Laryngoscope最新文献

Objectives: Pepsin is a key driver of epithelial injury and inflammation in laryngopharyngeal reflux (LPR). Prior work in esophageal cells implicates hypoxia-inducible factor-2α (HIF-2α) in refluxate-mediated cytokine secretion. We investigated whether pepsin increases HIF-2α under neutral (pH 7) conditions in immortalized human true vocal cord (TVC) cells and whether amprenavir, a pepsin inhibitor, can reverse this response.

Methods: TVCs were treated with 0.1-1 mg/mL pepsin and/or 10 μM amprenavir at pH 7 for 2, 4, 6, and 24 h. HIF-2α protein levels were evaluated by Western blot. Based on the most inflammatory condition, expression of proinflammatory genes was assessed with or without a HIF-2α transcriptional inhibitor.

Results: The 6-h 1 mg/mL pepsin treatment induced the highest HIF-2α levels and was selected for further analysis. Pepsin significantly increased HIF-2α expression (p < 0.01), and amprenavir reduced it numerically (p = 0.056). Pepsin significantly upregulated ICAM1, IL1B, and IL8 (p < 0.05), while amprenavir significantly reduced ICAM1, IL8, and TNF (p < 0.05). Inhibition of HIF-2α selectively reduced IL1B expression (p < 0.05).

Conclusion: Pepsin exposure increased HIF-2α and upregulated key inflammatory genes. While amprenavir significantly reduced cytokine expression, HIF-2α inhibition alone had only a modest effect, suggesting additional pathways contribute to pepsin-induced inflammation. Amprenavir's ability to attenuate this response supports its therapeutic potential in LPR.

Level of evidence: N/A.

This report describes the step-by-step surgical technique of Bocca's hemipharyngo-total laryngectomy for right pyriform sinus squamous cell carcinoma in an elderly patient with significant comorbidities. The procedure allowed oncologically radical resection with immediate neohypopharyngeal reconstruction using the preserved hemilaryngeal mucosa, avoiding flap reconstruction. Bocca's technique represents a valuable option in carefully selected cases, providing adequate functional outcomes while reducing operative complexity.

Objectives: To estimate the prevalence of balance disorders in young and middle-aged adults, examine associations with risk factors, and changes over the past 20 years.

Methods: The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional complex random sample of the civilian, non-institutionalized United States population. In 2001-2004 and 2021-2023, NHANES included questions about balance, dizziness, and falls in the past 12 months. The modified Romberg test (MRT) was used to examine vestibular balance function. Logistic regression models were used to assess risk factor associations with balance disorders.

Results: Among 4525 middle-aged adults 40-69 years in 2001-2004, 21.5% (95% confidence interval [CI]: 19.1%, 23.9%) reported difficulty with balance and dizziness, and 29.7% (27.3%, 32.1%) failed to pass four MRT (MRT-4) conditions. Among 3986 middle-aged adults in 2021-2023, 36.2% (34.5%, 37.8%) reported specific balance and dizziness problems (BDP), and 25.9% (23.2%, 28.6%) failed the MRT-4. An enhanced MRT with a fifth condition (MRT-5) increased the discrimination of adults at risk of balance problems and falls. Risk factors for vestibular balance disorders, including age, education, income, cigarette smoking, physical activity, hypertension, diabetes, trouble hearing, and severe headaches/migraines, remained consistent. Reported functional disabilities (hearing, mobility, and vision) were significantly associated with BDP and MRT. In 2021-2023, comparisons of 2084 young adults 20-39 years with middle-aged adults showed increased age-specific prevalences of BDP and falls.

Conclusion: Middle-age-specific MRT-4 results in 2021-2023 improved. Balance disorders are associated with other health conditions, increased risk of falls, and need for medical services.

Level of evidence: 3:

Background: Vocal fold polyps and Reinke's edema are among the benign vocal cord lesions. Although they have different pathogeneses, their histological features are similar, making their diagnosis challenging. This study aims to investigate gene expression differences between Reinke's edema and vocal fold polyps to enhance diagnosis and provide insights into their pathophysiological mechanisms.

Methods: This cross-sectional study analyzed intraoperative tissue samples from the true vocal folds of patients diagnosed with either Reinke's edema or vocal fold polyps. Using RT-qPCR, we compared the mRNA expression levels of six genes central to extracellular matrix (ECM) composition and inflammatory processes, namely COL1A1, COL3A1, FN1, MMP-9, IL-8, and IL-1β, between the two patient groups. FDR correction analysis was employed for multiple comparisons.

Results: A total of 12 vocal fold polyps and 10 of Reinke's edema samples were included in this study. COL1A1, FN1, and MMP-9 were significantly upregulated in vocal fold polyps compared with Reinke's edema after FDR correction (q < 0.01). COL3A1, IL-1β, and IL-8 showed nominal differences that did not survive multiple-testing correction and were considered exploratory.

Conclusion: The findings of the present study revealed the differences in expression levels of genes implicated in inflammation, ECM production, and degradation in tissue samples from patients diagnosed with Reinke's edema and vocal fold polyps. This may lead to facilitated diagnosis and better understanding of these lesions' etiology. Future studies of larger sample sizes, including healthy controls, are warranted to validate our findings.

Level of evidence: 3:

This report describes a rare primary subglottic adenoid cystic carcinoma harboring a SMARCA4 loss-of-function mutation, a molecular driver not previously reported in this anatomical site. Despite presenting with locally advanced pT4a disease and early pulmonary metastasis, the patient achieved 5-year local control following total laryngectomy and adjuvant radiotherapy. The findings suggest that molecular profiling can identify non-MYB-driven subtypes and guide individualized management for atypical laryngeal malignancies.

Objective: One legacy of the COVID-19 pandemic has been an increase in electronic health record (EHR) patient-generated messages to providers, which has increased the amount of time providers spend on EHR tasks. We sought to evaluate clinical and demographic variables associated with high EHR patient message generation in a head and neck oncologic surgery (HNS) clinic.

Methods: A randomized 20% sample of unique outpatient visits to the HNS service at a tertiary academic medical center from July to December 2023 was retrospectively reviewed. Patient-generated EHR messages to providers for 6 months following the index visit date were categorized by quintiles, with high-utilizers defined as the top quintile.

Results: High-utilizers sent a greater number of messages (mean, 27.6 [range: 8-110] vs. 3.2 [1-7], p < 0.001). On multivariable regression analysis, high-utilizers were less likely to be elderly (OR = 0.13 [95% CI 0.04-0.52]), single (OR = 0.44 [0.19-0.98]), and more likely to have malignancy (OR = 2.27 [1.27-4.04]), advanced comorbidity (OR = 5.33 [1.71-16.53]), surgical treatment (OR = 3.16 [1.78-5.58]), and a specific provider (OR = 4.20 [1.21-14.53]). Sex, payor status, location, and new vs. established patient status were not associated with high-utilization.

Conclusion: Within an academic HNS practice, patients with malignant disease, comorbidity, surgical patients, and those who saw a specific provider were more likely to be high-utilizers, while older patients were less likely to use EHR messaging. These data suggest that some patient populations require more personalized and frequent support to address communication needs and raise concern about the ability of elderly patients to use electronic communications, who may have unmet needs.

Level of evidence: NA.

Objective: Nasolacrimal duct obstruction (NLDO) in children typically resolves without surgery. Endoscopic dacryocystorhinostomy (En-DCR) is considered in cases refractory to irrigation, probing, and/or stent placement. The incidence of revision after pediatric En-DCR ranges from 0% to 22%. The objective of this review is to determine the incidence of revision and failure after pediatric En-DCR.

Data sources: In this systematic review, Medline, Embase, and Cochrane databases were searched on 11/21/2025.

Review methods: Studies investigating primary, pediatric En-DCR outcomes were included. Case reports and articles that published no primary data or reported results aggregated with data from adult, revision, or external DCRs were excluded. Two reviewers (M.H. and R.W.) selected studies using these criteria and assessed quality with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. R V4.1.1 and GraphPad Prism 10.3.1 were used in statistical analysis and creation of Forest plots. The study protocol was pre-registered with Prospero.

Results: Thirty-one studies were included, involving 1470 ducts in 1230 patients. The mean age of these patients was 5.3 years old, and the study population was 49.5% male. Revision was performed in 9.1% of cases, and surgical failure occurred in 11.7% of cases. The mean follow-up time was 17.4 months.

Conclusion: En-DCR is an effective treatment for NLDO. The incidence of revision was found to be lower than that of surgical failure, potentially due to short follow-up times of some studies or reluctance to undergo revision. The calculated incidence of complications and revision may underestimate true values due to significant heterogeneity among studies.

Objectives: RCPD is a condition characterized by the inability to belch. Our study aims to assess the prevalence of anxiety and depression within this population while evaluating the impact of cricopharyngeal botulinum toxin injection (CPBTI) on associated symptoms.

Methods: RCPD patients selected for treatment with CPBTI were given three validated questionnaires for anxiety (GAD-7, ASQ) and depression (PHQ-9) before CPBTI, as well as 6 weeks and 6 months after. The changes were assessed with ANOVA, and minimal clinically important differences (MCID) of the surveys were used to qualify improvement in scores.

Results: Seventy-seven patients completed the pretreatment questionnaire. Of the 69 patients who ultimately received treatment, 45 completed at least one follow-up questionnaire and 32 completed all three. Mean age was 30.9% and 61% self-reported a diagnosed mental health comorbidity (MHC). GAD-7 identified at least mild anxiety in 73%, 50%, and 46% of patients at each timepoint, respectively. PHQ-9 identified at least mild depression in 68%, 52%, and 34%, respectively. Mean pretreatment, 6-week, and 6-month scores were 8.16, 5.04, and 4.4, respectively, for GAD-7 (p < 0.001); 7.87, 5.71, and 4.20, respectively, for PHQ-9 (p = 0.002); and 112.4, 75.6, and 65.20, respectively, for ASQ (p = 0.001). Using MCID values for GAD-7 and PHQ-9, 64% showed significant improvement in anxiety and 60% showed significant improvement in depression after treatment.

Conclusion: RCPD patients have a high prevalence of comorbid anxiety and depression. Treatment with CPBTI correlates strongly with a sustained reduction in these symptoms beyond the duration of botulinum toxin.

Level of evidence: 4: