Laryngoscope最新文献

Objective: To characterize the microbiomes of adenoids and tonsils in pediatric Obstructive Sleep Apnea Syndrome (OSAS) patients compared to healthy controls. We hypothesized that the microbiome composition of the tonsils and adenoids in OSAS patients differs significantly from that of healthy controls.

Methods: Thirty OSAS patients and 30 healthy controls were included. Samples from adenoids and tonsils were analyzed using 16S rRNA amplicon sequencing to characterize bacterial communities. Differential abundance and alpha and beta diversity were used to compare the microbiome compositions between groups.

Results: Significant differences in the microbial composition of adenoids and tonsils were observed within both OSAS and control groups. The tonsillar microbiome in OSAS patients exhibited lower alpha diversity and distinct microbial composition compared to controls, with an overrepresentation of pathogenic genera such as Haemophilus and Neisseria. Adenoid microbiomes, however, showed no significant differences in alpha diversity between OSAS and controls but displayed a trend toward variation in beta diversity.

Conclusion: This study highlights distinct microbiome profiles in adenoids and tonsils, with significant microbial shifts in the tonsillar microbiome of OSAS patients. These findings underscore the importance of syndrome-specific studies and suggest the potential contribution of microbial communities to pathogenesis. Future research should focus on further characterizing the microbiomes of healthy individuals and OSAS patients, aiming to establish a clearer distinction between normal and pathological microbial populations, which could inform the development of novel, non-invasive therapies.

Level of evidence: 3:

Objective: Mental fatigue is a common but understudied symptom in individuals with tinnitus. This study aimed to examine the relationship between tinnitus-related distress, anxiety symptoms, and mental fatigue.

Methods: A total of 119 participants (52 with tinnitus, 67 healthy controls) were included. All participants completed the Mental Fatigue Scale (MFS) and Generalized Anxiety Disorder-7 (GAD-7). The tinnitus group also completed the Tinnitus Handicap Inventory (THI), Visual Analog Scales (VAS), and psychoacoustic assessments (pitch matching, loudness level, minimum masking level). Group comparisons and correlation analyses were conducted.

Results: MFS scores were significantly higher in the tinnitus group than in controls (11.74 ± 5.51 vs. 8.13 ± 4.34, p = 0.015, d = 0.45). A moderate positive correlation was found between mental fatigue and anxiety symptoms (r = 0.44, p = 0.001). Within the tinnitus group, mental fatigue was weakly associated with THI and VAS attention deficit scores (r = 0.31, p = 0.022 and r = 0.30, p = 0.033, respectively), though these did not survive correction for multiple comparisons, nor with tinnitus loudness, masking levels, sleep disturbance, or hearing loss.

Conclusion: Mental fatigue in tinnitus appears more closely related to psychological and attentional factors than to auditory variables. Routine screening for fatigue and cognitive complaints may support more comprehensive tinnitus management and improve patient outcomes.

Level of evidence: 3:

Objective: The optimal treatment and timing for sudden sensorineural hearing loss (SSNHL) remain debated. This study aimed to determine if the hearing improvement and recovery time were better in the NAD+ group as compared to the control group.

Methods: There was a randomized, double-blind, controlled clinical trial conducted between June 2022 and June 2024. SSNHL patients were randomly divided into two groups: the NAD+ group (NAD+ plus standard treatment, n = 18) and the control group (standard treatment, n = 20). The primary outcomes were PTA improvement, recovery rate per Siegel's criteria, and average recovery time, measured from baseline to 3-month follow-ups.

Results: The study with 38 participants (average age 41.74 years, 78.98% male, 42.11% right ear, average Pre-PTA 76.88 dB HL) showed that the NAD+ group experienced significantly greater hearing improvement (40.21 dB HL) compared to the control group (23.06 dB HL, t = 2.722, p = 0.010). The effective rate was higher in the NAD+ group (94.44% vs. 60.00%, Z = -3.014, p = 0.003). Significant group × time interactions were noted in the NAD+ group (F = 2.867, p = 0.030), with greater improvements from 7 days to 3 months post-treatment. Recovery time was shorter in the NAD+ group (62.97 vs. 175.98 days, p = 0.028). Tinnitus and aural fullness improved more in the NAD+ group, especially after 3 months. Higher pre-treatment tinnitus and aural fullness scores were linked to better outcomes with NAD+ for SSNHL.

