Laryngoscope最新文献

Objectives: To determine if tinnitus is associated with glymphatic system dysfunction and cognitive decline and whether repetitive transcranial magnetic stimulation (rTMS) treatment associates with an improvement in glymphatic function.

Methods: We compared glymphatic function in tinnitus patients and healthy controls (HCs) using multimodal MRI indices. Multimodal MRI analyses of choroid plexus volume (CPV), enlarged perivascular space (EPVS), diffusion tensor image analysis along the perivascular space (DTI-ALPS) index, and free water (FW). Tinnitus patients received repetitive transcranial magnetic stimulation (rTMS) and the changes in their tinnitus handicap questionnaire (THQ) scores were then correlated with changes in glymphatic function.

Results: Tinnitus patients exhibited reduced DTI-ALPS indices (median, 1.51 vs. 1.55, p = 0.008, effect size = 0.242) and increased CPV (median, 2.39 vs. 2.10, p = 0.026, effect size = -0.203) compared to HCs. Elevated CPV was correlated with impaired executive function (TMT-B: r = 0.197, p = 0.033), while the reduction of the ALPS index was correlated with increased tinnitus severity (THQ: r = -0.340, p = 0.010). ROC analysis showed DTI-ALPS-mean optimally discriminated tinnitus patients from HCs (AUC = 0.896). Treatment of tinnitus patients with rTMS showed a significant decrease in FW values (median, 0.30 vs. 0.29, p = 0.007, effect size = 0.631) and a significant increase in the ALPS-index (mean, 1.35 vs. 1.37, p = 0.013, effect size = 0.653).

Conclusion: Our findings suggest that glymphatic dysfunction is associated with tinnitus, highlighting a potential link that requires confirmation in longitudinal and mechanistic studies. rTMS treatment is related to reduced tinnitus severity and enhanced glymphatic function, suggesting its therapeutic potential.

Level of evidence: 3:

Objective: Primary hyperparathyroidism (PHPT) has varied presentations whose successful surgical management demands integration of the expanding literature within a comprehensive decision-making framework. Our objective is to compare the workup and management of variant (i.e., normocalcemic hyperparathyroidism (NCPHPT) and normohormonal hyperparathyroidism (NHPHPT)) to classic hyperparathyroidism (CPHPT), taking into account localization studies, surgical considerations, utility of intraoperative parathyroid hormone (IOPTH), and surveillance to identify gaps in knowledge that limit management outcomes of variant PHPT presentations.

Data sources: A comprehensive search of PubMed and Google Scholar was conducted from June 11, 2024, to March 17, 2025, using MeSH terms and free-text queries focused on imaging, surgery, and outcomes in PHPT and reported using PRISMA ScR guidelines.

Review methods: Peer-reviewed studies addressing surgical management of PHPT in adults, published in English, were included. Two reviewers independently screened all titles, abstracts, and full texts using previously developed inclusion criteria recorded in a shared spreadsheet. Twenty-seven studies were included. Data were synthesized into a flow diagram to identify areas in need of further guidance.

Results: Imaging accuracy was highest with 4DCT and PET scans in both classic and variant PHPT, particularly in the setting of multiglandular disease. Not obtaining ≥ 50% IOPTH drop and/or levels below 40 pg/mL are risk factors for persistence or recurrence.

Conclusions: PHPT has varied presentations that demand nuanced approaches. Our review highlights knowledge gaps that, if addressed, will improve the care of patients with variant PHPT. Further prospective validation of this algorithmic summary is warranted to improve long-term impact and patient outcomes.

Objectives: The purpose of this study is to compare the economics of in-office tympanostomy tube placement using single use devices versus standard placement in the operating room (OR).

Methods: A retrospective chart review was completed for all pediatric patients who underwent in-office tympanostomy tube placement (CPT 69433) along with insurance and date matched patients with placement in the OR (CPT 69436) between 12/1/21-3/1/24. Financial data were compared among the public vs. private insurance cohorts using the Wilcoxon rank-sum test with a two-sided significance level of 5%.

Results: One hundred and thirty-six in-office patients were identified, 102 private versus 34 public, and compared with 136 insurance and date matched OR patients. The average total payment for both privately insured patients, $647.14 in-office versus $6873.45 in the OR, and publicly insured patients, $312.74 in-office versus $2656.34 in the OR, was statistically significant. The average insurance payment for both privately insured patients, $301.58 in-office versus $5445.73 in the OR, and publicly insured patients, $310.63 in-office versus $2258.65 in the OR, was statistically significant. For the patient payment, public insurance usually has 0 copay and is therefore excluded. The patient payment of the private insurance cohort, $308.30 in-office versus $670.61 in the OR, was not found to be statistically significant.

Conclusion: As expected, this study demonstrates significant reductions in overall cost with in-office tympanostomy tube placement even with the added cost of single-use devices compared to the standard placement in the OR, particularly for insurance companies, suggesting the potential benefit of providing reimbursement for these devices.

Level of evidence: N/A.

The present video case report details technical notes of Nasopharyngeal Endoscopic Resection (NER) Type III, performed for a mucosal melanoma in a 71-year-old patient. Key surgical steps-such as achieving optimal exposure, employing Doppler-guided internal carotid artery localization, and applying vascularized flap coverage-are outlined, demonstrating the precision and feasibility of this approach for treatment of these complex malignancies.

Objectives: This study aimed to comparatively evaluate the therapeutic efficacy of balloon dilation eustachian tuboplasty (BDET) versus tympanostomy tube insertion (TTI) in adult patients with unilateral chronic otitis media with effusion (COME), and to assess potential synergistic effects when combining both procedures (BDET + TTI).

Methods: We conducted a retrospective cohort study of 46 adult COME patients from the Eye and ENT Hospital of Fudan University who had failed a standardized 3-month non-surgical interventions and underwent one of three interventions: (1) TTI alone, (2) BDET + TTI, or (3) BDET alone. Preoperative evaluations included otoscopy, pure-tone audiometry (PTA), tympanometry, nasopharyngeal endoscopy, eustachian Tube Dysfunction Questionnaire (ETDQ-7), and temporal bone CT scans. Postoperative evaluation incorporated PTA, tympanometry, and ETDQ-7 assessment. Statistical analysis incorporated both within-group (pre-post) and between-group comparisons of therapeutic outcomes.

Results: All interventions demonstrated therapeutic safety with no postoperative complications. While all groups showed hearing improvement, the BDET group failed to achieve statistically significant improvement in air conduction (AC) thresholds. The BDET + TTI combination yielded superior outcomes to TTI alone in AC thresholds, air-bone gap (ABG), and ETDQ-7 scores improvements. Tympanometric normalization was significant in both TTI-containing groups but not in the BDET-alone group.

Conclusions: While BDET monotherapy shows limited efficacy in adult COME management, its combination with TTI produces superior therapeutic outcomes compared to either procedure alone. These results position BDET as a potentially valuable adjunct to conventional TTI rather than an independent treatment modality for this patient population.

Level of evidence: 3:

Objective(s): Robotic-assisted electrode array (EA) insertion is a promising technique that may enhance preservation of residual acoustic hearing after cochlear implant (CI) surgery. The purpose of this study is to evaluate the impact of robotic-assisted EA insertion on rates of delayed-onset hearing loss (DOHL).

Methods: Sixty (Advanced Bionics [AB]: 30, MED-EL: 30) adult patients underwent CI surgery with manual EA insertion and 29 (AB: 13, MED-EL: 16) with robotic-assisted insertion using the iotaSOFT system. The primary outcome variable was longitudinal change in low frequency pure-tone average (LFPTA). DOHL was defined as a decrease in LFPTA of > 10 dB compared to previous best postoperative LFPTA.

