Laryngoscope最新文献

Objectives/hypothesis: To evaluate costs associated with perioperative gastrostomy tube (G-tube) placement for neonates with Robin sequence (PRS) that undergo mandibular distraction osteogenesis (MDO).

Methods: Retrospective chart review was performed to examine the medical records of neonates with RS who received treatment at our institution between 2012 and 2021. Patients under 6 months of age that underwent MDO for RS were included. Billing records of hospital costs over a 2-year period were analyzed.

Results: The study included 26 total patients with 11 in the MDO-only group, 9 in G-tube after MDO group, and 6 in G-tube before MDO group. There was a significant difference (p < 0.001) in total hospital costs between groups with MDO-only group averaging $119,532 (SD $\pm$ 33,503), the G-tube after MDO group averaging $245,315 (SD $\pm$ 102,327), and G-tube before MDO group averaging $252,300 (SD $\pm$ 84,990). Multiple linear regression was performed controlling for genetic syndrome and birth weight, which still showed a statistically significant difference in total cost between the MDO-only group and G-tube after MDO (p = 0.006), and between the MDO-only group and G-tube prior to MDO (p = 0.01). There was a significant difference in costs between all three groups for total inpatient/outpatient costs with MDO-only group averaging $78,502 (SD $\pm$ 30,953), the G-tube after MDO group averaging $176,125 (SD $\pm$ 84,315), and the G-tube prior to MDO group averaging $156,309 (SD $\pm$ 95,746).

Conclusions: MDO performed without perioperative G-tube placement may reduce charges by >$100,000. The associated improvement of dysphagia after MDO surgery and potential for avoiding a G-tube has tremendous downstream cost and social benefits for families.

Level of evidence: NA Laryngoscope, 2024.

Background/objectives: The Singing Voice Handicap Index-10 (SVHI-10) is a validated patient-reported outcome measure (PROM) that assesses patients' perception of handicap related to singing voice. A normative value has been established with a score ≥20 being abnormal. However, there is no defined minimal clinically important difference (MCID). This study prospectively determines the MCID of SVHI-10 among a diverse group of singers.

Methods: 103 adult singers with and without voice complaints completed SVHI-10 twice, 30 days apart. MCID for the SVHI-10 was determined using distribution-based receiver-operating characteristic (ROC) curve analysis.

Results: Twenty-two men (1 transgender), 75 women (1 transgender), and 6 nonbinary individuals participated. The most frequently reported singing genres were classical (44.7%), musical theater (17.5%), and pop (10.7%). Mean initial SVHI-10 score was 13.05 (standard deviation 7.397), and mean follow-up SVHI-10 was 13.13 (7.994). There was a significant positive correlation between initial and follow-up SVHI-10 scores (r = 0.879, p < 0.001). SVHI-10 scores were significantly higher among participants who reported voice changes in the past year (p < 0.001) or sought voice treatment (p = 0.001) compared with participants who did not. SVHI-10 scores varied significantly based on singing type. The area under the ROC curve for SVHI-10 was 0.700 (p = 0.003). The SVHI-10 MCID was determined to be 9.5.

Conclusions: An SVHI-10 score change ≥10 should be considered clinically meaningful. This definition has been missing from the literature and will improve understanding of patients' responses to treatment, which will help advance clinical care and track research outcomes.

Level of evidence: 4 Laryngoscope, 2024.

Objectives: Here we describe the development and pilot testing of the first artificial intelligence (AI) software "copilot" to help train novices to competently perform flexible fiberoptic laryngoscopy (FFL) on a mannikin and improve their uptake of FFL skills.

Methods: Supervised machine learning was used to develop an image classifier model, dubbed the "anatomical region classifier," responsible for predicting the location of camera in the upper aerodigestive tract and an object detection model, dubbed the "anatomical structure detector," responsible for locating and identifying key anatomical structures in images. Training data were collected by performing FFL on an AirSim Combo Bronchi X mannikin (United Kingdom, TruCorp Ltd) using an Ambu aScope 4 RhinoLaryngo Slim connected to an Ambu® aView™ 2 Advance Displaying Unit (Ballerup, Ambu A/S). Medical students were prospectively recruited to try the FFL copilot and rate its ease of use and self-rate their skills with and without the copilot.

Results: This model classified anatomical regions with an overall accuracy of 91.9% on the validation set and 80.1% on the test set. The model detected anatomical structures with overall mean average precision of 0.642. Through various optimizations, we were able to run the AI copilot at approximately 28 frames per second (FPS), which is imperceptible from real time and nearly matches the video frame rate of 30 FPS. Sixty-four novice medical students were recruited for feedback on the copilot. Although 90.9% strongly agreed/agreed that the AI copilot was easy to use, their self-rating of FFL skills following use of the copilot were overall equivocal to their self-rating without the copilot.

Conclusions: The AI copilot tracked successful capture of diagnosable views of key anatomical structures effectively guiding users through FFL to ensure all anatomical structures are sufficiently captured. This tool has the potential to assist novices in efficiently gaining competence in FFL.

Level of evidence: NA Laryngoscope, 2024.

Objective: The aim of this study was to investigate the risks of lingual tonsillectomy (LT) in a large cohort and compare these risks to those of palatine tonsillectomy (PT).

Methods: A retrospective cohort study was conducted using data from the United States collaborative network within TriNetX. The LT group was defined using Current Procedural Terminology (CPT) code 42870 and PT group using CPT codes 42820, 42821, 42825, or 42826. Groups were further subdivided into pediatric and adult populations and matched based on propensity scores within the cohorts. Complications occurring within 14 days of procedure were compared within each cohort.

Results: There were 1,357 adult patients (mean age, 42.9 years) and 863 pediatric patients (mean age, 8.1 years). Adults who had LT were more likely to experience postoperative dysphagia (OR = 2.6, p < 0.001) and require admission to the hospital (OR = 4.3, p < 0.001) or intensive care unit (OR = 6.1, p < 0.001). There was no significant difference in bleeding between adult PT and LT groups, occurring at rates of 3.8% and 4.4%, respectively (p = 0.50). Pediatric patients who had LT were also more likely to experience postoperative dysphagia (OR = 2.4, p = 0.017) and require admission to the hospital (OR = 8.2, p < 0.001) or intensive care unit (OR = 2.7, p = 0.012). The postoperative bleed rate was 3.2% in the pediatric PT cohort, which was 2.4 times higher compared to those who underwent LT (1.5%, p = 0.016).

Conclusion: Postoperative complications after lingual tonsillectomy are more common than after palatine tonsillectomy in both adults and children.

Level of evidence: III Laryngoscope, 2024.

Background: Laryngeal dystonia (LD) is an isolated focal dystonia characterized by involuntary spasms in laryngeal muscles selectively impairing speech production. Anecdotal observations reported the worsening of LD symptoms in stressful or vocally demanding situations.

Objectives: To examine the impact of surrounding audio-visual complexity on LD symptomatology for a better understanding of disorder phenomenology.

Methods: We developed well-controlled virtual reality (VR) environments of real-life interpersonal communications to investigate how different levels of audio-visual complexity may impact LD symptoms. The VR experiments were conducted over five consecutive days, during which each patient experienced 10 h of 4100 experimental trials in VR with gradually increasing audio-visual complexity. Daily reports were collected about patients' voice changes, as well as their comfort, engagement, concentration, and drowsiness from using VR technology.

Results: After a weekly VR exposure, 82% of patients reported changes in their voice symptoms related to changes in background audio-visual complexity. Significant differences in voice symptoms were found between the first two levels of the audio-visual challenge complexity independent of study sessions or VR environments.

Conclusion: This study demonstrated that LD symptoms are impacted by audio-visual background across various virtual realistic settings. These findings should be taken into consideration when planning behavioral experiments or evaluating the outcomes of clinical trials in these patients. Moreover, these data show that VR presents a reliable and useful technology for providing real-life assessments of the impact of various experimental settings, such as during the testing of novel therapeutic interventions in these patients.

Level of evidence: Level 3 Laryngoscope, 2024.

Objectives: To assess the efficacy of intralesional steroid treatment in preventing vocal fold scarring following vocal fold surgery using a rabbit model.

Methods: The research involved 42 male New Zealand white rabbits. Fourteen rabbits underwent vocal fold scar surgery using a 532nm laser and served as controls (control group). The remaining rabbits were divided into two groups of 14: one group received vocal fold scar surgery followed by dexamethasone injection (Dexa group) and the other received the same surgery followed by triamcinolone injection (Triam group). Four weeks after surgery, histological examinations and high-speed video analyses of vocal fold vibration were conducted. The maximum amplitude of vibration was the primary measure for assessing vocal fold function. In addition, real-time polymerase chain reaction (PCR) studies were undertaken to analyze scar regeneration and remodeling.

Results: The maximum amplitude differences were notably higher in the Dexa and Triam groups than in controls. Histologically, the collagen density (CD) ratios in both the Dexa and Triam groups were significantly reduced compared with controls. Real-time PCR analysis indicated marked elevations of Has-2 and Mmp-9 in the Dexa and Triam groups relative to controls.

Conclusions: Intralesional steroid injections after vocal fold surgery are effective for reducing vocal fold scarring in a rabbit model.

Level of evidence: NA Laryngoscope, 2024.

