Laryngoscope最新文献

Objectives: Microlaryngoscopy and bronchoscopy (MLB) are essential tools for evaluating airway inflammation, but the reliability of endoscopic assessments for this purpose remains unclear. The aim of this study was to assess surgeons' interrater reliability during endoscopic assessment of airway inflammation. The endoscopic factors used to determine overall airway inflammation were also assessed.

Methods: We conducted a cross-sectional study involving 24 pediatric patients who underwent MLB and arytenoid biopsy. Surgeons rated airway inflammation based on endoscopic images, and interrater reliability was assessed using Fleiss' Kappa.

Results: Fleiss's Kappa demonstrated poor interrater reliability among all surgeons (0.111) and experienced surgeons (0.117). Surgeons varied in prioritizing visual features for assessing inflammation.

Conclusion: Current subjective assessments of airway inflammation during MLB exhibit poor interrater reliability, necessitating further research for improved diagnostic accuracy and informed treatment decisions in pediatric airway interventions.

Level of evidence: Level 3 Laryngoscope, 2024.

Objective: Postradiation nasopharyngeal necrosis (PRNN) is a severe postradiation complication of nasopharyngeal carcinoma. PRNN not only severely impacts the quality of life but also endangers the lives of patients. Definite grades of PRNN and their corresponding standard surgical procedures are lacking. we aimed to establish the classifications of PRNN for transnasal endoscopic skull base surgery (TESS).

Methods: We enrolled 82 postirradiation NPC patients with PRNN, 75 of whom received TESS. PRNN was categorized into four grades: I, necrosis of the nasopharyngeal mucosa and submucosal muscularis; II, necrosis extending to the pharyngobasilar fascia; III, necrotic area breaking through the pharyngobasilar fascia and involving the internal carotid artery (ICA); IV, necrosis encompassing the ICA or invading the posterior cranial nerves. Overall survival (OS) analysis based on the PRNN grades was assessed. Headache was assessed using a numeric rating scale.

Results: The classifications of PRNN were as follows: Grade I, 18.3% (n = 15); Grade II, 30.5% (n = 25); Grade III, 24.4% (n = 20); Grade IV, 26.8% (n = 22). After surgery, headache was alleviated in most PRNN patients to varying degrees. By the last follow-up visit, 24 patients had died, including 6 of 7 in the unoperated group and 18 out of 75 in the operated group.

Conclusion: The classifications of PRNN grade provide an effective guideline for the TESS treatment of PRNN.

Level of evidence: 4 Laryngoscope, 2024.

Objective: One concern for patients suffering from dysphagia is whether their swallowing improves enough to allow oral intake. Predicting oral intake independence would be practical for deciding the treatment strategy, such as swallowing improvement surgeries, at an early stage. This study describes the prognostic factors and predictive method for achieving oral intake independence at discharge from acute care hospitals.

Methods: A total of 128 patients managed by the dysphagia treatment team were retrospectively examined. They were divided into two groups: the independent oral intake group and the restricted oral intake group. The patients' age, sex, causes of dysphagia, calf circumference (CC), body mass index (BMI), Hyodo score obtained through flexible endoscopic evaluation, Food Intake Level Scale (FILS) score, and Dysphasia Severity Scale (DSS) score at the initial consultation were determined.

Results: The independent group had 32 patients, whereas the restricted group had 96 patients. The independent group had higher CC, BMI, and number of dysphagia cases caused by stroke. This group also had lower Hyodo scores and higher DSS scores. Multiple logistic regression analysis revealed that the Hyodo score and CC were independent prognostic factors for oral intake independence. Moreover, the prediction model developed using both factors showed relatively high accuracy (sensitivity: 42.9%, specificity: 94.0%, predictive accuracy: 81.3%).

Conclusion: A lower Hyodo score and higher CC at the initial consultation may be positive prognostic factors for achieving oral intake independence. The predictive model exhibited high accuracy, indicating it may help in determining alternative treatment strategies for serious dysphagia patients.

Level of evidence: Level 3 Laryngoscope, 2024.

Objective: To summarize the Solute Carrier Family 26 Member 4 (SLC26A4) mutations and clinical phenotypic characteristics of patients with Pendred syndrome/nonsyndromic enlarged vestibular aqueduct (PS/NSEVA).

Design: A retrospective cohort study for the Chinese population was performed to analyze the hearing test results of 406 patients with PS/NSEVA who had a SLC26A4 mutation and the relationship between inner ear imaging and audiology.

Results: There was a significant difference in the mean hearing threshold in patients with biallelic mutations (M2), monoallelic mutations (M1), and nonallelic mutations (M0) and between patients with isolated vestibular aqueduct enlargement (IEVA) and patients with IEVA combined with Mondini malformation. There was no significant difference between patients with different gene mutation types or different sexes, or between the width of the vestibular aqueduct (VA) and the mean hearing threshold. The degree of hearing loss was linearly correlated with age.

Conclusions: We propose that the presence and absence of SLC26A4 mutation, whether combined with Mondini malformation and patient age, are essential factors affecting the degree of hearing loss in the Chinese population. However, the number and type of mutations, degree of VA expansion, and sex of the patients did not affect the clinical audiological phenotype.

Level of evidence: 3 Laryngoscope, 2024.

Objectives: To examine the effects of scala tympani (ST) volume, cochlear duct length (CDL), and angular insertion depth (AID) on low-frequency hearing preservation for cochlear implant (CI) recipients of lateral wall electrode arrays.

Methods: A retrospective review identified 45 adult CI recipients of 24-, 28-, or 31.5-mm lateral wall electrode arrays with preoperative unaided hearing thresholds ≤45 decibel hearing level (dB HL) at 250 Hz. All patients underwent preoperative and postoperative computed tomography to evaluate cochlear morphology and electrode array position. A linear mixed effects model evaluated effects of ST volume, CDL, AID, preoperative low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz), age at surgery, and biological sex on the postoperative change in LFPTA at activation and 6 months post-activation.

Results: There were significant main effects of ST volume (p = 0.044), age (p = 0.028), and biological sex (p = 0.003), indicating better low-frequency hearing preservation for CI recipients with larger ST volumes, younger age at surgery, and female biological sex. Although CDL positively correlated with ST volume (r = 0.74, p < 0.001), there was no significant main effect of CDL (p = 0.367). A broad range in AID of the most apical electrode contact was observed (301.4°-681.8°); however, there was no significant main effect of AID on low-frequency hearing preservation (p = 0.700).

Conclusions: During the initial 6 months following implantation, intrinsic factors such as cochlear morphology may have a greater impact on low-frequency hearing preservation than apical positioning of a flexible lateral wall electrode array when using soft surgical techniques.

Level of evidence: 3 Laryngoscope, 2024.

Objective(s): To investigate the role of microRNA-378 (miR-378) in the regulation of mucin gene expression and inflammatory response in human middle ear epithelial cells (HMEEC) during bacterial infection by non-typeable Haemophilus influenzae (NTHi).

Methods: Human middle ear epithelial cells (HMEEC) were cultured and transfected with miR-378 or control miRNA. Post-transfection, cells were exposed to NTHi lysates. mRNA levels of MUC5B, MUC5AC, and IL-8 were quantified using RT-qPCR, and promoter activity was measured via luciferase assays. The effects of miR-378 on mucin and cytokine gene expression were analyzed.

Results: Transfection with miR-378 significantly increased the expression of MUC5B (3.6 fold, p < 0.01), MUC5AC (19.1 fold, p < 0.01), and IL-8 (2.01 fold, p < 0.05) in HMEEC. NTHi exposure reduced MUC5B (1.385 fold, p < 0.05) and MUC5AC (1.61 fold, p < 0.05) gene expression in miR-378 transfected cells but significantly increased IL-8 levels (1.32 fold, p < 0.05). Luciferase assays showed that miR-378 upregulated the promoter activity of MUC5B (1.4 fold, p < 0.01) and MUC5AC (1.6 fold, p < 0.01) genes, indicating its role in transcriptional regulation.

Conclusion: miR-378 plays a crucial role in promoting mucin overproduction and an inflammatory response in the middle ear epithelium during OM. Targeting miR-378 could offer a novel therapeutic strategy for preventing the progression from AOM to COM.

Level of evidence: na Laryngoscope, 2024.

Objectives: To develop methods for early detection of natural killer/T-cell lymphoma, nasal type (nasal NKTL) and to evaluate the use of apparent diffusion coefficient (ADC) measurements from diffusion-weighted imaging (DWI) for selecting biopsy sites to enhance the positive biopsy rate.

Methods: The clinical data of 32 cases of nasal NKTL were retrospectively collected and analyzed. Cases were graded from 1 to 5 based on endoscopic and imaging findings. Biopsy methods included the superficial forceps method and deep incisional method. Data recorded included biopsy method, time to confirmed diagnosis, number of biopsies required, and ADC values of biopsy sites.

Results: Both endoscopic and MRI lesion severity did not affect biopsy outcomes (p = 0.8248, 0.7571). The deep incisional biopsy method had a significantly higher probability of yielding positive pathological results compared to the superficial clamping method [OR (95% CI) = 23.2143 (6.0448, 89.1513) (χ² = 26.1089, p < 0.0001)]. The ADC value at the site with a positive biopsy result is significantly lower than at the site with a negative result (p = 0.0003). The diagnostic threshold for ADC value to predict a positive biopsy result was 0.603 × 10^-3 mm²/s, with a Youden index of 0.43.

Conclusions: Nasal NKTL has distinct characteristics distinguishing it from sinusitis and other tumors. Deep incision biopsy under general anesthesia is superior to the superficial method. The location of the positive sampling site can be guided by measuring the ADC value, and the optimal diagnostic threshold of this proposed method is 0.603 × 10^-3 mm²/s.

Level of evidence: 4 Laryngoscope, 2024.

Confocal laser endomicroscopy (CLE) represents an emerging probe-based intraoperative optical imaging modality, contingent on differential fluoroscein uptake, equipped to improve intraoperative identification of subclinical mucosal disease. In the analysis herein, we describe improved sensitivity, compared to narrow band imaging and small-volume tissue biopsies, of CLE in the discrimination of occult disease based on cellular and subcellular morphology during endoscopic resection of early-staged larynx cancers. Laryngoscope, 2024.

Electrical stimulation in proximity to a cochlear implant (CI) is contraindicated due to the potential risk of damaging the implant and thermal insult to the inner ear. Yet, during surgical procedures that pose a risk to the nervous system, the use of transcranial electrical stimulation for neuromonitoring is crucial for assessing the integrity of the motor pathways and preventing neurological insults. The current paper depicts a case of a patient with CI undergoing two consecutive surgeries for scoliosis correction, revealing a suspected pending neurological insult in the second operation. An audiological and electrical examination after each operation demonstrated preserved auditory function and normal functioning of the CI, respectively. The current case is consistent with previous reports reviewed in the paper, showing no CI failures nor hearing deterioration following transcranial electrical stimulation for neuromonitoring and electroconvulsive therapy. In light of this accumulating evidence, there is an urgent need for manufacturers and regulatory bodies to proactively undertake a comprehensive review of this declared contraindication. Subsequently, an updated data-driven risk analysis is essential to weigh the consequences of preventing the contraindicated tools and treatments, as well as their potential benefits to these patients. Laryngoscope, 2024.

Background: Nose picking is a common habit that rarely leads to mutilating self-injury. It is important to distinguish between rhinotillexomania (compulsive nose picking) as a disease and nose picking that results in or contributes to nasal septal perforation (NSP). The aim of this study is to investigate the impact of rhinotillexomania and NSP repair on sinonasal symptoms and quality of life (QoL).

Methodology/principal: Patients with symptomatic NSP due to rhinotillexomania and candidates for surgical repair were included. Sinonasal symptoms and QoL were measured using a visual analogue scale (VAS), Sinus CT scan, Barcelona Smell Test 24 (BAST-24), Sinonasal outcome test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE), NOSE-Perf, and Medical Outcome Study Short Form (SF-36). Healthy volunteers without sinonasal disorders (n = 43) were also included.

Results: A total of 37 patients with Rhinotillexomania (20 male [54.1%]; mean age, 49.2 years [SD 15.4]) were recruited. Totally 32 patients (86.5%) had NSP with the posterior border anterior to the incisive canal. Follow-up data were registered for 29 patients with a mean follow-up duration of 22.1 months (standard deviation, SD 16.7). The overall success rate of NSP repair was 96.6%. Patients experienced significant improvement in sinonasal symptoms and QoL after surgery.

Conclusions: Rhinotillexomania is a distinct entity from nose picking. Multidisciplinary approach including behavior therapy and NSP repair are considered the best approaches to relieve sinonasal symptoms. Placing nasal silicone sheets is recommended when the diagnosis of rhinotillexomania is confirmed. The greater palatine artery flap combined with inverted edges appears to be the most effective approach.

Level of evidence: Level 3 Laryngoscope, 2024.