Results: Twenty-two (37%) out of the 60 subjects in the manual cohort and two (7%) out of the 29 subjects in the robotic-assisted cohort had DOHL over the entire length of available follow-up (p = 0.002, Fisher's exact test, two-tailed). When evaluating DOHL results for subjects who had LFPTA data at 12 months (±4 weeks) post initial activation, 11 (29%) out of the 38 (AB: 15, MED-EL: 23) subjects in the manual cohort and zero (0%) out of the 18 (AB: 8, MED-EL: 10) subjects in the robotic-assisted cohort had DOHL (p = 0.011, Fisher's exact test, two-tailed). The number needed to treat was 4.

Conclusion: Robotic-assisted EA insertion is associated with a clinically meaningful reduction in rates of DOHL. Preservation of residual acoustic hearing is a critical goal in CI surgery, and robotic-assisted EA insertion contributes towards achieving this goal.

Level of evidence: 3:

Objectives: Airway collapsibility varies with the level of anesthetic depth during drug-induced sleep endoscopy (DISE). Bispectral index (BIS) monitoring uses EEG signals to quantify anesthetic depth. We conducted a prospective study to examine changes in VOTE scores and pharyngeal opening pressure (PhOP) during DISE with positive airway pressure (DISE-PAP), at light and deep sedation.

Methods: Anesthetic depth was monitored using BIS during DISE-PAP for 17 patients. We classified BIS ≥ 55 as light sedation and < 55 as deep sedation. The DISE exam was performed and subsequently PAP applied to assess PhOP at both light and deep sedation. We defined PhOP as the minimum pressure wherein all areas of the airway were opened. A blinded evaluation of the procedure video was performed by either one of two sleep surgery fellows or an attending sleep surgeon to create a VOTE score for the DISE exam and PhOP.

Results: All n = 17 patients enrolled had OSA with a mean AHI of 30.5 and standard deviation 17.8. PhOP significantly correlated with BIS readings (rho = -0.45, p = 0.0328) but VOTE classification did not significantly correlate with BIS level (rho = 0.18, p = 0.189). The velum and epiglottis had opening pressures that correlated to BIS level (rho = -0.398; p = 0.044) and (rho = -0.426; p = 0.038), respectively.

Conclusions: Anesthetic depth measured by BIS correlates with airway resistance as measured by PhOP. PAP appears to be a useful tool during DISE as it gives a highly titratable and immediate measurement of pharyngeal collapsibility.

Level of evidence: 3:

Isolated superior orbital roof blow-in fractures are rare and may result in functional or aesthetic impairment requiring surgical intervention. This case report demonstrates the successful endoscopic repair of such a fracture, emphasizing the advantages of endoscopic techniques in achieving adequate visualization when direct access to the fracture site is limited.

Objective: To describe the prevalence and morphology of vocal fold contralateral reactive lesions in patients with vocal fold polyps or cysts, and to report disease regression following office-based laryngeal surgery (OBLS).

Methods: Medical records and video recordings of patients with vocal fold polyps or cysts who underwent OBLS between November 2023 and September 2025 were reviewed. Demographic data included age, gender, history of smoking, history of reflux disease, type of vocal fold pathology, and type of office-based laryngeal procedure. Prevalence, morphology, and disease regression of CRLs were assessed by two otolaryngologists who independently reviewed the video recordings of patients included in this study.

Results: Twenty-six males and 19 females were included in the study. The mean age was 48.9 ± 14.9 years. The prevalence of CRLs was 60%. Most of these lesions were fibrous. Eighteen lesions were treated with ILSI, and 8 lesions were treated with the blue laser and steroid injection. Five patients were lost to follow-up. Analysis of 21 CRLs showed complete disease regression in 52.4% of cases, and partial disease regression in 47.6% of cases. There was no statistically significant difference in disease regression between the two treatment subgroups (p = 0.284). There was a statistically significant difference in total disease regression of the primary lesion between those who had partial vs. complete disease regression of their CRL (p < 0.001).

Conclusion: CRLs are common in patients with vocal fold polyps and cysts. All lesions regressed partially or completely following OBLS using the blue laser and/or steroid injection.

Level of evidence: 3: