Laryngoscope最新文献

Transoral endoscopy thyroidectomy by vestibular approach (TOETVA) provides the opportunity for thyroidectomy without cervical scarring. This procedure has yet to be widely studied in younger pediatric patients. We provide a case report of the youngest patient at our institution to successfully undergo TOETVA.

Objectives: The development of an endotracheal tube (ETT) prototype to measure the pressure on the posterior glottis during intubation.

Methods: Three ETTs, size 6, 7, and 8 mm, were modified with a piezoelectric pressure sensor. These ETTs were then used to intubate a laryngeal model. Pressures were measured at a hypopharyngeal laryngeal angle (HLA) of 90°, and the laryngeal platform was raised to create a more acute HLA ranging from 90° to 45°. These same ETTs were also used to intubate the larynx of a fresh frozen cadaver, with pressure measured with the head in neutral and flexed positions.

Results: The pressures exerted by the 6 mm ETT ranged from 7.33 cm H₂O at 90 degrees HLA to 62.57 cm H₂O at 45 degrees HLA. The 7 mm ETT ranged from 5.42 to 451.19 cm H₂O and the 8 mm ETT pressure ranged from 136.98 to 534.38 cm H₂O, respectively. The differences were statistically significant. The cadaveric study revealed the average pressure for the 6-, 7-, and 8-mm ETT to be 2.03, 166.78, and 228.49 cm H₂O, respectively, in the neutral position and 0.85, 30.37, and 158.51 cm H₂O, respectively, in the flexed position. These differences were statistically significant.

Conclusion: Posterior laryngeal pressure monitoring can be conducted utilizing ETT-based pressure sensors. Progression of this technology may help minimize laryngeal injury caused by intubation by determining which patients may be optimal candidates for early tracheostomy.

Level of evidence: 5:

Objectives: To review the current literature findings dedicated to the toxicity of nano- and microplastics (NMPs) in the upper respiratory tract.

Data sources: PubMED, Cochrane Library and Embase databases.

Review methods: Three independent investigators conducted the literature search for the documentation and toxicity of NMP in the upper respiratory tract according to the PRISMA statements. Primary outcomes included NMP types, shape, density, sizes, the environment (air, mask wearing, plasticdevice), and the histological and physiological modifications associated with the deposit of NMP.

Results: The scoping review included 12 studies (10 clinical, 2 experimental) with 356 human subjects. NMPs were detected in all samples, predominantly as fragments (10-500 μm), except in mask-wearers where fibers predominated. Polypropylene, polycarbonate, and polyurethane were the most common. Clinical studies showed higher NMP density in patients with nasal disorders with an increased permeability of mucosa (rhinosinusitis and allergic rhinitis) than in healthy controls. Mask wearing and nasal lavage devices contributed to NMP deposition. Experimental studies demonstrated NMP cellular internalization with potential physiological disruption, including oxidative stress, autophagy dysfunction, and respiratory microbiome alterations. There was substantial heterogeneity across studies for NMP detection methods.

Conclusions: The current clinical and experimental studies demonstrate that both exposed and unexposed humans have nasal NMP detected in their nasal tissues and fluids. Mask wearing and the use of old plastic nasal lavage devices can contribute to this deposition. While experimental studies suggest changes in tissue and cell physiology, the toxicity of NMP in nasal tissue remains poorly investigated and has not been conclusively demonstrated.

Objectives: Transitional foods are foods that start as one texture and change to another with minimal chewing required. While transitional foods have been promoted for pharyngeal swallowing dysfunction, their effects on swallowing safety and efficiency are not well understood. The aims of this study were to characterize differences in swallowing efficiency and safety between transitional, pureed, and regular food textures.

Methods: This was a retrospective study of consecutive outpatient adults who underwent flexible endoscopic evaluation of swallowing (FEES) at a multidisciplinary dysphagia clinic. FEES were used to obtain measures of swallowing safety and efficiency and were included if containing at least one trial of transitional, pureed, and regular food textures. FEES were blindly analyzed by pairs of raters. Multilevel statistical models were used to compare differences in outcome measures across textures.

Results: A total of 219 swallowing trials were analyzed. A greater number of swallows was required for pureed compared to transitional foods (p = 0.011). There was a greater amount of epiglottic residue (p < 0.05) and oropharyngeal residue (p < 0.0001) for pureed and regular foods compared to transitional foods (p < 0.05). There was also a greater amount of hypopharyngeal residue for pureed compared to transitional foods (p < 0.0001). Differences in swallowing safety could not be determined.

Conclusion: Transitional foods were associated with better swallowing efficiency than pureed and regular food textures in this heterogeneous sampling of dysphagic adults. Future research should prospectively assess the effects of transitional foods on swallowing safety and efficiency in specific dysphagic populations.

Level of evidence: 3:

Objective: To estimate the risk of cholesteatoma in patients with alpha-1 antitrypsin deficiency (AATD) compared to the general population using time-to-event analysis.

Methods: We conducted a nationwide nested cohort study identifying all patients with AATD in Denmark and subsequently matching each case with up to 10 controls based on age, sex, and municipality. Hazard ratios (HR) of cholesteatoma by AATD were calculated using Cox regression analysis adjusted for age and sex.

Results: The study identified 2702 individuals with AATD and 26,750 control subjects. Individuals with AATD versus controls had a HR for cholesteatoma surgery of 3.62 (95% CI: 1.93-6.80) and a HR for non-cholesteatoma surgery of 1.40 (1.04-1.89).

Conclusion: Individuals with AATD had a 3.6-fold increased risk of cholesteatoma surgery compared with matched controls without AATD. The data support that AATD contributes to pathophysiological processes underlying the development of cholesteatoma.

Level of evidence: 3:

Objective: With regulatory approval of HPV-specific immunotherapy for recurrent respiratory papillomatosis (RRP) and growing experience with systemic bevacizumab, a management algorithm incorporating these medical treatments is warranted.

Data sources and methods: RRP Foundation (RRPF) Key Opinion Leaders offer a proposed management algorithm for adults with RRP considering published literature and commercial drug availability.

Results: Preventative HPV vaccination should be considered for all patients. Determination of HPV type and pulmonary imaging are important for contemporary RRP patient care and assist in decision making. Risks and benefits of papilloma debulking as needed versus medical management of RRP must be deliberated on a patient case-by-case basis. HPV-specific immunotherapy that induces an HPV-specific T cell response to target the underlying HPV infection that is the cause of RRP is safe, offers the possibility of durable disease control following a short treatment course and is the recommended first-line medical treatment for patients who wish to avoid the risks of repeat procedural management. Papilloma disease control with systemic bevacizumab, which carries defined risks and must be continued for clinical benefit is the recommended second-line medical treatment for patients who do not achieve a complete response with immunotherapy and wish to continue medical management. For patients who elect to be treated with debulking procedures as needed, use of locally-administered adjuvant should be considered.

Conclusion: This proposed management algorithm from the RRPF serves as a contemporary resource and information guide for adult patients with RRP and their physicians considering treatment options.

Level of evidence: 5:

Objective: To describe the role of optical coherence tomography (OCT) in the evaluation and surgical planning of pediatric patients with complex airway pathology.

Methods: We conducted a retrospective case series of four pediatric patients who underwent OCT imaging of the trachea and mainstem bronchi between 2020 and 2024 at a tertiary children's hospital. Imaging was performed intraoperatively using a microcatheter-based OCT catheter under general anesthesia. OCT findings were reviewed in conjunction with bronchoscopy, preoperative imaging, and operative reports.

Results: In each case, OCT provided high-resolution structural detail that refined diagnosis and informed surgical planning. OCT was instrumental in delineating the extent of stenosis, evaluating mainstem bronchial involvement, and assessing stent patency and epithelialization. OCT imaging demonstrated value both in preoperative assessment and postoperative follow-up.

Conclusion: OCT offers a high-resolution, radiation-free imaging modality for pediatric airway evaluation. In this small, uncontrolled series, OCT served as a feasible adjunct that provided additional structural detail concordant with operative findings and, in selected cases, informed surgical approach. Prospective studies are needed to define workflow, performance, and impact on outcomes.

Level of evidence: 4:

Excess growth hormone in acromegaly induces characteristic acral and soft tissue overgrowth (particularly in the face and hands), arthropathies, as well as cardiovascular and metabolic complications. Similar proliferative changes can occur in the larynx, where hypertrophy of the arytenoid and cricoid cartilages may impair vocal fold mobility. We describe a rare case of acromegaly affecting the cricoarytenoid joints (CAJ), leading to proximal airway obstruction and demonstrating that these diarthrodial joints are susceptible to systemic arthropathies.

Objective: To identify prognostic factors for unilateral idiopathic sudden sensorineural hearing loss (SSNHL) in pediatric and adult patients, and to compare therapeutic efficacy between these age groups: METHODS: This retrospective cohort study included 1947 hospitalized patients (219 pediatric, 1728 adult) with unilateral idiopathic SSNHL from January 2008 to December 2022. All patients received inpatient therapy following the Chinese Guidelines for SSNHL, with pediatric dosing adjusted for age and weight. To compare therapeutic outcomes, multivariable logistic regression, full propensity score matching (PSM), restricted cubic spline (RCS), and machine learning algorithms were employed.

Results: Baseline median ages were 13 (IQR, 10-15) years for pediatric and 43 (IQR, 33-50) years for adult patients. Shared independent prognostic factors in both groups included audiogram configuration, degree of hearing loss, and treatment-onset time. Furthermore, after matching, pediatric and adult patients had comparable complete recovery (18.7% vs. 16.4%) and overall efficacy rates (52.5% vs. 54.1%). The therapeutic window was identified as 14 days for children and 15 days for adults. Consistent with this, treatment-onset time emerged as the most influential feature in predictive models, with pediatric outcomes achieving an area under the curve (AUC) of 0.849 and adult outcomes an AUC of 0.901.

Conclusions: Pediatric and adult patients with unilateral idiopathic SSNHL share major prognostic factors. Therapeutic efficacy is comparable between groups when appropriate treatment is provided. Early intervention, ideally within 2 weeks of symptom onset, is critical to maximize auditory recovery.

Level of evidence: 3:

Objective: Surgical treatment represents an adjunct to medical therapy in the management of primary diffuse chronic rhinosinusitis (CRS). Despite advancement in endoscopic sinus surgery (ESS), there are currently no established guidelines delineating the appropriate surgical extent for defining adequate ESS in cases of primary diffuse CRS.

Methods: Through a modified Delphi technique, 33 statements regarding the extent of surgery for each paranasal sinus were drafted following a literature review and submitted to an expert panel composed of 15 internationally recognized ESS experts. A consensus meeting was held to discuss the results for each iteration. An additional statement was added during the meeting, and a total of 34 statements were voted on during the last round.

Results: Consensus was reached in 17 statements out of 34. Type 1 medial maxillary antrostomy, bilateral anteroposterior ethmoidectomy, and at least DRAF I frontal sinusotomy should be performed in all cases of primary diffuse CRS, with a particular focus on mucosal sparing, regardless of the likelihood of subsequently needing biologic therapy. DRAF III frontal sinusotomy should not be considered as a first-line approach even in patients with risk factors for recurrence. Treatment of the sphenoid sinus might be avoided in cases where it is not involved by the pathology.

Conclusion: This document outlines a consensus on the appropriate surgical approach for primary diffuse CRS, aiming to promote standardization while preserving individual clinical judgment.

Level of evidence: 5: