Laryngoscope最新文献

Objective: To develop and validate a deep-learning classifier trained on voice data extracted from videolaryngostroboscopy recordings, differentiating between three different vocal fold (VF) states: healthy (HVF), unilateral paralysis (UVFP), and VF lesions, including benign and malignant pathologies.

Methods: Patients with UVFP (n = 105), VF lesions (n = 63), and HVF (n = 41) were retrospectively identified. Voice samples were extracted from stroboscopic videos (Pentax Laryngeal Strobe Model 9400), including sustained /i/ phonation, pitch glide, and /i/ sniff task. Extracted audio files were converted into Mel-spectrograms. Voice samples were independently divided into training (80%), validation (10%), and test (10%) by patient. Pretrained ResNet18 models were trained to classify (1) HVF and pathological VF (lesions and UVFP), and (2) HVF, UVFP, and VF lesions. Both classifiers were further validated on an external dataset consisting of 12 UVFP, 13 VF lesions, and 15 HVF patients. Model performances were evaluated by accuracy and F1-score.

Results: When evaluated on a hold-out test set, the binary classifier demonstrated stronger performance compared to the multi-class classifier (accuracy 83% vs. 40%; F1-score 0.90 vs. 0.36). When evaluated on an external dataset, the binary classifier achieved an accuracy of 63% and F1-score of 0.48, compared to 35% and 0.25 for the multi-class classifier.

Conclusions: Deep-learning classifiers differentiating HVF, UVFP, and VF lesions were developed using voice data from stroboscopic videos. Although healthy and pathological voice were differentiated with moderate accuracy, multi-class classification lowered model performance. The model performed poorly on an external dataset. Voice captured in stroboscopic videos may have limited diagnostic value, though further studies are needed.

Level of evidence: 4 Laryngoscope, 2025.

Purpose: Variations in vocal fold bowing, as measured endoscopically with the bowing index (BI), across neurodegenerative diseases remain unexplored, which may inform interventions to minimize morbidity and mortality secondary to voice and airway protective dysfunction. The study's aim was to compare BI between people with Parkinson's disease, progressive supranuclear palsy, and cerebellar ataxia.

Methods: Thirty individuals with Parkinson's disease, 23 with progressive supranuclear palsy, and 24 with cerebellar ataxia were included and underwent flexible laryngoscopy. BI was measured using ImageJ software and a linear regression model was used to compare differences in total BI between groups, controlling for age.

Results: Average total BI was 14.60 (SD = 6.26, range 4.03-28.62) for people with progressive supranuclear palsy, 10.10 (SD = 6.64, range 0-34.13) for Parkinson's disease, and 8.35 (SD = 5.90, range 0-25.95) for cerebellar ataxia. Controlling for age, people with progressive supranuclear palsy demonstrated 4.74 greater BI compared to Parkinson's disease (95 CI: 1.19-8.28; p = 0.001), but there was no significant difference between people with Parkinson's disease and cerebellar ataxia (β = 0.37; 95% CI: -5.02, 5.77; p = 0.891) or people with progressive supranuclear palsy and cerebellar ataxia (β = 5.11; 95% CI: 0.01-10.21; p = 0.050).

Conclusions: The results suggest that BI is significantly greater in people with progressive supranuclear palsy compared to Parkinson's disease. It is important to recognize vocal fold atrophy and its potential impact on voice and airway protective measures in these patients.

Level of evidence: 3 Laryngoscope, 2025.

Amyloidosis localized to the head and neck most commonly affects the laryngo-tracheobronchial tree or tongue. It rarely affects the hypopharynx, with only 3 cases reported in literature. All of these cases describe females presenting with hypopharyngeal amyloid masses and associated multiple myeloma or monoclonal gammopathy of undetermined significance. They were treated with chemotherapy and CO₂ laser, respectively. In comparison, our case identifies a 69-year-old female, with a history of MALT lymphoma but no concurrent malignancy. She initially presented with dysphagia and was diagnosed with hypopharyngeal amyloidosis. After 532 nm potassium titanyl phosphate laser treatment, she ultimately felt improvement in her dysphagia. Laryngoscope, 2025.

Objective: This study aims to investigate the differences in pathogenic bacterial spectra between patients with deep neck infection (DNI) with and without liver cirrhosis (LC). The goal is to identify specific pathogens prevalent in LC-DNI to guide the selection of empiric antibiotics, improving treatment outcomes and prognosis.

Study design: This is a retrospective study.

Methods: The Chang Gung Research Database (CGRD) is a deidentified medical database encompassing seven hospitals within Taiwan's largest medical system. We analyzed data from 2004 to 2018 on DNI patients hospitalized with or without LC, categorizing them into these two groups. This study primarily focused on comparing the bacterial culture results of these groups, alongside an analysis of their treatment modalities (medication alone or surgery) and prognostic outcomes.

Results: From a total of 11,455 DNI patients identified in the CGRD, 76 LC-DNI patients and 11,178 non-LC-DNI patients met the inclusion criteria after exclusions. The LC group had significantly higher rates of surgical debridement (34.2% vs. 19.4%, p = 0.002), ICU admission (22.4% vs. 10.7%, p = 0.004), and mediastinal complications (7.9% vs. 2.1%, p = 0.005). Although the overall mortality rates were not significantly different between the two groups (6.6% vs. 4.6%, p = 0.401), the mediastinitis-related mortality rate was significantly higher in the LC-DNI group (2.6% vs. 0.2%, p = 0.015). Bacterial culture analysis revealed that LC-DNI patients predominantly presented with Klebsiella pneumoniae (KP) as the primary facultative anaerobic pathogen, whereas non-LC-DNI patients were most infected with Viridans streptococcus (VS). For anaerobic bacteria, both groups consistently cultured Peptostreptococcus micros and Prevotella intermedia as the predominant species.

Conclusions: LC-DNI patients are predominantly infected with KP, a Gram-negative bacillus, unlike the Gram-positive cocci, VS, in non-LC-DNI. Anaerobic pathogens were similar in both groups. Empiric antibiotics for LC-DNI should target KP and anaerobes to improve outcomes.

Level of evidence: 3 Laryngoscope, 2025.

Objective: Tympanostomy tube removal is a common procedure, the most common complication of which is persistent perforation. Multiple surgical techniques exist. This study seeks to determine whether the technique used affects success rate or surgical time.

Methods: This was a retrospective cohort study in a tertiary-care children's hospital. Tube removal procedure codes were used to extract charts from 2008 to 2023. Data were collected on surgical technique, success, operative time, indications, and patient factors. Primary outcome measure was surgical success, defined as no residual perforation.

Results: A total of 1562 patient ears were analyzed. Success rate was 95.5% for trichloroacetic acid (TCA) myringoplasty with patch, 86.5% for cold myringoplasty with patch placement (CMwP), 74.7% for cold myringoplasty without patch placement (CMsP), and 73.8% for tube removal alone (TR). TR as compared with CMsP did not show a difference in closure rates (p = 1.0000). CMwP was more likely to be successful than TR (p = 0.0162) or CMsP (p = 0.0117). TCA was more likely to be successful than CMwP (p = 0.0197). Median operative time was 4 min for TR, CMsP, and CMwP and 5 min for TCA. This difference in operative time between the groups was statistically significant (p < 0.001).

Conclusion: TCA myringoplasty with patch shows greater surgical success rate than cold myringoplasty with patch, cold myringoplasty without patch, or tube removal alone, but it has a longer operative time. Cold myringoplasty with patch has greater surgical success than cold myringoplasty without patch or tube removal alone.

Level of evidence: 3 Laryngoscope, 2025.

Objective: Posttransplant lymphoproliferative disorder (PTLD) is a complication of pediatric solid organ transplantation. Benign adenotonsillar lymphoid hyperplasia confounds the ability to diagnose PTLD. Our aim was to identify factors that predict the presence of PTLD to inform decision-making regarding adenotonsillectomy.

Methods: The electronic medical records at a quaternary children's hospital were queried over a 23-year period (2000-2023) for solid organ transplant patients that underwent tonsillectomy and/or adenoidectomy. Demographics, clinical presentation, and EBV serologies were analyzed to determine factors associated with presence of PTLD on final pathology.

Results: A total of 114 patients met inclusion criteria for analysis. Thirty-two of the 114 patients (28.1%) who underwent tonsillectomy and/or adenoidectomy had PTLD. Age at transplant, age at biopsy, sex, race, and type of organ transplanted were not found to be associated with development of PTLD. Patients with PTLD were more likely to have smaller tonsils, sore throat, fever, and tonsillar exudate; they were less likely to experience sleep disordered breathing. The immunosuppression agent used for induction and the number of maintenance immunosuppressive medications were not associated with the development of PTLD. Increased Epstein-Barr Virus (EBV) PCR copy number correlated to increased risk of developing PTLD (p < 0.003).

