Laryngoscope最新文献

Objective: To compare instrumental swallow assessment findings and diet recommendations in high versus low vagal unilateral vocal fold paralysis (UVFP).

Methods: Retrospective review of patients with UVFP who underwent instrumental swallow assessment, September 2019-February 2024. Demographics, Eating Assessment Tool-10 (EAT-10) score, flexible laryngoscopy findings, instrumental swallow parameters, diet recommendations, treatment modalities, and posttreatment outcomes were analyzed.

Results: Ninety-six patients were included: 28 (29%) high-vagal and 68 (71%) low-vagal UVFP. High vagal UVFP had a higher incidence of premature spillage (57% vs. 13%, p < 0.0001); residue (82% vs. 22%, p < 0.0001), penetration (89% vs. 35%, p < 0.0001), aspiration (50% vs. 22%, p = 0.013), modified diet (61% vs. 16%, p < 0.0001), and behavioral modifications (89% vs. 38%, p < 0.001) compared to low vagal UVFP. Thirty-one patients (32%) underwent injection laryngoplasty (16 high, 15 low vagal) with similar pretreatment prevalences of premature spillage, penetration, and aspiration, but a higher prevalence of residue in the high vagal group (100% vs. 53%, p = 0.002). Both groups improved posttreatment (high vagal: 63%-19%, p = 0.016; low vagal: 80%-7%, p = 0.001).

Conclusion: High vagal UVFP is associated with greater swallowing dysfunction and higher prevalences of diet and behavioral modifications compared to low vagal UVFP. Treated high and low vagal subgroups had similar dysphagia profiles. Injection laryngoplasty improved aspiration, regardless of vagal level, although many patients continued to require behavioral modifications. Future studies are needed to identify predictors of poor functional swallowing outcomes in UVFP.

Level of evidence: 3:

Objective(s): Acute laryngeal injury (ALgI) occurs in over 50% of patients after intubation and mechanical ventilation and is associated with significantly worse voice, breathing, and swallowing outcomes. Currently, there are no small animal models for the study of ALgI and its progression to glottic stenosis. The objective of this study was to develop and validate a novel murine model of ALgI.

Methods: Thirty adult C57BL/6 mice underwent chemomechanical injury to the posterior glottis, and 16 control mice did not undergo injury. Glottic injury was performed under endoscopic guidance using a bleomycin-dipped wire brush. Mice underwent repeat endoscopy at 14- or 21-days following injury, and the maximal interarytenoid angle during respiration was quantified using ImageJ to evaluate glottic mobility. Histologic and gene expression analyses were performed on larynges from each group.

Results: The interarytenoid angle of injured mice was significantly reduced compared to controls at both 14 (35.3° vs. 68.0°, p = 0.016) and 21 days post-injury (34.5° vs. 68.0°, p < 0.001). There was a significant increase in posterior glottic thickness in injured compared to control mice at 21 (132.5 vs. 53.9, p < 0.001) but not 14 days post-injury (90.4 vs. 53.9, p = 0.1535). Trichrome staining and RT-qPCR demonstrated collagen upregulation in the posterior glottis of injured mice.

Conclusion: Chemomechanical injury to the posterior glottis produces a novel murine model of ALgI. This safe, reliable, and feasible model lays the foundation for future translational study of ALgI and its progression to glottic stenosis.

Level of evidence: N/A animal study.

Objectives: To analyze risk factors for Laryngeal Web (LW) formation following CO2 laser surgery combined with topical photodynamic therapy (T-PDT) in patients with recurrent respiratory papillomatosis (RRP).

Methods: This retrospective study analyzed RRP patients treated with CO2 laser surgery combined with T-PDT at a single academic medical center between January 2021 and April 2024. The Cohen grading system was used to assess laryngeal web severity before and after treatment. The Wilcoxon rank-sum test was performed to compare pre- and post-treatment adhesion scores. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for LW formation, including gender, surgical age, onset age, HPV genotype, lesion distribution (Derkay score), preoperative LW presence, previous surgical history, bilateral involvement, and preoperative bevacizumab treatment within 1 month.

Results: A total of 86 RRP patients received CO2 laser surgery combined with T-PDT treatment. Post-treatment LW occurred in 23.26% (20/86) of patients. No significant difference was observed in Cohen grading distribution between pre- and post-treatment groups (W = 226.5, p = 0.934). Multivariate analysis identified preoperative LW presence (OR = 8.81, p < 0.001) as an independent risk factor for post-treatment LW formation, whereas preoperative bevacizumab treatment was associated with a lower risk of LW formation (OR = 0.16, p = 0.022).

Conclusion: CO2 laser surgery combined with T-PDT demonstrated a relatively low incidence of LW formation in RRP treatment. Preoperative LW presence significantly increased the risk of post-treatment LW formation, while preoperative bevacizumab treatment was associated with a lower risk of LW formation.

