38–0.63). Similarly, subgroup analysis of the advanced-stage cohort showed that non-surgical patients had higher rates of gastrostomy tube placement (5.5% vs. 17.5%, RR = 0.31, CI: 0.19–0.52) and tracheostomy (3.1% vs. 6.4%, RR = 0.48, CI: 0.23–0.99). At 5-year follow-up, surgical intervention was associated with significantly lower all-cause mortality (9.9% vs. 25.3%, HR = 0.43, 95% CI: 0.37–0.49). This survival benefit persisted in the advanced-stage subgroup (14.1% vs. 25.5%, HR = 0.53, 95% CI: 0.37–0.76) (p < 0.001).
Conclusions
While surgical treatment for oropharyngeal cancer was associated with higher rates of certain short-term complications, it demonstrated superior long-term survival outcomes compared to non-surgical interventions, including in patients with advanced disease. These findings provide valuable evidence to inform treatment selection and patient counseling in oropharyngeal cancer management.
{"title":"Comparative Outcomes of Surgical vs. Non-Surgical Interventions in Advanced Oropharyngeal Cancer: A Large-Scale Retrospective Cohort Study","authors":"Khang Win Vu, Martha Watson, Abdallah Attia, Ahmed Abdelmaksoud, Manal S. Fawzy, Eman A. Toraih","doi":"10.1002/lio2.70279","DOIUrl":"https://doi.org/10.1002/lio2.70279","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare short-term complications and long-term survival outcomes between surgical and non-surgical treatments for oropharyngeal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a large-scale retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data from 154,494,403 patients across 128 healthcare organizations. After applying inclusion criteria and propensity score matching, we compared 2413 surgical patients with 2413 non-surgical patients. Primary outcomes included short-term complications at 6 months (dysphagia, gastrostomy tube placement, tracheostomy, respiratory complications) and 5-year all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 6 months post-treatment, surgical patients showed higher rates of dysphagia (46.83% vs. 40.61%, RR = 1.15, 95% CI: 1.08–1.23) and respiratory complications (6.30% vs. 3.69%, RR = 1.71, 95% CI: 1.32–2.21). Non-surgical patients experienced increased rates of gastrostomy tube placement (17.86% vs. 6.09%, RR = 0.34, 95% CI: 0.29–0.41) and tracheostomy (7.34% vs. 3.61%, RR = 0.49, 95% CI: 0.38–0.63). Similarly, subgroup analysis of the advanced-stage cohort showed that non-surgical patients had higher rates of gastrostomy tube placement (5.5% vs. 17.5%, RR = 0.31, CI: 0.19–0.52) and tracheostomy (3.1% vs. 6.4%, RR = 0.48, CI: 0.23–0.99). At 5-year follow-up, surgical intervention was associated with significantly lower all-cause mortality (9.9% vs. 25.3%, HR = 0.43, 95% CI: 0.37–0.49). This survival benefit persisted in the advanced-stage subgroup (14.1% vs. 25.5%, HR = 0.53, 95% CI: 0.37–0.76) (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While surgical treatment for oropharyngeal cancer was associated with higher rates of certain short-term complications, it demonstrated superior long-term survival outcomes compared to non-surgical interventions, including in patients with advanced disease. These findings provide valuable evidence to inform treatment selection and patient counseling in oropharyngeal cancer management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>2b.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272500","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}
Aman M. Patel, Afash Haleem, Praneet C. Kaki, Rohini Bahethi, Soly Baredes, Richard Chan Woo Park
Objective
To investigate adjuvant therapy considerations, utilization, and associated overall survival (OS) following upfront laryngectomy for laryngeal squamous cell carcinoma (LSCC).
Methods
The 2010 to 2017 National Cancer Database was retrospectively reviewed for patients undergoing upfront laryngectomy (N = 3360). Kaplan–Meier, multivariable binary logistic, and Cox proportional hazards regression models were implemented.
Results
Among 2997 patients with consideration(s) for adjuvant radiotherapy (aRT) (i.e., pT3-4, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and/or positive surgical margins [PSM]), 1176 (39.2%) did not undergo adjuvant therapy and were considered to have missed aRT. Among 992 patients with consideration(s) for adjuvant chemoradiotherapy (aCRT) (i.e., pENE and/or PSM), 169 (17.0%) underwent aRT alone and were considered to have missed aCRT. Older age and increased distance to the reporting facility were associated with higher adjusted odds of both missed aRT (p < 0.001) and missed aCRT (p < 0.025). Patients with pENE only (N = 343, 57.6%) and pENE and PSM (N = 96, 56.8%) underwent aCRT more frequently than those with PSM only (N = 97, 42.5%) (p < 0.001). Missed aRT was associated with worse OS among 2005 patients with consideration(s) for aRT alone (i.e., pT3-4, pN2-3 classification, and/or LVI without pENE or PSM) (aHR 1.23, 95% CI 1.05–1.44, p = 0.011) and among 992 patients with consideration(s) for aCRT (aHR 1.85, 95% CI 1.52–2.24, p < 0.001).
Conclusion
Missed aRT following upfront laryngectomy for LSCC occurs frequently and portends worse OS. Identifying patients at risk of off-guideline management may create opportunities for quality improvement in the multidisciplinary care of patients undergoing upfront laryngectomy for LSCC.
Level of Evidence
4.
目的探讨喉部鳞状细胞癌（LSCC）术前切除后辅助治疗的考虑、使用和相关的总生存率（OS）。方法回顾性分析2010年至2017年国家癌症数据库中接受喉前切除术的患者（N = 3360）。采用Kaplan-Meier、多变量二元logistic和Cox比例风险回归模型。结果在考虑辅助放疗（aRT） （pT3-4、pN2-3分型、淋巴血管侵犯、病理性结外延伸（pENE）和/或手术缘阳性[PSM]）的2997例患者中，1176例（39.2%）未接受辅助治疗，被认为错过了aRT。在考虑辅助放化疗（aCRT）（即pENE和/或PSM）的992例患者中，169例（17.0%）单独接受了aRT治疗，被认为错过了aCRT。年龄越大和距离报告机构的距离越远，aRT漏诊（p < 0.001）和aCRT漏诊（p < 0.025）的调整后几率越高。单纯pENE患者（N = 343, 57.6%）和pENE合并PSM患者（N = 96, 56.8%）接受aCRT的频率高于单纯PSM患者（N = 97, 42.5%） （p < 0.001）。在考虑单独接受aRT治疗（即pT3-4、pN2-3分类和/或LVI不含pENE或PSM）的2005例患者（aHR 1.23, 95% CI 1.05-1.44, p = 0.011）和考虑接受aCRT治疗的992例患者（aHR 1.85, 95% CI 1.52-2.24, p < 0.001）中，错过aRT治疗与较差的OS相关。结论喉鳞癌术前喉切除术后aRT漏诊发生率高，预后较差。识别有偏离指南管理风险的患者，可能为LSCC术前喉切除术患者的多学科护理质量改善创造机会。证据级别4。
{"title":"Missed Adjuvant Therapy Following Upfront Laryngectomy for Laryngeal Squamous Cell Carcinoma","authors":"Aman M. Patel, Afash Haleem, Praneet C. Kaki, Rohini Bahethi, Soly Baredes, Richard Chan Woo Park","doi":"10.1002/lio2.70276","DOIUrl":"https://doi.org/10.1002/lio2.70276","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate adjuvant therapy considerations, utilization, and associated overall survival (OS) following upfront laryngectomy for laryngeal squamous cell carcinoma (LSCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2010 to 2017 National Cancer Database was retrospectively reviewed for patients undergoing upfront laryngectomy (<i>N</i> = 3360). Kaplan–Meier, multivariable binary logistic, and Cox proportional hazards regression models were implemented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2997 patients with consideration(s) for adjuvant radiotherapy (aRT) (i.e., pT3-4, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and/or positive surgical margins [PSM]), 1176 (39.2%) did not undergo adjuvant therapy and were considered to have missed aRT. Among 992 patients with consideration(s) for adjuvant chemoradiotherapy (aCRT) (i.e., pENE and/or PSM), 169 (17.0%) underwent aRT alone and were considered to have missed aCRT. Older age and increased distance to the reporting facility were associated with higher adjusted odds of both missed aRT (<i>p</i> < 0.001) and missed aCRT (<i>p</i> < 0.025). Patients with pENE only (<i>N</i> = 343, 57.6%) and pENE and PSM (<i>N</i> = 96, 56.8%) underwent aCRT more frequently than those with PSM only (<i>N</i> = 97, 42.5%) (<i>p</i> < 0.001). Missed aRT was associated with worse OS among 2005 patients with consideration(s) for aRT alone (i.e., pT3-4, pN2-3 classification, and/or LVI without pENE or PSM) (aHR 1.23, 95% CI 1.05–1.44, <i>p</i> = 0.011) and among 992 patients with consideration(s) for aCRT (aHR 1.85, 95% CI 1.52–2.24, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Missed aRT following upfront laryngectomy for LSCC occurs frequently and portends worse OS. Identifying patients at risk of off-guideline management may create opportunities for quality improvement in the multidisciplinary care of patients undergoing upfront laryngectomy for LSCC.</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 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272580","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}
To investigate the association between cardiovascular health, measured by Life's Essential 8 (LE8) score, and hearing loss and tinnitus among U.S. adults.
Methods
A cross-sectional analysis was conducted on 4624 adults (≥ 20 years) from NHANES 2005–2018 cycles. Cardiovascular health was assessed via the LE8 score, encompassing eight health behaviors and factors. Audiometry-measured speech-frequency hearing loss, defined as pure-tone average (PTA) ≥ 20 dB in the better ear at 500–4000 Hz, and subjective hearing loss and tinnitus were assessed using self-reported questionnaires. Multivariable logistic regression models adjusted for confounders examined associations between LE8 scores and auditory conditions. Additional analyses included restricted cubic spline regression, subgroup, and sensitivity analyses.
Results
Higher LE8 scores, indicating better cardiovascular health, were significantly associated with lower odds of audiometry-measured speech-frequency hearing loss (adjusted OR: 0.84; 95% CI: 0.77–0.92), subjective hearing loss (adjusted OR: 0.82; 95% CI: 0.77–0.88), and tinnitus (adjusted OR: 0.88; 95% CI: 0.81–0.96). Subgroup analyses showed consistent associations for audiometry-measured hearing loss and tinnitus across demographic strata, while findings for subjective hearing loss varied by sex. Sensitivity analyses confirmed the robustness of the findings.
Conclusions
Better cardiovascular health, as measured by LE8 score, is associated with lower odds of hearing loss and tinnitus among U.S. adults. These findings suggest that the LE8 score may serve as a valuable integrated metric for evaluating cardiovascular health in relation to auditory outcomes.
{"title":"Association of Life's Essential 8 With Hearing Loss and Tinnitus in U.S. Adults","authors":"Xing Lin, Yuxi Lin, Siyi Tang, Huimin Cai, Heng Xiao, Chang Lin, Shengnan Ye","doi":"10.1002/lio2.70270","DOIUrl":"https://doi.org/10.1002/lio2.70270","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the association between cardiovascular health, measured by Life's Essential 8 (LE8) score, and hearing loss and tinnitus among U.S. adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional analysis was conducted on 4624 adults (≥ 20 years) from NHANES 2005–2018 cycles. Cardiovascular health was assessed via the LE8 score, encompassing eight health behaviors and factors. Audiometry-measured speech-frequency hearing loss, defined as pure-tone average (PTA) ≥ 20 dB in the better ear at 500–4000 Hz, and subjective hearing loss and tinnitus were assessed using self-reported questionnaires. Multivariable logistic regression models adjusted for confounders examined associations between LE8 scores and auditory conditions. Additional analyses included restricted cubic spline regression, subgroup, and sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher LE8 scores, indicating better cardiovascular health, were significantly associated with lower odds of audiometry-measured speech-frequency hearing loss (adjusted OR: 0.84; 95% CI: 0.77–0.92), subjective hearing loss (adjusted OR: 0.82; 95% CI: 0.77–0.88), and tinnitus (adjusted OR: 0.88; 95% CI: 0.81–0.96). Subgroup analyses showed consistent associations for audiometry-measured hearing loss and tinnitus across demographic strata, while findings for subjective hearing loss varied by sex. Sensitivity analyses confirmed the robustness of the findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Better cardiovascular health, as measured by LE8 score, is associated with lower odds of hearing loss and tinnitus among U.S. adults. These findings suggest that the LE8 score may serve as a valuable integrated metric for evaluating cardiovascular health in relation to auditory outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>2b.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272925","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}
Matteo Lazzeroni, Jèrôme René Lechien, Mario Lentini, Pasquale Capaccio, Alberto Maria Saibene, Michele Gaffuri, Antonio Mario Bulfamante, Luca Giovanni Locatello, Portelli Tancredi, Ingrassia Angelo, Federico Sireci, Antonino Maniaci
Objective
Extracorporeal septoplasty (ECS) is a surgical technique used to address severe nasal septal deviations, especially in patients in whom in situ septoplasty (ISS) is insufficient. This systematic review assesses the efficacy, safety, and clinical outcomes of ECS techniques, including conventional and modified ECS methods.
Data Sources
PRISMA-compliant systematic search of PubMed, Scopus, Web of Science, and Embase.
Methods
Studies on ECS techniques were included. Eligibility criteria were established using the PICOTS framework. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. Functional and aesthetic improvements were primary outcomes, while complication rates represented secondary outcomes.
Results
Twenty-two studies (retrospective, prospective, and RCTs) met the inclusion criteria. ECS was associated with significant functional improvement, as assessed by nasal obstruction scores measured by NOSE scores, acoustic rhinometry, and rhinomanometry. Aesthetic results were also satisfactory, with a significant improvement in the nasofrontal angle, nasolabial angle, and the tip projection index, as well as good patients' satisfaction. Complications were rare, with few cases of septal perforation, graft resorption, or residual nasal obstructive symptoms. Evidence strength was limited considering the majority of included studies were retrospective, with inherent bias risks, small sample sizes, and inconsistent follow-up durations.
Conclusions
ECS may be a successful and safe method for severe septal deviation correction, providing functional and aesthetic results with a low complication rate. More high-quality, multicenter RCTs with long-term follow-up will be required for a standardization of surgical protocols and outcome measures.
Level of Evidence
2.
目的体外鼻中隔成形术（ECS）是一种用于治疗严重鼻中隔偏曲的手术技术，特别是在原位鼻中隔成形术（ISS）不足的患者中。本系统综述评估了ECS技术的有效性、安全性和临床结果，包括传统的和改进的ECS方法。数据来源：PubMed， Scopus， Web of Science和Embase的prisma兼容系统搜索。方法纳入ECS技术的研究。使用PICOTS框架建立资格标准。使用Cochrane风险偏倚2工具和Newcastle-Ottawa量表评估研究质量。功能和美观的改善是主要结果，而并发症率是次要结果。结果22项研究（回顾性、前瞻性和随机对照试验）符合纳入标准。通过鼻塞评分、声学鼻测量和鼻流测量来评估，ECS与显著的功能改善相关。美观效果也令人满意，鼻额角、鼻唇角、鼻尖投影指数均有明显改善，患者满意度良好。并发症很少，很少有鼻中隔穿孔、移植物吸收或残留的鼻塞症状。考虑到纳入的大多数研究是回顾性的，具有固有的偏倚风险，样本量小，随访时间不一致，证据强度有限。结论ECS是一种安全有效的重度鼻中隔矫治方法，具有良好的功能和美观性，并发症发生率低。需要更多高质量、多中心、长期随访的随机对照试验来标准化手术方案和结果测量。证据级别2。
{"title":"Extracorporeal Septoplasty for Severe Nasal Septal Deviation: A Systematic Review","authors":"Matteo Lazzeroni, Jèrôme René Lechien, Mario Lentini, Pasquale Capaccio, Alberto Maria Saibene, Michele Gaffuri, Antonio Mario Bulfamante, Luca Giovanni Locatello, Portelli Tancredi, Ingrassia Angelo, Federico Sireci, Antonino Maniaci","doi":"10.1002/lio2.70280","DOIUrl":"https://doi.org/10.1002/lio2.70280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Extracorporeal septoplasty (ECS) is a surgical technique used to address severe nasal septal deviations, especially in patients in whom in situ septoplasty (ISS) is insufficient. This systematic review assesses the efficacy, safety, and clinical outcomes of ECS techniques, including conventional and modified ECS methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>PRISMA-compliant systematic search of PubMed, Scopus, Web of Science, and Embase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Studies on ECS techniques were included. Eligibility criteria were established using the PICOTS framework. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. Functional and aesthetic improvements were primary outcomes, while complication rates represented secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two studies (retrospective, prospective, and RCTs) met the inclusion criteria. ECS was associated with significant functional improvement, as assessed by nasal obstruction scores measured by NOSE scores, acoustic rhinometry, and rhinomanometry. Aesthetic results were also satisfactory, with a significant improvement in the nasofrontal angle, nasolabial angle, and the tip projection index, as well as good patients' satisfaction. Complications were rare, with few cases of septal perforation, graft resorption, or residual nasal obstructive symptoms. Evidence strength was limited considering the majority of included studies were retrospective, with inherent bias risks, small sample sizes, and inconsistent follow-up durations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ECS may be a successful and safe method for severe septal deviation correction, providing functional and aesthetic results with a low complication rate. More high-quality, multicenter RCTs with long-term follow-up will be required for a standardization of surgical protocols and outcome measures.</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 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272924","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}
Zain Mehdi, Heli Majeethia, Jagan M. R. Dwarampudi, Aatin K. Dhanda, Meher Gajula, Lexi Goehring, Faizaan Khan, Roshan Dongre, Franklin Wu, Renjie Hu, Michael T. Yim, Masayoshi Takashima, Omar G. Ahmed
Objective(s)
With growing cannabis use in the US, it is crucial to understand the impact of recreational use on sinonasal diseases like chronic rhinosinusitis (CRS), allergic rhinitis (AR), and chronic rhinitis (CR).
Methods
This cross-sectional study leveraged the NIH AllOfUs database to query patient surveys assessing cannabis usage frequency (lifetime never, monthly, weekly, or daily within the past 3 months) and consumption route (smoking or non-smoking). Cannabis users were matched to never users for demographics, healthcare visit frequency, and insurance. A stringent logistic regression model calculated odds ratios (OR) of developing AR, CRS, or CR after survey completion. Cox regression hazard ratios (HR) compared consumption routes.
Results
Twenty-five thousand one hundred sixty-four cannabis users were matched with 113,418 never users. Users demonstrated significantly lower odds of AR, CRS, and CR than never users. For CRS, the ORs compared to never users are as follows: daily users 0.64 (95% CI 0.53–0.78), weekly users 0.61 (95% CI 0.48–0.77), and monthly users 0.80. For AR, the ORs were 0.64 (95% CI 0.58–0.71) for daily users, 0.62 (95% CI 0.54–0.71) for weekly users, and 0.69 (95% CI 0.58–0.80) for monthly users. For CR, the ORs were 0.61 (95% CI 0.47–0.79) for daily users, 0.64 (95% CI 0.47–0.87) for weekly users, and 0.41 (95% CI 0.26–0.65) for monthly users. There was no significant difference between smokers and non-smokers (HR 0.64, 95% CI 0.27–1.5).
Conclusion
There is an inverse, associative relationship between cannabis use and sinonasal disease. This relationship is insufficiently understood, and there remain significant concerns about the impact of cannabis use, especially smoking, on airway pathologies.
Level of Evidence
4.
目的：随着美国大麻使用量的增长，了解娱乐性使用对慢性鼻窦炎（CRS）、过敏性鼻炎（AR）和慢性鼻炎（CR）等鼻窦疾病的影响至关重要。方法：本横断面研究利用NIH AllOfUs数据库查询评估大麻使用频率（过去3个月内从不，每月，每周或每天）和消费途径（吸烟或不吸烟）的患者调查。大麻使用者与从未使用者在人口统计、医疗保健访问频率和保险方面进行了匹配。严格的logistic回归模型计算了调查完成后发生AR、CRS或CR的比值比（OR）。Cox回归风险比（HR）比较消费途径。结果：25,164名大麻使用者与113,418名从不使用大麻的人相匹配。使用者发生AR、CRS和CR的几率明显低于从不使用者。对于CRS，与从不使用用户相比的or值如下：每日用户0.64 (95% CI 0.53-0.78)，每周用户0.61 (95% CI 0.48-0.77)，每月用户0.80。对于AR，每日用户的or值为0.64 (95% CI 0.58-0.71)，每周用户的or值为0.62 (95% CI 0.54-0.71)，每月用户的or值为0.69 （95% CI 0.58-0.80）。对于CR，每日用户的or值为0.61 (95% CI 0.47-0.79)，每周用户的or值为0.64 (95% CI 0.47-0.87)，每月用户的or值为0.41 （95% CI 0.26-0.65）。吸烟者和非吸烟者之间无显著差异（HR 0.64, 95% CI 0.27-1.5）。结论：大麻使用与鼻窦疾病呈负相关关系。人们对这种关系的了解还不够充分，大麻的使用，特别是吸烟对气道病变的影响仍然令人担忧。证据等级：4。
{"title":"The Associative Impact of Recreational Cannabis Use on Sinonasal Diseases","authors":"Zain Mehdi, Heli Majeethia, Jagan M. R. Dwarampudi, Aatin K. Dhanda, Meher Gajula, Lexi Goehring, Faizaan Khan, Roshan Dongre, Franklin Wu, Renjie Hu, Michael T. Yim, Masayoshi Takashima, Omar G. Ahmed","doi":"10.1002/lio2.70261","DOIUrl":"10.1002/lio2.70261","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective(s)</h3>\u0000 \u0000 <p>With growing cannabis use in the US, it is crucial to understand the impact of recreational use on sinonasal diseases like chronic rhinosinusitis (CRS), allergic rhinitis (AR), and chronic rhinitis (CR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study leveraged the NIH AllOfUs database to query patient surveys assessing cannabis usage frequency (lifetime never, monthly, weekly, or daily within the past 3 months) and consumption route (smoking or non-smoking). Cannabis users were matched to never users for demographics, healthcare visit frequency, and insurance. A stringent logistic regression model calculated odds ratios (OR) of developing AR, CRS, or CR after survey completion. Cox regression hazard ratios (HR) compared consumption routes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five thousand one hundred sixty-four cannabis users were matched with 113,418 never users. Users demonstrated significantly lower odds of AR, CRS, and CR than never users. For CRS, the ORs compared to never users are as follows: daily users 0.64 (95% CI 0.53–0.78), weekly users 0.61 (95% CI 0.48–0.77), and monthly users 0.80. For AR, the ORs were 0.64 (95% CI 0.58–0.71) for daily users, 0.62 (95% CI 0.54–0.71) for weekly users, and 0.69 (95% CI 0.58–0.80) for monthly users. For CR, the ORs were 0.61 (95% CI 0.47–0.79) for daily users, 0.64 (95% CI 0.47–0.87) for weekly users, and 0.41 (95% CI 0.26–0.65) for monthly users. There was no significant difference between smokers and non-smokers (HR 0.64, 95% CI 0.27–1.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is an inverse, associative relationship between cannabis use and sinonasal disease. This relationship is insufficiently understood, and there remain significant concerns about the impact of cannabis use, especially smoking, on airway pathologies.</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 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253223","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}
The individual mapping of cochlear implants (CIs) aims to optimize the user's speech understanding. Recent investigations have shown the importance of soft speech: (1) According to Datalog studies, a large proportion of speech components lies in the range below 60 dB, and (2) soft speech represents a separate category in CI outcome, in addition to supra-threshold speech and speech in noise. Soft-speech understanding can be influenced by optimizing T-values or by global parameters (loudness growth and TSPL in the Nucleus system). This study focussed on improving soft speech below 60 dB by optimizing loudness growth.
Methods
Speech understanding with varying loudness growth in the speech processor CP11 (Cochlear Ltd.) was compared in 20 experienced adult CI users. The mean soft-speech score based on monosyllabic words at 40 and 50 dB was introduced for quantification.
Results
Six of the 20 patients studied showed significant individual improvement for soft speech when loudness growth was optimized, while none showed a significant decrease under quiet or noisy test conditions.
Conclusion
Actual CI systems offer a broad loudness range of speech understanding. In addition to suprathreshold speech understanding, additional attention should be paid to soft speech, and the result should therefore be confirmed by speech audiometry at low levels.
{"title":"Optimizing CI Systems for Better Recognition of Soft Speech —the Concept of Broad-Range Mapping","authors":"Matthias Hey, Thomas Hocke","doi":"10.1002/lio2.70273","DOIUrl":"10.1002/lio2.70273","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The individual mapping of cochlear implants (CIs) aims to optimize the user's speech understanding. Recent investigations have shown the importance of soft speech: (1) According to Datalog studies, a large proportion of speech components lies in the range below 60 dB, and (2) soft speech represents a separate category in CI outcome, in addition to supra-threshold speech and speech in noise. Soft-speech understanding can be influenced by optimizing T-values or by global parameters (loudness growth and TSPL in the Nucleus system). This study focussed on improving soft speech below 60 dB by optimizing loudness growth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Speech understanding with varying loudness growth in the speech processor CP11 (Cochlear Ltd.) was compared in 20 experienced adult CI users. The mean soft-speech score based on monosyllabic words at 40 and 50 dB was introduced for quantification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six of the 20 patients studied showed significant individual improvement for soft speech when loudness growth was optimized, while none showed a significant decrease under quiet or noisy test conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Actual CI systems offer a broad loudness range of speech understanding. In addition to suprathreshold speech understanding, additional attention should be paid to soft speech, and the result should therefore be confirmed by speech audiometry at low levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Levels of Evidence</h3>\u0000 \u0000 <p>2.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253210","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}
Praneet C. Kaki, Aman M. Patel, Lily Huang, Gavin Turner, Afash Haleem, Jason A. Brant, Robert M. Brody, Ryan M. Carey
Objective
To investigate the impact of clinical surveillance, primary radiotherapy, and primary surgery on overall survival (OS) in laryngeal carcinoma in situ (Cis).
Methods
The 2006–2020 National Cancer Database was queried for adults with a biopsy-proven diagnosis of laryngeal Cis. Multivariable binary logistic and Cox proportional hazards regression models were implemented.
Results
Of 3567 unique patients satisfying inclusion criteria, 514 (14.4%) underwent clinical surveillance, 1074 (30.1%) underwent primary radiotherapy, and 1979 (55.5%) underwent primary surgery. Receiving treatment at an academic/research facility was associated with higher odds of undergoing primary surgery compared to primary radiotherapy. Among 646 patients undergoing primary surgery with known pT classification and margins, 570 (76.6%) had pTis and NSM and 174 (23.4%) had pT1 and/or PSM. 5-year OS of clinical surveillance, primary radiotherapy, and primary surgery was 73%, 81%, and 86%, respectively (p < 0.001). Patients undergoing primary surgery with invasive or residual disease (i.e., pT1 and/or PSM) had similar 5-year OS as those without (84% vs. 88%, p = 0.057). Compared with primary radiotherapy, clinical surveillance (aHR 1.29, 95% CI 1.06–1.57, p = 0.003) was associated with worse OS, and primary surgery (aHR 0.80, 95% CI 0.69–0.92, p = 0.003) was associated with higher OS.
Conclusion
Primary surgery is associated with higher OS than clinical surveillance and primary radiotherapy among patients with laryngeal Cis.
Level of Evidence
4.
目的：探讨临床监测、初次放疗和初次手术对喉癌原位（Cis）患者总生存期（OS）的影响。方法：查询2006-2020年国家癌症数据库中经活检证实诊断为喉癌的成年人。采用多变量二元logistic回归模型和Cox比例风险回归模型。结果：在3567例符合纳入标准的独特患者中，514例（14.4%）接受了临床监测，1074例（30.1%）接受了原发性放疗，1979例（55.5%）接受了原发性手术。与初次放疗相比，在学术/研究机构接受治疗与进行初次手术的几率更高相关。在646例原发性手术患者中，已知pT分类和边缘，570例（76.6%）有pti和NSM， 174例（23.4%）有pT1和/或PSM。临床监测、初次放疗和初次手术的5年OS分别为73%、81%和86% （p p = 0.057）。与初次放疗相比，临床监测（aHR 1.29, 95% CI 1.06-1.57, p = 0.003）与较差的OS相关，而初次手术（aHR 0.80, 95% CI 0.69-0.92, p = 0.003）与较高的OS相关。结论：在喉癌患者中，初次手术的OS高于临床监测和初次放疗。证据等级：4。
{"title":"Treatment of Biopsy-Proven Laryngeal Squamous Cell Carcinoma In Situ","authors":"Praneet C. Kaki, Aman M. Patel, Lily Huang, Gavin Turner, Afash Haleem, Jason A. Brant, Robert M. Brody, Ryan M. Carey","doi":"10.1002/lio2.70267","DOIUrl":"10.1002/lio2.70267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the impact of clinical surveillance, primary radiotherapy, and primary surgery on overall survival (OS) in laryngeal carcinoma in situ (Cis).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2006–2020 National Cancer Database was queried for adults with a biopsy-proven diagnosis of laryngeal Cis. Multivariable binary logistic and Cox proportional hazards regression models were implemented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 3567 unique patients satisfying inclusion criteria, 514 (14.4%) underwent clinical surveillance, 1074 (30.1%) underwent primary radiotherapy, and 1979 (55.5%) underwent primary surgery. Receiving treatment at an academic/research facility was associated with higher odds of undergoing primary surgery compared to primary radiotherapy. Among 646 patients undergoing primary surgery with known pT classification and margins, 570 (76.6%) had pTis and NSM and 174 (23.4%) had pT1 and/or PSM. 5-year OS of clinical surveillance, primary radiotherapy, and primary surgery was 73%, 81%, and 86%, respectively (<i>p</i> < 0.001). Patients undergoing primary surgery with invasive or residual disease (i.e., pT1 and/or PSM) had similar 5-year OS as those without (84% vs. 88%, <i>p</i> = 0.057). Compared with primary radiotherapy, clinical surveillance (aHR 1.29, 95% CI 1.06–1.57, <i>p</i> = 0.003) was associated with worse OS, and primary surgery (aHR 0.80, 95% CI 0.69–0.92, <i>p</i> = 0.003) was associated with higher OS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Primary surgery is associated with higher OS than clinical surveillance and primary radiotherapy among patients with laryngeal Cis.</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 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253324","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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