Laryngoscope最新文献

Background: Management of mandibular osteoradionecrosis (ORN) is challenging and often requires large surgical resection. Alternatively, mandibular preservation and wrapping with a periosteal free flap may achieve healing in selected patients. Our objective was to assess the success rate and morbidity of revascularization of mandibular ORN using a humeral periosteal free flap.

Methods: A retrospective study was performed using medical records of patients who had undergone humeral periosteal free flap reconstruction for mandibular ORN. Clinical data, including age, gender, ORN site, ORN grade according to the Notani classification, clinical and radiological outcomes and complications were analyzed. The primary endpoint was ORN healing, defined as complete resolution of the main symptom (exposure, chronic infection, fistula, or fracture) at 6 months postoperatively.

Results: A total of 36 lesions in 34 patients with mandibular ORN associated with bone exposure and/or infection and/or pathologic fracture were included. ORN healing at 6 months was achieved in 64.7% (n = 22/34) of treated sites in the overall cohort and in 91.6% (n = 22/24) of patients with a viable flap.

Conclusion: The humeral periosteal free flap can be considered a reasonable surgical option for advanced mandibular ORN to avoid segmental mandibulectomy.

Level of evidence: 4:

Objectives: Abnormal nasal mucosal function has been frequently implicated in the symptomatology of empty nose syndrome (ENS), yet with limited evidence. This prospective pilot study aims to compare nasal mucosal sensitivity to air-jet stimuli between ENS patients and patients who underwent septoplasty/turbinate reduction (septo-turb) surgery, but without ENS symptoms.

Methods: Seven ENS and seven septo-turb subjects were recruited through a sample of convenience (from 06/2023 to 09/2024) due to the rarity of ENS. A precise, 0.25 s air jet ranging from 0.5 to 5 L/min was delivered via a 25-gage microcannula, with a 0.4 × 1.6 mm side opening placed 2 mm from the mucosal surface at predetermined sites that include the medial and lateral side of the nasal valve, the head and the center of inferior turbinate and their opposing septum. Detection thresholds were determined using a single-staircase method in 0.5 L/min steps.

Results: The ENS group had a significantly higher (less sensitive) threshold than the septo-turb group for the septum opposing the center of the inferior turbinate (ENS: 2.43 ± 1.37 L/min; septoplasty: 1.39 ± 1.27 L/min, p = 0.016); however, not for other sites. This regional threshold significantly correlated with all self-reported symptom scores (NOSE, SNOT-22, ENS6Q, VAS) (r = 0.45-0.54, all p < 0.05).

Conclusion: Significant regional differences in air-jet stimulus sensitivity between ENS and septoplasty patients were found that significantly correlated with symptom scores. A future larger sample size would make a more definitive conclusion.

Level of evidence: 3:

The expanded endonasal approach (EEA) to resect skull base lesions has classically included the resection of one or both middle turbinates (MT). Here, we describe for the first time a technique that spares the MT entitled middle turbinate release with preservation (MTRP) that can give an alternative and feasible approach to skull base surgeons that wish to maintain this endonasal landmark.

Objective: To determine the prevalence and characteristics of objectively confirmed laryngopharyngeal reflux (LPR) in patients with laryngeal contact granuloma (LCG) using 24-h hypopharyngeal-esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring, and to compare patient and disease features by reflux status.

Methods: This retrospective study included patients diagnosed with LCG who underwent 24-h HEMII-pH monitoring. Reflux episodes were classified by acidity (acid, weakly acidic, weakly alkaline) and posture (upright, recumbent). Clinical characteristics, reflux episode profiles, lesion laterality, and Reflux Symptom Index (RSI) scores were compared between reflux-positive and reflux-negative patients.

Results: Among 41 patients, 25 (61.0%) were reflux-positive and 16 (39.0%) were reflux-negative, with no hypopharyngeal reflux event detected. The pH-based classification of reflux events identified a predominance of weakly acidic (46.2%) and weakly alkaline (44.3%) episodes; acidic events were uncommon (9.5%). Most reflux events occurred during upright periods (94.8%), with only 5.2% during recumbent position. Among unilateral lesions, a higher proportion of hypopharyngeal reflux-positive cases involved the left side (76.2% left, 23.8% right), while reflux-negative cases showed no lateral preference (60.0% left, 40.0% right). Symptom screening with the RSI had limited discrimination for hypopharyngeal reflux status (sensitivity 50.0%, specificity 46.7%, PPV 60.0%, NPV 36.8%).

Conclusion: Our findings highlight the limitations of symptom-based diagnosis and empiric acid suppression in patients with LCG. Pre-treatment 24-h HEMII-pH monitoring can provide a more evidence-based initial approach than routine empiric therapy and supports individualized behavioral interventions.

Level of evidence: 4:

Objectives: To investigate the effect of interview format on the post-interview assessment of otolaryngology residency applicants.

Methods: A sample of 30 otolaryngology residency programs were asked to submit applicant ratings following the residency interview process during the 2024 application cycle. Home applicants and away rotators were removed from the analysis to better assess each applicant's interview performance. Program ratings were standardized, and applicant assessments were compared across interview formats. Applicants were surveyed for their self-assessment of performance and perceived impressions left on a program across interview formats. Survey results and demographic characteristics were analyzed relative to program assessments in both virtual and in-person interview formats.

Results: Of the 29 programs included in final review, 15 (52%) provided data from in-person interviews alone compared to virtual only data from 14 (48%) programs. There were a total of 1065 observations for 367 unique applicants. Interview format did not demonstrate a significant impact on applicant ratings; nor did applicant type (MD, DO, IMG), gender, or URiM status. Applicants who believed they performed well during either virtual or in-person interview settings were rated more highly by programs following residency interviews. Applicants perceived they left a better impression on programs following in-person interviews.

Conclusion: Program ratings of applicants did not appear to be impacted by interview format. Interview format did not appear to favor any demographic groups within the otolaryngology applicant pool. Applicants' perceptions of their performance in both virtual and in-person interview formats align with program post-interview ratings.

Level of evidence: N/A.

Objective: Various components of speech, such as pitch, volume, and resonance, influence gender perception, but little is known about gender differences in non-speech upper airway sounds such as cough. This gap has implications for gender-affirming voice care, as coughs are harder to modulate. We aimed to explore how cough acoustics differ by gender using a transformer model with self-attention to identify salient cough features for gender classification.

Methods: We analyzed 327 cough recordings (154 male, 173 female) from the Coswara dataset, using a 70/15/15 split for model training, validation, and testing. Preprocessing included resampling, silence removal, normalization, and trimming to uniform length. The HuBERT transformer model was used for its ability to handle unstructured audio. Gender balance was verified through SMD (standardized mean difference) screening across seven variables, all of which showed negligible imbalance.

Results: On the held-out test set, the model achieved an accuracy of 84.0% with an F1 score of 0.8462 when classifying gender from cough series, compared to 71.4% accuracy and an F1 score of 0.7308 when using single-cough/first-cough samples. Attention-aligned cough visualization revealed the highest attention on the explosive phases of the cough, suggesting that these segments encapsulate the most salient gender-distinct acoustic cues.

Conclusion: Cough sounds contain gender-discriminative features detectable by transformer models. Attention to specific cough phases reveals physiologically meaningful segments in cough sounds supporting gender classification. These insights may inform gender-affirming interventions, particularly for non-speech sound production. Future research should explore further socio-demographic factors shaping cough acoustics.

Level of evidence: 4:

Objectives: To identify the prevalence and polysomnography (PSG) features of obstructive sleep apnea (OSA) in subcategories of children with obesity.

Methods: Children with obstructive sleep-disordered breathing evaluated in pediatric otolaryngology clinic and referred for PSG between January 2023 and December 2023 were included. Children with a history of tonsillectomy and/or adenoidectomy were excluded. Collected data included demographics, comorbidities, PSG parameters, and BMI categories including underweight, healthy weight, overweight, and obesity (Class I, II, and III). The prevalence of OSA and PSG parameters were compared using the χ² test, logistic regression, multivariate analysis of variance, and linear regression models. p < 0.05 was considered significant.

Results: Out of 604 children (342 male, 262 female, age range: 2-18), 488 (81%) had OSA. Most children were healthy weight (46%) or had obesity (38%). Prevalence of OSA was significantly different across BMI categories (p < 0.001), with highest odds of OSA in children with Class III Obesity (OR = 5.01, 95% CI [1.77, 21.04], p = 0.008). Compared to patients with healthy weight and no OSA, patients with Class II (OR = 2.67, 95% CI [1.16, 6.16], p = 0.02) and Class III Obesity (OR = 8.31, 95% CI [2.40, 28.81], p < 0.001) were more likely to have severe OSA (apnea-hypopnea index > 10). PSG parameters including obstructive apnea-hypopnea index, minimum SpO₂, and mean CO₂ differed among BMI categories (p < 0.001, p < 0.001, p = 0.003, respectively).

Conclusion: The prevalence of OSA varies among weight groups. The severity of obesity is associated with increased odds of OSA and OSA severity. Obesity has a significant effect on minimum SpO₂ saturation and mean CO₂ levels. The utility of these findings in decision-making for PSG referral and surgical planning merits further investigation.

Level of evidence: 4:

Artificial intelligence (AI) tools to facilitate residency application review are available to all residency programs using the Electronic Residency Application System (ERAS) through the Thalamus Cortex system. Responsible use of this technology requires rigorous quality control in the high-stakes process of residency selection. This article documents persistent errors in the Thalamus Cortex system with potential to negatively impact residency applicants and programs.