Laryngoscope最新文献

Objectives: The relationship between the middle temporal (MTG) and occipital cortices in post-lingually deaf (PLD) individuals is unclear. This study aimed to investigate changes in the MTG and occipital cortices excitability and their effects on the occipital cortex in individuals with PLD after receiving a cochlear implant (CI).

Methods: Twenty-six individuals with severe-to-profound binaural sensorineural PLD were assessed clinically. Nine individuals had received a unilateral cochlear implant over 6 months, while 17 had not. Brodmann area 19 (BA19, extra-striate occipital cortex) and MTG (auditory-related area of cortex) were selected as regions of interest. The excitability of the ROI was observed and compared in the surgery and no-surgery groups by functional near-infrared spectroscopy (fNIRS) in the resting state, and correlations between connectivity of the MTG and occipital cortex, and as well as the duration of time that had elapsed following CI surgery, were investigated.

Results: fNIRS revealed enhanced global cortical connectivity in the BA19 and MTG on the operative side (p < 0.05) and the connectivity between BA19 and the MTG also increased (p < 0.05). The connectivity between the MTG and BA19 was positively correlated with the duration of cochlear implantation, as was the case for BA18.

Conclusion: There was evidence for remodeling of the cerebral cortex: increased excitability was observed in the MTG and BA19, and their connectivity was enhanced, indicating a synergistic effect. Moreover, the MTG may further stimulate the visual cortex by strengthening their connectivity after CI.

Level of evidence: 3 Laryngoscope, 2024.

Objective: To describe postoperative analgesic regimens and patient-reported pain-related outcomes after tonsil surgery.

Methods: Cohort study including perioperative data (n = 9274) and patient-reported outcome measures (n = 5080) registered in the Swedish Quality Register for Tonsil Surgery during 2023.

Results: After tonsil surgery, 92.7% received at least paracetamol and a NSAID/COX inhibitor, while 6.8% received no NSAID/COX inhibitor. Opioids were prescribed after tonsillectomy to 62.9% of adults and less often to adolescents and children (13-17-year-olds: 48.2%, 6-12-year-olds: 8.8%, 0-5-year-olds: 4.0%). Clonidine was frequently prescribed to 0-5-year-olds after tonsillectomy (54.4%). Overall, 11.7% reported dissatisfaction with the pain treatment, with the highest dissatisfaction rate after tonsillectomy in adolescents (20.6%) and adults (20.0%), and the lowest after tonsillotomy in children (4.9-6.8%). The most common complaint among dissatisfied patients was analgesics not being sufficiently helpful. Adult patients who received addition of opioids were less dissatisfied with the pain treatment (15.9% vs. 25.9%, p < 0.001), but also reported more side effects (5.7% vs. 2.7%, p = 0.039), compared with patients who received only paracetamol and NSAID/COX inhibitors.

Conclusion: Tonsil surgery patients in Sweden receive various analgesic regimens. Although most are satisfied with pain treatment, there is room for improvement, particularly among adolescents and adults undergoing tonsillectomy. Paracetamol and a NSAID/COX inhibitor seem advisable as basic treatment. However, many patients need more effective treatment. The addition of opioids in adults results in greater satisfaction with pain treatment, but safety issues with opioid prescriptions must be taken into consideration.

Levels of evidence: Level 4 Laryngoscope, 2024.

Background: Transoral robotic surgery (TORS) lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) are effective surgical interventions for well-selected patients with obstructive sleep apnea (OSA) intolerant to continuous positive airway pressure (CPAP) therapy. Previous publications have demonstrated that HGNS patients have a lower postoperative apnea-hypopnea index (AHI) and length of hospital stay than TORS patients. No prior study has investigated the differences in costs between HGNS and TORS.

Objectives: This study aims to compare surgery-related costs in patients undergoing HGNS versus TORS lingual tonsillectomy for OSA intolerant to CPAP.

Methods: A retrospective study on OSA patients intolerant to CPAP that underwent HGNS or TORS from 2015 to 2022 at a tertiary care center. Cost was defined as the dollar amount associated with providing a specific service prior to the application of insurance.

Results: This study included 395 patients (375 UAS and 20 TORS). Average total cost was significantly higher in the UAS group than the TORS group (UAS: $25,582.60; TORS: $5832.60; p < 0.001). Operating room costs were also significantly higher in the UAS group (UAS: $1978.20; TORS: $1490.90; p = 0.001). The TORS cohort averaged higher costs for pharmacy (UAS: $201.30; TORS: $416.60; p < 0.001) and anesthesia (UAS: $139.00; TORS: $307.60; p < 0.001).

Discussion: The total cost was significantly higher in the UAS group compared to the TORS group. When making management decisions, it is important to consider the cost of care provided as well as patient-centered outcomes to optimize the value of care.

Level of evidence: N/A Laryngoscope, 2024.

Background: Empty nose syndrome (ENS) is a poorly understood, debilitating condition affecting a minority of patients who underwent nasal airway surgery, most commonly following inferior turbinate surgery. Few publications have demonstrated middle turbinate resection (MTR) causing ENS, but MTR is still considered a potential cause of ENS. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) is validated for ENS diagnosis, with ENS6Q ≥ 11 considered highly suggestive of ENS. The purpose of this multicenter study was to determine the incidence of patients with ENS6Q ≥ 11 following subtotal MTR during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) by comparing preoperative and postoperative ENS6Q scores.

Methods: A multi-institutional prospective cohort study (8 US institutions) was conducted on patients who underwent bilateral subtotal MTR during ESS for CRSwNP. Preoperative and postoperative ENS6Q scores were compared after at least 12 months of postoperative follow-up.

Results: Of 110 patients, mean age was 51.6 years and 59.1% were male. Mean follow-up was 14.5 ± 2.5 months (range 12.1-22.3 months). Mean preoperative and postoperative ENS6Q were 7.7 and 2.2, respectively, demonstrating a mean 5.5 point decrease postoperatively (p < 0.0001). At final follow-up, no patient had an ENS6Q ≥ 11. Of note, 20% of patients had preoperative ENS6Q scores ≥11, but all decreased to <11 postoperatively.

Conclusions: Based on prospective multicenter data over 1-2 years postoperatively, subtotal MTR for CRSwNP never led to ENS6Q scores ≥11, and patients experienced significant decreases in ENS6Q postoperatively. Subtotal MTR during ESS for CRSwNP was, therefore, unlikely to cause ENS even with long-term follow-up.

Level of evidence: 4 Laryngoscope, 2024.

Objective: Little is known about age-related variations in sites and grade of sleep-dependent airway obstruction in children with obstructive sleep apnea (OSA) or obstructive sleep-disordered breathing (oSDB). The objective was to compare sites and grade of obstruction on drug-induced sleep endoscopy (DISE) across different age groups of surgically naïve children with OSA or oSDB.

Methods: A retrospective chart review was performed for surgically naïve children aged 0-18 years with OSA/oSDB who underwent DISE from July 2021 to August 2023. Participants were categorized into: infants (aged 0-1 years), younger toddlers (aged 1-2 years), older toddlers (aged 2-3 years), preschool (aged 3-5 years), younger school-aged (aged 5-10 years), and older school-aged (aged 10-18 years). On DISE, obstruction was rated 0 = none/mild, 1 = moderate, 2 = severe for inferior turbinates, adenoid, velum, palatine tonsils/lateral pharyngeal wall, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. A series of multiple regression analyses were used to identify age differences in the grade of obstruction across all sites combined and at each individual site separately.

Results: The sample consisted of 252 children aged 1 month to 17 years with 57.9% males. Older patients had greater total obstruction scores (B = 0.42, SE = 0.10, p < 0.01) and greater number of sites that were severely obstructed (B = 0.11, SE = 0.05, p = 0.03). Older age groups had more obstruction at inferior turbinates (p = 0.02), adenoid (p < 0.01), palatine tonsils/lateral pharyngeal wall (p < 0.01), lingual tonsil (p < 0.01), and base of tongue (p < 0.01). Younger age groups had more obstruction at the supra-arytenoid tissue (p < 0.01).

Conclusion: Varying patterns of sleep-dependent airway obstruction should be expected across different age groups in children with OSA or oSDB.

Level of evidence: 3 Laryngoscope, 2024.

Background/objectives: Head and neck radiation therapy (HNRT) has traditionally been considered a contraindication to vocal fold medialization procedures. Although safety has been demonstrated, we hypothesize that actual management varies. This study evaluates practice patterns of otolaryngologists regarding vocal fold medialization in patients after HNRT.

Methods: A 25-question survey evaluating respondents' management of patients status post HNRT with vocal fold paresis/paralysis was distributed to 357 otolaryngologists. Practice patterns regarding injection laryngoplasty (IL), medialization thyroplasty (MT), and arytenoid adduction (AA) were queried.

Results: Eight-two clinicians (23%) completed the survey. Ninety-one percent of respondents were laryngologists, 9% head and neck surgeons, 3% comprehensive otolaryngologists, and 3% "other." Eleven (15%) had been in practice <5 years, 19 (25%) for 5-10 years, and 46 (61%) for >10 years. No respondents considered HNRT a contraindication to IL, and 11 (14%) reported complications from the procedure. Hyaluronic acid (58, 75%) was most commonly injected. Twenty percent considered HNRT a contraindication to MT, and 37% considered it a contraindication to AA. Gore-Tex was used most commonly (65%). Twenty-seven percent reported major complications after MT. All complications occurred in the >10-year practice group, and this group was more likely to delay surgery after HNRT (p = 0.022). Respondents with complications were more likely to perform MT in HNRT patients (p = 0.0191).

Conclusions: Otolaryngologists generally do not consider HNRT to be a contraindication to IL, but some consider it a contraindication to MT/AA. Previous complications do not appear to deter surgeons from performing MT.

Level of evidence: N/A (Survey Study) Laryngoscope, 2024.

Background: Pre-vascular facial nodes (PV-FNs; perifacial lymph nodes) are supra-mandibular lymph nodes above the inferior border of the mandible. These are not part of routine neck dissection done for OCSCC. These lymph nodes can be sentinel station for metastatic lymph nodes from gingivobuccal complex cancers and are missed during routine neck dissection. It is imperative to include this sentinel station in routine neck dissection to prevent nodal recurrences.

Materials and methods: One hundred thirty-seven patients with GBCC (T1-T4) were prospectively recruited between May 2020 and June 2022 with the intent to evaluate the incidence of PV-FN metastases and clinicopathological factors predicting them.

Results: PV-FN metastases were seen in 26 patients (18.9%; 26/137). The occult metastasis rate was 8.7% (12/137). On multivariate analysis, pathological T4 stage (pT4), LVE positivity, and intermediate-high BGS were statistically significant predictors of PV-FN metastases in our study.

Conclusions: Incidence of PV-FN metastasis is high (18.9%) in GBCC, which can be potentially the first sentinel station in the lymphatic drainage pattern for this sub-site. Meticulous clearance of this nodal basin is of paramount importance during neck dissection to prevent nodal recurrences.

Level of evidence: Level 2 (CEBM-Level of Evidence-2.1) Laryngoscope, 2024.

Objectives: Percutaneous tracheostomy is rarely performed in children, especially in infants. In the present study, we aimed to evaluate the complications and outcomes of PT via the Griggs technique according to the age and size of pediatric patients.

Methods: This study included 110 PICU patients who underwent PT using the Griggs technique between 2012 and 2020. The patients were divided into six groups according to their age, demographic data, primary disease, mean duration of intubation before PT, mean duration of PICU and hospitalization after PT, complications, and decannulation outcomes were compared between these groups.

Results: The mean age and mean weight of the patients were 43.6 ± 58.9 months (1 month-207 months) and 14.6 ± 14.9 kg (2.6-65 kg), respectively. Mean intubation times before the procedures were 64.6 ± 40 days and 38.6 ± 37.9. Thirty-seven (33.6%) infants were under 6 months of age(Group 1). There were no intraoperative complications. Tracheostomy site stenosis was significantly greater in Group 1 than in the other age groups (p = 0.032). Granuloma formation and dermatitis incidence were similar in all age groups.

Conclusion: PT is a safe and feasible procedure even in small infants. The accidental decannulation risk is lower than standard tracheostomy. Interacting with rigid bronchoscopy guidance is essential to perform a safer procedure. The first tracheostomy change after PT in small infants under 6 months of age, the possibility of tracheostomy site (stoma) stenosis should be considered.

Level of evidence: Level III Laryngoscope, 2024.

Objective: Superior laryngeal nerve (SLN) function is critical to laryngeal sensation. Sensory dysfunction in the larynx, mediated through the internal branch of the superior laryngeal nerve (iSLN), is thought to occur with aging and neurodegenerative disease. However, objective analysis of iSLN neurophysiology is difficult due to its anatomic location and small diameter. This study measures sensory nerve action potentials (SNAP) from the iSLN in a rat model.

Methods: SNAP data were obtained from two adult rat strains (Sprague-Dawley, SD and Fischer 344 × Brown Norway F1 Hybrid rats, FBN). Evoked responses were obtained by stimulating the main trunk of the SLN and recording the response using a 160-μm cuff electrode placed around the iSLN. SNAP were averaged from 10 stimulations. Laryngeal adductor reflex (LAR) threshold measurements were obtained with stimulation of the iSLN and direct laryngoscopy. The sections of the iSLN were obtained for histologic analysis.

Results: SLN-evoked responses were successfully obtained in 18 hemi-laryngeal preparations (SD n = 13 and FBN n = 5) with corresponding LAR threshold measurements. Mean(±SD) SNAP latency, total duration, amplitude, negative durations, and intensity were 2.28 ms (±0.56), 2.13 ms (±0.70), 879 μV (±535), and 0.69 mA (±0.25), respectively. SLN stimulation threshold to elicit an LAR was of 0.84 mA (±0.31).

Conclusion: It is feasible to record evoked SLN responses in two adult rat strains. This work may lead to a tractable animal model for objective measurements of SLN neurophysiology with various disease states.

Level of evidence: N/A Laryngoscope, 2024.

Objectives: Posterior glottic diastasis (PGD) is an underappreciated etiology of dysphonia in patients with prior airway reconstruction or prolonged intubation. In endoscopic posterior cricoid reduction (ePCR), cricoid is removed to minimize the posterior glottic gap. Dynamic voice computed tomography (DVCT) permits visualization of the posterior glottis, estimating the amount of cricoid to be removed. Posterior glottic gaps in patients undergoing ePCR were compared to non-dysphonic patients to describe pediatric PGD and establish surgical parameters for ePCR.

Methods: DVCTs performed in non-dysphonic patients and dysphonic patients undergoing ePCR from 2014 to 2023 were reviewed. EPCR operative reports were queried. Pre- and postoperative Pediatric Voice Handicap Index (pVHI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and aerodynamic measures were reviewed.

Results: Seventeen pediatric patients who underwent ePCR and 19 non-dysphonic patients were included. Posterior glottic gaps were significantly larger in the dysphonic group (median 2.4 mm [IQR: 2.0, 2.8] vs. 1.3 mm [IQR: 1.1, 1.7], p < 0.001). Mean width of the cricoid removed was 1.6 mm (SD 0.4 mm). Mean (SD) pre- and postoperative pVHI scores were 55.5 (19.9) and 34.6 (16.0; p < 0.001). Mean (SD) pre- and postoperative CAPE-V scores were 52.7 (15.4) and 36.5 (20.4; p < 0.001), respectively.

Conclusions: Children in this cohort tolerated an average 1.3 mm posterior glottic gap without dysphonia. Dysphonic patients with PGD had a median 2.4 mm gap and underwent cricoid reduction by 1.6 mm. All ePCR patients demonstrated improvement in dysphonia. Results seek to optimize the management of pediatric PGD and present a safe and effective amount of cricoid to remove during ePCR.

Level of evidence: 4 Laryngoscope, 2024.