Objective: The human temporal bone comprises more than 30 identifiable anatomical components. With the demand for precise image interpretation in this complex region, the utilization of artificial intelligence (AI) applications is steadily increasing. This systematic review aims to highlight the current role of AI in temporal bone imaging.

Data sources: A Systematic Review of English Publications searching MEDLINE (PubMed), COCHRANE Library, and EMBASE.

Review methods: The search algorithm employed consisted of key items such as 'artificial intelligence,' 'machine learning,' 'deep learning,' 'neural network,' 'temporal bone,' and 'vestibular schwannoma.' Additionally, manual retrieval was conducted to capture any studies potentially missed in our initial search. All abstracts and full texts were screened based on our inclusion and exclusion criteria.

Results: A total of 72 studies were included. 95.8% were retrospective and 88.9% were based on internal databases. Approximately two-thirds involved an AI-to-human comparison. Computed tomography (CT) was the imaging modality in 54.2% of the studies, with vestibular schwannoma (VS) being the most frequent study item (37.5%). Fifty-eight out of 72 articles employed neural networks, with 72.2% using various types of convolutional neural network models. Quality assessment of the included publications yielded a mean score of 13.6 ± 2.5 on a 20-point scale based on the CONSORT-AI extension.

Conclusion: Current research data highlight AI's potential in enhancing diagnostic accuracy with faster results and decreased performance errors compared to those of clinicians, thus improving patient care. However, the shortcomings of the existing research, often marked by heterogeneity and variable quality, underscore the need for more standardized methodological approaches to ensure the consistency and reliability of future data.

Level of evidence: NA Laryngoscope, 2024.

Self-diagnosis of retrograde cricopharyngeus dysfunction (RCPD) or abelchia has been increasing over the past 5 years with patients seeking treatment for lifelong symptoms of inability to burp, neck gurgling, bloating, and flatulence. There is a distinct paucity of objective data in diagnosis and underlying pathophysiology of this disorder.

Objective: The purpose of this study was to prospectively evaluate patients with abelchia using standardized investigations to explore possible underlying mechanisms.

Methods: Patients presenting with clinical scenario consistent with RCPD were recruited into the study after informed consent. All patients underwent standardized investigations: Self reporting questionnaires EAT-10, VHI-10, and RSI scores, as well as esophagogastroscopy, barium swallow, and high-resolution esophageal manometry (HRM), were performed.

Results: RCPD patients demonstrated a minor increase in the mean EAT-10 (5.2 ± 1.2) and normal RSI/VHI-10 scores. Barium swallow revealed 53% (CI 38%-64%) were abnormal with reflux with hiatus hernia (37%) and dysmotility (16%) as most common findings. HRM showed that 67% (CI 54%-78%) were abnormal. Ineffective motility was found in 41%, a further 23% showed a complete absence of peristalsis, whereas 33% were normal.

Conclusions: RCPD is a clinical condition of lifelong inability to belch and associated symptoms. The underlying pathophysiology is poorly understood. This study demonstrates that a significant number of RCPD patients have abnormal esophageal neural network with high proportion of abnormal or absent esophageal peristalsis.

Level of evidence: 3 Laryngoscope, 2024.

Objective: Analyze joint effects of race and social determinants on survival outcomes for patients undergoing total laryngectomy for advanced or recurrent laryngeal cancer at a tertiary care institute.

Methods: Retrospective chart review of adult patients undergoing total laryngectomy for laryngeal cancer at a tertiary care center from 2013 to 2020. Extracted data included demographics, pathological staging and features, treatment modalities, and outcomes such as recurrence, fistula formation, and 2- and 5-year disease-free survival (DFS) and overall survival (OS). Area Deprivation Index (ADI) was calculated for each patient.

Results: Among 185 patients identified, 113 were Black (61.1%) and 69 were White (37.3%). No significant differences were observed between racial groups regarding age, gender, ADI, or cancer stage. There was no significant difference in 2-year DFS/OS between groups. ADI was comparable between racial groups, with the majority in the highest deprivation quintile (63.8% of Whites vs. 62.5% of Blacks). No significant differences were observed in gender, race, cancer stage, positive margins, extracapsular extension, or smoking status among ADI quintiles. We observed a significant difference in 2-year DFS stratified by ADI (p = 0.025). Stratifying by ADI and race revealed improved survival of White patients in lower quintiles but higher survival of Black patients in the highest disparity quintile (p = 0.013).

Conclusion: Overall, survival outcomes by race were comparable among laryngectomy patients, but there was a significant difference in 2-year DFS when stratified by ADI. Further research into survival outcomes related to social determinants is needed to better delineate their effects on head and neck cancer outcomes.

Level of evidence: 3 Laryngoscope, 2024.