Conclusion: Tonsillar hypertrophy and sleep disordered breathing are not necessarily indicative of the presence of PTLD. Suspicion for adenotonsillar PTLD should be based on symptomatology, clinical exam, EBV serologies, and degree of EBV PCR positivity. Sore throat, fever, tonsillar exudates, and significant elevation in EBV PCR copy number are particularly concerning for PTLD.

Level of evidence: 3 Laryngoscope, 2025.

Objectives: Ultrasound is a promising low-risk imaging modality that can provide objective airway measurements that may circumvent limitations of drug-induced sleep endoscopy (DISE). This study was devised to identify ultrasound-derived anatomical measurements that could accurately predict collapse pattern and location based on the VOTE criteria (VOTE: Velum, Oropharynx, Tongue, and Epiglottis).

Methods: Ultrasonography was performed on 20 adult patients of various airway subsites while awake and sedated with concurrent endoscopy performed during drug-induced sleep. Measurements were obtained from the ultrasonographic images, and percent collapse (P_c) was estimated then graded using a standard VOTE score. Generalized Least Squares regression (GLS) was used to establish models predictive of P_c on a continuous scale, while multiple machine learning (ML) models were trained to predict each VOTE score (binary, >50% collapse) from ultrasound measurements.

Results: Measurements of multiple ultrasonographic airway subsites demonstrated associations with endoscopic collapse using Kendall Tau correlation. The GLS models showed moderate to strong correlation between multiple ultrasound features and P_c (R² _adj 0.53-0.82) across all VOTE subsites. ML models accurately predicted binarized VOTE scores from ultrasound measurements in four out of five VOTE subsites (F1 score >0.65), while the VOTE subsite with the most accurately predicted collapse was lateral velum collapse with an F1 score of 0.93 averaged across all models.

Conclusions: Ultrasound is a reliable imaging modality and can identify features of airway collapse during drug-induced sleep. Regression (GLS) and ML models show promise in predicting severity of collapse during DISE with analysis of airway ultrasonographic measurements.

Level of evidence: 3 Laryngoscope, 2025.

A 63 year old female patient presented to our office with two chief complaints, (1) severe OSA with CPAP intolerance and (2) cosmetic face and neck concerns regarding facial rhytids, jowls, and neck laxity. She was evaluated for Inspire candidacy and found to be an appropriate candidate. She underwent a combined Inspire hypoglossal nerve stimulator implant and deep plane facelift and necklift surgery to address her sleep apnea and her cosmetic concerns. Through the combined approach, we were able to provide appropriate exposure for the hypoglossal nerve implant and achieve excellent cosmetic results. Techniques utilized that contributed to her superior cosmetic results include gonion augmentation, partial submandibular gland resection, anterior belly of the digastric resection, and extended platysmal myotomy and plication. We demonstrate through this case that deep plane facelift/necklift and Inspire hypoglossal nerve stimulator implant can be performed together safely and with successful sleep and cosmetic outcomes. Laryngoscope, 2025.

Objectives: The study aims to investigate the relationship between the presence of laryngopharyngeal reflux (LPR) and obstruction levels identified during drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) among nonobese patients.

Methods: We conducted a prospective study of 105 adult patients diagnosed with OSA who underwent DISE using propofol sedation from 2019 to 2024 at a tertiary hospital. To control for the confounding impact of obesity on LPR, the study selectively enrolled individuals presenting a body mass index within the normal range. LPR was assessed using Reflux Symptom Index and Reflux Finding Score. DISE was performed to evaluate upper airway obstruction at various levels, documented using the VOTE classification system by three blinded reviewers. Hypertrophy of the lingual and palatine tonsils was graded using a four-point scale.

Results: Approximately 48.57% of 105 patients showed the presence of LPR. The chi-square test demonstrated a statistically significant association between LPR and the level of airway obstruction, particularly at the tongue base (p = 0.039). Lingual tonsil hypertrophy Grade 3 at the tongue base and palatine tonsil hypertrophy Grade 3 at the oropharynx both showed significant overrepresentation, with adjusted residual values of 4.0 and 4.8, respectively. Complete tongue base obstruction showed a statistically significant association with LPR, with a strong predictive value in both univariate (β = 2.325, OR = 10.227, p = 0.007) and multivariate analyses (β = 2.295, OR = 9.921, p = 0.008).

Conclusions: The presence of LPR in nonobese OSA patients appears to be significantly associated with an increased likelihood of tongue base obstruction.

Level of evidence: 3 Laryngoscope, 2025.