Laryngoscope最新文献

Objective: The impact of climate change on health has become an increasingly widespread global health concern. This impact is especially relevant in the field of Otolaryngology; global warming has been shown to affect inflammatory upper airway disease, specifically allergic rhinitis (AR). This study aims to characterize the effect of climate change on the epidemiology of AR in adult and pediatric populations globally.

Data sources: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed across four databases. Inclusion criteria were: (1) published in English, (2) published between 2000 and 2023, (3) reported on the current epidemiological state of AR, (4) described factors related to climate change, and (5) observed global warming affecting allergy season and AR symptoms.

Review methods: Two reviewers screened articles and performed full-text reviews.

Results: Of the 502 articles assessed, 30 studies were eligible for inclusion. Sixteen studies reported longer pollen seasons and/or higher pollen concentrations related to climate change, with two projecting total pollen emissions to increase by 16-40% and pollen season length to increase by 19 days in North America. Four studies reported an increase in AR-related healthcare usage; low-income residents were most impacted by increased usage. Two studies identified that healthcare professionals want more education on climate change.

Conclusion: Our scoping review highlights how climate change is altering pollen seasons and concentrations, AR disease prevalence, allergy sensitization, and AR symptom severity. Health professionals have expressed an understanding of climate change's impact on health and a desire for further education.

Level of evidence: N/A.

Objectives: The osteocutaneous radial forearm free flap (OCRFFF) is used for the reconstruction of bony head and neck defects. Being a weight-bearing bone, precise harvesting of the radius is required to maintain structural integrity, postoperative forearm function, and to prevent postoperative fracture. A radius cutting guide may allow head and neck surgeons to be more precise and confident in performing bony harvest, and may improve allocation of orthopedic specialist resources.

Methods: A custom radius cutting guide was developed in an iterative process with six head and neck surgeons and one hand surgeon. Following design approval, a prospective feasibility study was conducted. Patient-specific cutting guides were created using pre-operative upper-extremity computed tomography (CT) scans. The length and cross-sectional width of harvested radius bone were measured. The length of time using the guide was recorded. Providers were surveyed to assess their perception of cutting guide utility.

Results: A total of eight patients were enrolled, and the cutting guide was used successfully in seven patients. The mean length of the radius harvested was 77.1 ± 13.8 mm. The mean cross-sectional width of the radius planned for harvest was 11.7 ± 1.7 mm. The mean width of the bone harvested was 12.1 ± 1.2 mm, with a mean difference of + 0.81 mm. The mean total time using the guide was 12.94 min (range 10.0-20.1 min). Survey respondents (n = 7) agreed that the guide did not interfere with their ability to harvest radius bone (mean response 9.0 ± 1.3) and that they would utilize the guide in practice (9.4 ± 1.1).

Conclusions: Patient-specific cutting guides for OCRFFF harvest are feasible and may improve head and neck reconstructive surgeons' comfort with harvest.

Level of evidence: 3:

Objective: Temporal bone fractures (TBFs) can result in long-term adverse outcomes including meningitis, facial nerve disorders (FNDs), and hearing loss (HL) that may require surgical intervention. This epidemiologic study aims to examine the sequelae of adult TBF with HL, including the utilization of cochlear implantation (CI), using data from a large, multinational database.

Methods: Using the TriNetX database, a retrospective cohort study was performed of adults (≥ 18 years) using ICD10 codes for other fractures of the base of the skull and hearing loss, an approximation of TBF with hearing loss. A control group of adults without TBF was used. Measured outcomes included meningitis, CI, FND, cerebrospinal fluid (CSF) leak, and labyrinthitis. Propensity score matching (1:1) was used for cohorts smaller than 33,333,333. Ninety-five percent of patient data used was from 2006 to 2023.

Results: Adults with TBF and HL (n = 34,878) had a greater risk of meningitis any time after TBF than those without TBF (n = 105,035,185) (RR: 6.65, 95% CI: 5.74-7.70). Labyrinthitis (RR: 3.56, 95% CI: 2.86-4.41), CSF leak (RR: 40.71, 95% CI: 37.91-43.71), and FND (RR: 12.08, 95% CI: 11.62-12.55) were more common after TBF. CI was more common after TBF (RR: 26.22, 95% CI: 22.12-31.07). Meningitis after TBF was associated with an increased risk of CSF leak (RR: 3.0, 95% CI: 1.52-5.93) compared to those without meningitis.

Conclusion: Adults who sustain TBFs resulting in HL have an increased risk of developing meningitis, labyrinthitis, CSF leak, and FND and are more likely to undergo CI for aural rehabilitation compared to a control cohort.

Level of evidence: Level IV.

Objective: To evaluate the rate at which the Relative Value Scale Update Committee (RUC) recommended relative value unit (RVU) values for otolaryngology procedures are accepted by the Centers for Medicare and Medicaid Services (CMS).

Methods: The Federal Register (https://www.federalregister.gov) was queried from 1995 to 2021 to identify the annual Medicare Final Rule. Within the Medicare Final Rule, all codes reviewed by the RUC were evaluated by two independent authors. Codes where the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) and/or the Triologic Society participated in the valuation were extracted.

Results: From 1995 to 2021, 271 codes relating to otolaryngology were surveyed and valued by the RUC. In 201 (74%) of those codes, CMS did not alter the RUC recommended value. CMS did alter the RUC recommended value of 70 (26%) codes. From 1995 to 2008, 91 otolaryngology codes were valued. Eighty (88%) of those values were not altered by CMS. Eleven (12%) values were altered by CMS in the Medicare Final Rule. From 2009 to 2021, 180 otolaryngology codes were valued. One hundred twenty-one (67%) of those values were not altered by CMS. Fifty-nine (33%) of those values were altered by CMS. The difference between the two time periods was significant (p = 0.0002). The reduction by CMS throughout all codes ranged from 2% to 100%, with an average alteration of 5%.

Conclusion: CMS is taking an increasing role in altering RUC-approved values for otolaryngology procedures. This has implications for both otolaryngology and all medical societies in terms of how their procedures are valued.

Level of evidence: N/A.

Objective: To evaluate the safety and clinical outcomes (bleeding rate, requirement for revision surgery, and patient-reported symptom relief) of pediatric cold steel tonsillotomy with or without adenoidectomy (TT/TTA).

Methods: Patients aged ≤ 18 years who underwent cold steel TT/TTA for the management of upper airway obstruction in Region Jönköping County, Sweden, between October 1, 2013, and September 31, 2023, were included in this single center, retrospective, cohort study. Data regarding postoperative bleeding and revision surgery were extracted from electronic medical records. Patient-reported outcomes were obtained from the Swedish Quality Register of Tonsil Surgery.

Results: Among the 1810 cold steel TT/TTA procedures included in the analysis, 36 (2.0%) bleeding events were identified, comprising 12 (0.7%) and 24 (1.3%) cases involving tonsils and adenoid beds, respectively. Four (0.2%) and seven (0.4%) patients with tonsil and adenoid bleeding, respectively, required surgical intervention. No significant risk factors for postoperative bleeding were identified. The rate of revision surgery owing to regrowth of tonsil tissue or recurrent infections was 5.1%. Younger age at the time of the first surgery was a significant risk factor for revision surgery (p < 0.001). Complete (64.9%) or almost complete (29.5%) resolution of symptoms was reported in 94.4% (n = 868) of the patients 6 months postoperatively.

Conclusion: Cold steel TT/TTA is a safe and efficient surgical procedure for pediatric patients with upper airway obstruction owing to tonsil and adenoid hypertrophy.

Level of evidence: 4:

Background: Sensory and autonomic nerves supply the sinonasal mucosa and contribute to the pathophysiology of certain forms of chronic rhinitis, rhinosinusitis, and craniofacial pain. The compositions of these intranasal nerves have been incompletely studied. The purpose of this cadaveric study was to investigate the relative areas of sensory, parasympathetic, and sympathetic nerve fibers within different nasal nerves.

Methods: Ten fresh cadaver heads were dissected, and anterior ethmoid (AEN), posterior nasal (PNN), and posterolateral (PLNN) sections were harvested unilaterally via endonasal and transorbital approaches. Specimens were formalin-fixed, sectioned, and stained with hematoxylin and eosin, as well as for neuropeptides (substance-P, calcitonin gene-related peptide [CGRP], neurokinins-A and B [NKA, NKB], vasointestinal peptide [VIP], neuropeptide Y [NPY]), and enzymes (choline acetyltransferase [ChAT] and tyrosine hydroxylase [TH]). Enzyme and neuropeptide nerve marker percent areas were calculated using brightfield analysis. Sensory and autonomic nerve marker percent areas were then compared within and between AENs, PNNs, and PLNNs.

Results: In total, 10 PNNs and AENs and 8 PLNNs were available for analyses. Sensory, parasympathetic, and sympathetic nerve markers were identified in every PNN, PLNN, and AEN, and were mostly equivalent between nerves. Only neurokinin-A demonstrated a significantly greater percent area than other markers across different nasal nerves.

Conclusion: Sensory and autonomic nerve markers were present in all AENs, PNNs, and PLNNs, and were largely equivalent between nerves. NKA presented the greatest percent area consistently across each of the nerve types. Future studies should explore the relative contributions of sensory versus autonomic dysfunction in chronic rhinitis, rhinosinusitis, and craniofacial pain.

Level of evidence: Level 4.

Objective: To develop and preliminarily validate a 3D-printed, multi-material, patient-specific simulator of the external and middle ear affected by stapes fixation. The simulator was designed for training in endoscopic stapes surgery (SS), addressing the lack of reliable training platforms for this technically challenging procedure.

Methods: Imaging data from a CT scan of a patient were used to create a virtual 3D model of significant ear structures. The simulator consisted of a multi-use temporal bone holder and a single-use middle ear box, printed with material Jetting 3D printing technology. Eight participants to a university ear surgery course used the simulator to perform endoscopic stapes surgery. The surgical performance was evaluated using modified Objective Structured Assessment of Technical Skills (OSATS) scoring, and participant feedback was gathered through qualitative questionnaires.

Results: Seven of the eight participants successfully completed the simulated SS, with a mean surgical time of 24 min. OSATS scores showed acceptable performance, with 75% of participants achieving a score above 20. The tactile feedback, particularly for the stapes fixation, was well received, although the chorda tympani was deemed too fragile. The simulator was highly valued for visuomotor coordination development.

Conclusions: The 3D Stapes Trainer represents a promising platform for training in endoscopic SS. Despite its limitations, the model provided young surgeons with a valuable platform to gain confidence in the steps of endoscopic SS, offering a high-fidelity simulation that contributes to the development of the technical skills required in this demanding procedure.

Level of evidence: N/A.

(1) Trigeminal stimulation induced a clear NMP; trigeminal-olfactory co-stimulation induced an even greater NMP. (2) Olfactory stimulation may enhance peripheral neural processing of trigeminal stimulation. (3) Olfactory-trigeminal interaction might occur before reaching the central nervous system.