Level of evidence: 3:

Objective: Lesions of the parapharyngeal space (PPS) represent a challenging surgical pathology for resection, especially when critical structures like the parapharyngeal internal carotid artery (ppICA) are difficult to visualize and access. Current approaches provide inadequate visualization and incomplete access with significant morbidity. We investigate a novel approach, the intermaxillary-mandibular (IMM) approach, and compare this approach to traditional surgical approaches for visualization and access to the PPS and ppICA.

Methods: A single-institution anatomical study with endoscopic IMM approach and transcervical/transparotid (TCTP) approach dissections was performed in two cadaver heads. The qualitative advantages and disadvantages of both the IMM and traditional TCTP approaches are described and compared.

Results: Using the IMM approach, the ppICA can be completely mobilized as it enters the skull base in the upper PPS (UPPS). Compared to traditional TCTPA approaches, the IMM approach provides greater visualization of the ppICA entering the skull base with less risk of facial nerve injury, and provides more direct access to the ppICA entering the skull base compared to the TCTPA with a surgical corridor length (SCL) of 50.2 versus 63.5 mm, p = 0.001.

Conclusion: Achieving surgical access to the PPS for ppICA lesions is difficult due to the proximity of critical structures and the bony confines of the mandible, maxilla, and skull base. Lesions near or involving the ppICA require wide access to the ppICA including complete mobilization for optimal and safe surgical intervention. Our novel IMM approach allows access to the entire UPPS and mobilization of the ppICA.

Level of evidence: N/A.

Objectives: Botulinum toxin A (BtxA) injection for AdLD is typically performed approxiamately every 3 months. DaxibotulinumtoxinA-lanm (Daxi) is a peptide-formulated neuromodulator with reported longer therapeutic duration. This study compared the safety and efficacy of Daxi to historical BtxA results in AdLD patients.

Methods: In this open-label, prospective clinical trial, 22 stable-dose, BtxA-responsive AdLD patients underwent Daxi injection. To optimize safety, the first 10 patients' doses were given in a staged fashion (3-6 days between half doses). Safety and duration of voice benefit (DVB) were the primary outcomes. PROMs and voice analyses were obtained pre- and monthly post-injection.

Results: Of 22 patients, 20 (75% female, mean age = 58.3) were analyzed, with two excluded for injection "misses." No adverse reactions were reported. EAT-10 showed no difference pre- and post-Daxi injection (p = 0.068). VHI-10 significantly improved (p = 0.004) pre- to post-injection. Procedural LEMG quantitative data for Daxi and BtxA were comparable (p = 0.279). DVB of Daxi was longer than BtxA in 8/20 (40%), equal to BtxA in 7/20 (35%), and shorter than BtxA in 5/19 (25%). Those with Daxi benefit had on average 43.9% (39.5 days) longer therapeutic duration than previous BtxA treatments. Seven patients (35%) returned to BtxA at subsequent injection whereas 13 patients (65%) desired repeat Daxi injection.

Conclusion: This study represents the first implementation of Daxi for AdLD. Daxi was notably safe and effective. Although no overall significant difference was noted for the entire study cohort, 40% of patients reported substantially longer duration of voice benefit with Daxi than with BtxA, with 43.9% longer duration than their previous BtxA treatments.

Level of evidence: 2:

Objectives: Red blood cell distribution width (RDW) predicts surgical success in adult patients undergoing open airway reconstruction for laryngotracheal stenosis, but similar biomarkers in pediatrics remain unidentified. This study identifies predictors of outcomes in pediatric patients undergoing triple endoscopy or surgical airway reconstruction.

Methods: A retrospective cohort study of 191 pediatric patients who underwent triple endoscopy or surgical airway reconstruction at an aerodigestive center between 4/18/2013 and 4/17/2023 was completed. Ninety-eight patients with lab values within 2 months of the procedure were included. Main outcome measures were prosthesis-free breathing at last follow-up, hospitalization length, and follow-up duration.

Results: Lower RDW values were associated with prosthesis-free breathing at last follow-up (p = 0.042) and shorter hospitalizations (p < 0.001). Higher monocyte-to-lymphocyte ratio (MLR) and systemic inflammation response indexes (SIRI) correlated with increased length of hospitalization (p = 0.003 and p = 0.01). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and tracheomalacia were associated with longer follow-up periods (p = 0.04). Patients with tracheomalacia and OSA prior to intervention were more likely to require tracheostomy at last follow-up (p = 0.005 and p = 0.041).

Conclusions: RDW may predict long-term surgical success and outcomes in pediatric patients with complex airway, pulmonary, and upper digestive tract disorders. Serologic markers including SIRI, MLR, NLR, and PLR may also predict outcomes. Patient demographics and surgical type did not correlate with long-term outcomes, but patients with tracheomalacia and OSA were more likely to require tracheostomy at later time points.

Level of evidence: 3:

Objective: To determine whether the type and timing of intervention for pediatric sleep-disordered breathing (SDB) affect the risk of developing neuropsychiatric and learning disorders.

Methods: A retrospective cohort study using TriNetX, from January 2016 to March 2025, was conducted. Patients < 18 years with a diagnosis of SDB were included. Propensity score matching (1:1) based on demographics and concomitant diagnoses was performed for three comparisons: untreated versus surgical management (n = 152,653), untreated versus non-surgical management (n = 8,634), and surgical versus non-surgical management (n = 8,873). The incidence of anxiety, depressive, eating, behavioral, and learning disorders at 1 year, 5 years, and anytime post-intervention was recorded. In surgical patients, outcomes were also stratified by timing of surgery: within versus beyond 3, 6, and 12 months of diagnosis.

Results: Compared to surgery, no treatment was associated with significantly elevated risk of anxiety (risk ratio [RR] 1.44), depressive (RR 1.71), eating (RR 1.27), behavioral (RR 1.31), and learning disorders (RR 1.39) at 1 year. Compared to surgery, non-surgical management significantly increased the risk of anxiety (RR 2.27), depressive (RR 1.69), behavioral (RR 1.24), and learning disorders (RR 2.72) at 1 year. Similar trends were observed at 5 years. Surgery within 6 months significantly reduced the risk of anxiety (RR 1.06), eating (RR 1.38), behavioral (RR 1.12), and learning disorders (RR 1.14) (p < 0.05 for all comparisons).

Conclusion: Early surgical intervention for pediatric SDB is associated with significantly lower risks of neuropsychiatric and learning disorders compared to delayed surgery, non-surgical management, or no treatment, necessitating validation through future prospective trials.

Level of evidence: 3:

Objectives: Subglottic and tracheal stenosis (SGS, TS) are severe manifestations of granulomatosis with polyangiitis (GPA), often-requiring endoscopic airway intervention and systemic immunosuppression. Rituximab (RTX) has shown efficacy for systemic GPA, but its role in SGS and TS remains unclear, with reports of both benefit and relapse. This study evaluated the impact of RTX and cyclophosphamide (CTX) on surgery-free intervals (SFIs) in GPA-associated SGS and TS.

Methods: A retrospective chart review was conducted on GPA patients with SGS or TS treated at a tertiary center between 1992 and 2023. Therapeutic RTX exposure was defined as 3-9 months post-induction or within 1 year of maintenance, and CTX during regular dosing before transitioning to another maintenance regimen. SFIs, calculated as time between endoscopic interventions, were compared with and without RTX and CTX exposure using weighted t-tests.

Results: A total of 55 patients met inclusion; 44 (80%) underwent at least one endoscopic intervention and 34 of those patients (77%) received RTX and/or CTX. Median follow-up time was 10.2 years (range 0.8-29.5 years). Mean SFIs were significantly longer during therapeutic RTX exposure or remission (45 ± 8 months) versus non-therapeutic intervals (20 ± 6 months) (p = 0.046). Prior RTX or CTX use, though not definitionally therapeutic, significantly increased mean SFI from 22 to 25 months compared to no exposure (p = 0.029). CTX alone did not significantly increase SFI.

Conclusion: Rituximab may contribute to longer intervals between endoscopic airway intervention and delay relapse in GPA-related airway stenosis, supporting its role in stabilization of airway manifestations. Multidisciplinary management remains essential for this life-threatening GPA manifestation.

Level of evidence: 3:

Objective: When counseling parents regarding the management of their child's hearing loss (HL), understanding parents' motivations is paramount. Our objective was to synthesize the factors affecting parental decision-making regarding hearing device initiation in the existing literature.

Data sources: Embase, Ovid Medline, Scopus, The Cochrane Library, APA PsycINFO, CINAHL Plus, and ClinicalTrials.gov.

Methods: A medical librarian conducted a systematic search for publications on parental decision-making in their child's HL management. Two reviewers independently assessed studies and extracted quotes for analysis.

Results: From 462 abstracts, 161 were potentially relevant, and 48 studies were included. Of these, 32 (67%) discussed cochlear implants (CIs), 8 (17%) discussed other devices, and 8 (17%) addressed both. Three broad themes emerged: Practical considerations, Value-Based considerations, and Information Gathering. Key sub-themes in CI decision-making were oral communication (27/40), child autonomy (20/40), and ethical/religious (8/40) or Deaf culture (10/40) considerations. For non-CI-deciding parents, concerns about aesthetics (4/16) or bullying (6/16), and understanding of audiologic results (3/16) were important factors not reported by CI-deciding parents. Experiences of other families were more commonly important in CI decision-making (24/40) than for other devices (6/16). Parents perceived medical professionals as biased towards CI (9/40) and felt overtly rushed and pressured. Parents considering other devices reported that information was one-sided (5/16), but did not often feel pressured.

Conclusions: Parents considering hearing devices for their children assess Practical considerations, personal values, and varied information sources. Sub-themes within these categories differed by device type. Medical professionals should elicit parental values and offer individualized counseling during conversations about hearing devices.

Level of evidence: N/A.