Conclusions: NAD+ was more effective in improving hearing and reducing recovery time in SSNHL patients and also benefited tinnitus and aural fullness management.

Level of evidence: 2:

Objective: The effectiveness of hypoglossal nerve stimulation (HGNS) for residual obstructive sleep apnea (OSA) in patients with prior bariatric surgery (BS) has not been previously reported. We evaluate and compare HGNS outcomes in this unique population.

Methods: We conducted a multi-institutional retrospective review between 2014 and 2023. Patients with prior BS were compared to those without (nBS). A 1:2 propensity score matching (PSM) was performed using age, gender, race, and baseline BMI. Data collected included demographics, pre/post-operative apnea-hypopnea index (AHI), body mass index (BMI), and Epworth Sleepiness Score (ESS). Treatment success was defined using Sher15 criteria. Analyses were conducted in R-Studio.

Results: After PSM, 72 patients met inclusion (mean age 61.3 years, 62% male, 83% White), including 24 (33%) with BS. Sher15 response rates were 71% in BS vs. 56% in nBS (p = 0.2). BS patients had significantly greater mean AHI reductions than NBS (-28.44 ± 16.39 vs. -17.68 ± 21.23; p = 0.009). Both groups had comparable reductions in ESS (-4.67 vs. -3.44; p = 0.2), with a mean postoperative ESS of 6.78 in BS and 6.17 in NBS (p = 0.5). On multivariable linear regression adjusting for demographics, baseline AHI, and BMI, prior BS was independently associated with greater AHI reduction (β = -8.6; 95% CI -16, -1.1; p = 0.026).

Conclusion: Patients with prior BS achieve comparable or superior outcomes following HGNS. Prior weight loss may enhance HGNS effectiveness and merits further study.

Level of evidence: 3:

Objectives: The EarWell Infant Ear Molding Device provides non-surgical correction for congenital ear deformities, but parental satisfaction data remain limited. This study evaluates our experience treating 120 infants with the EarWell system and assesses parental satisfaction with outcomes.

Method: We conducted a prospective case series of 120 infants treated with the EarWell device between January 2017 and January 2024. We collected demographic and clinical data, documented pre- and post-treatment ear conditions with photographs, and evaluated parental satisfaction via telephone interviews and questionnaires.

Results: The study included 120 infants (181 ears) with an overall success rate of 87.3% post-treatment and 81.8% at long-term follow-up. Treatment was most effective when initiated within the first week of life (93.8% success) compared to 8-14 days (90.6%) and 15-28 days (79.7%). Ear deformations achieved higher correction rates (95.2%) than malformations (76.3%). Minor complications occurred in 18.8% of cases, primarily pressure ulcers (14.4%) and dermatitis (4.4%). Parental satisfaction was high, with 78.3% of parents reporting being satisfied or very satisfied with outcomes, correlating with objective clinical results.

Conclusion: The EarWell Infant Ear Molding Device is an effective, safe, and parent-approved non-surgical intervention for congenital auricular deformities. Treatment is most successful when initiated within the first week of life and for ear deformations rather than malformations. Early intervention results in better outcomes and fewer complications. High parental satisfaction correlates with objective clinical improvements, supporting ear molding as a first-line treatment for congenital auricular deformities when applied during the optimal window of neonatal cartilage malleability.

Level of evidence: 4:

Background: Prior evidence has shown that female patients with chronic rhinosinusitis (CRS) suffer a worse disease-specific quality of life (QoL).

Objective: To study the gender-specific differences on the QoL of patients with recurrent acute rhinosinusitis (RARS).

Methods: Retrospective cohort study of patients presenting to the otolaryngology clinic with RARS defined by at least one objective evidence of rhinosinusitis (CT scan or endoscopy findings). Patients' characteristics and comorbidities were reviewed. The sinonasal outcome test (SNOT-22) and its subdomains were analyzed for gender-based differences at baseline and after surgical treatment.

Results: One hundred and sixteen patients with RARS were included (mean age of 41.1 years, 65.5% female). There was no difference in CT scores (3.7 vs. 4.9, p = 0.162) or endoscopy scores (2.8 vs. 2.6, p = 0.707). Female patients were significantly more likely to have autoimmune, headache, and anxiety disorders (p < 0.05 for all). Females had significantly worse baseline SNOT-22 scores (50.6 vs. 39.1, p = 0.001) and for subdomain scores except the rhinologic and extrarhinologic subdomains, which were similar between groups. SNOT-22 scores were comparable after surgical treatment (SNOT-22 score of 28.7.6 vs. 22.9, p = 0.229), with significant interval improvement from baseline for both groups (p < 0.001; p = 0.002). Multivariate regression analysis of the SNOT-22 scores and its subdomains adjusting for confounders showed that female gender was independently associated with worse QoL (SNOT-22: coeff. 8.4, 95% CI of 2.2-14.7).

Conclusion: Female patients with RARS show higher subjective disease burden. Further research is warranted to elucidate the biological and psychosocial mechanisms underlying these differences.

Level of evidence: 4:

Objectives: To evaluate epidemiological associations between the development of adult chronic rhinosinusitis (CRS) and treatment with surgery or biologic therapy following pediatric adenotonsillectomy.

Methods: This is a multicenter, retrospective cohort study utilizing data from 100 healthcare organizations in the United States. The TriNetX database identified adults older than 18 years with or without prior childhood tonsillectomy and/or adenoidectomy. Outcomes included CRS without nasal polyposis (CRSsNP), with nasal polyposis (CRSwNP), sinus surgery, and biologic therapy. Subgroup analysis of patients with childhood obstructive sleep apnea (OSA), recurrent/chronic tonsillitis, adenoiditis, or middle ear disease was performed.

Results: There was no statistically significant difference in the rate of adult CRSsNP, CRSwNP, surgery, and treatment with biologics after pediatric adenotonsillectomy for childhood OSA (HR: 0.94 [0.87-1.02]; 1.07 [0.79-1.44]; 0.87 [0.59-1.28]; 0.85 [0.66-1.09]). Children who had an adenoidectomy alone had a higher rate of CRSsNP as adults (HR: 1.55 [1.30-1.85]). Surgery for tonsillitis and adenoiditis had a higher rate of CRSwNP and surgery (HR: 1.63 [1.21-2.32]; 1.97 [1.36-2.86]). Adenoidectomy for adenoiditis was associated with CRSsNP (HR: 1.94 [1.73-2.19]). Adults with pediatric middle ear disease who had a childhood adenoidectomy alone had an increased rate of CRSsNP (HR: 1.47 [1.30-1.65]).

Conclusions: Tonsillectomy with adenoidectomy in the setting of specific childhood infectious diseases was associated with adult CRSwNP and the need for sinus surgery, whereas adenoidectomy was associated with CRSsNP.

Level of evidence: 3:

Introduction: Social determinants of health (SDoH) impact surgical outcomes, risk-adjusted prognoses, and overall health. The Social Vulnerability Index (SVI) measures SDoH based on 16 social factors. This study evaluates the impact of social vulnerability on the quality of life of those living with chronic rhinosinusitis (CRS).

Methods: A retrospective cohort review of 657 patients at a single institution. CRS patients with cystic fibrosis, nasal obstruction, and nasal cancer were excluded. Baseline covariates, including SNOT-22 scores, sex, and history of surgery, were collected. SVI was calculated using the National Social Vulnerability Index 2020 Database by Census Tract. Statistical analyses were conducted.

Results: A lower SVI score was associated with lower SNOT-22 scores, independent of sex, presence of polyps, or history of surgery (p < 0.001). Patients in the "Low to Medium" SVI category were significantly less likely to undergo surgery compared to those in other SVI categories (p = 0.04). Compared to patients with CRSwNP, those with CRSsNP had significantly worse SNOT-22 scores (p = 0.038) but no significant difference in SVI scores. Surgery was performed in 69% of patients with CRSsNP and 84% of those with CRSwNP.

Conclusion: Social vulnerability impacts the likelihood of surgery and quality of life in patients with CRS. Higher vulnerability is associated with worse sinonasal symptoms, regardless of confounders. CRS patients with lower social vulnerability are less likely to have surgery. SNOT-22 scores did not influence the likelihood of surgery.

Level of evidence: 3: