Laryngoscope最新文献

Objective: This study sought to compare topical lidocaine delivered through a channeled endoscope versus traditional anesthetic methods for office laryngology procedures.

Methods: A single-institution prospective, crossover study of adult patients undergoing office laryngology procedures from February 2023 to February 2024 was conducted. Patient-reported outcomes for procedural tolerance and anesthetic preference were compared between the investigational method of channel-nebulized lidocaine versus control anesthetic delivery (trans-tracheal or drip catheter), with each patient serving as his/her own control.

Results: Twenty-two subjects were included in the study. Control topical anesthesia included: 13 (59.1%) trans-tracheal and 9 (40.9%) drip catheter. On bivariate analysis, the use of channel-nebulized lidocaine was associated with reduced lidocaine dosage (0.4 vs. 1.7 mL, p < 0.001), increased anesthesia delivery time (335 vs. 119 s, p < 0.001), and increased total procedure time (543 vs. 321 s, p < 0.001). No significant differences in anesthetic delivery time or total procedure time were observed when comparing channel-nebulized delivery with drip catheter. Discomfort during lidocaine administration (p < 0.001) and cough/gag during lidocaine administration (p < 0.001) were significantly lower with channel-nebulized lidocaine. Multiple linear regression revealed these improvements were not significantly influenced by indication for procedure, years undergoing procedures, or control method of anesthesia. A majority (63.6%) of patients preferred channel-nebulized lidocaine.

Conclusion: Topical laryngeal anesthesia for office laryngology procedures can be challenging due to patient tolerance. Nebulized lidocaine delivered through an endoscopic working channel may improve patient tolerance and reduce lidocaine dosage but may be associated with longer procedure time.

Level of evidence: 3:

Objectives: Oval window atresia (OWA) is a rare otologic condition often associated with a maximal conductive hearing loss, and variable ossicular and facial nerve canal (FNC) anomalies, which have contributed to suboptimal middle ear surgical outcomes. No grading scheme exists to detail the spectrum of associated temporal bone anomalies in OWA; therefore, our objectives were to complete an audiometric and radiographic review to characterize audiometric patterns of hearing loss, and refine the classification system for OWA to determine suitability for middle ear surgery.

Methods: A retrospective audiometric and radiographic review was conducted at a pediatric tertiary care institution. Patients with OWA identified on temporal bone computerized tomography (CT) scans obtained from 01/2010 to 06/2024 were included. Audiological, radiological, and patient factors were analyzed.

Results: Thirty-one patients (48 ears) with OWA were identified. Across frequencies, the air-bone gap decreased significantly as frequency increased (ANOVA with pairwise comparisons, p < 0.001) due to a worsening of bone conduction thresholds and improvement in air conduction thresholds. The FNC was abnormal in 43/48 ears and was determined to overlay the oval window in 6 ears. Additional anomalies included inferiorly displaced, dehiscent, and duplicated canals. Ossicular anomalies were reported in 46/48 ears, and stapedial anomalies were most common.

Conclusions: Our findings indicate OWA may manifest audiometrically with consistent and specific hearing loss characterized by a 60-80 dB ABG at lower frequencies that decreases above 2 kHz. CT findings of OWA show considerable variability. We propose a new classification system for OWA based on facial nerve position as this directly influences middle ear surgical feasibility.

Level of evidence: 4:

Objectives: The impact of velopharyngeal insufficiency (VPI) on patient and caregiver quality of life (QOL) is well documented. The social determinants of health (SDOH) that affect this relationship remain unclear. This study aimed to evaluate these associations to better understand how social context impacts patients and caregivers at risk of VPI due to congenital cleft and craniofacial deformities.

Methods: Retrospective review of caregiver-reported Velopharyngeal Insufficiency Effects on Life Outcome (VELO) questionnaire responses was conducted for patients seen in a multidisciplinary cleft and craniofacial clinic from 2020 to 2023. Scores were matched to census data regarding educational opportunities, health/environmental factors, and socioeconomic factors using the Childhood Opportunity Index (COI). Associations between QOL and SDOH were evaluated via linear regression, with higher scores representing better values.

Results: Among the cohort (N = 161), multiple SDOH categories significantly predicted the QOL impacts of VPI (p < 0.05). Socioeconomic factors were positively correlated with speech limitations, situational difficulty, emotional impact, and caregiver impact (β = 0.23-0.36, p < 0.05). Contrary to our hypothesis, health/environmental factors exhibited a significant negative correlation across the same VELO domains in addition to swallowing problems (β = -0.29 to -0.12, p < 0.05). Educational opportunities showed no significant association with any VELO subcategory (β = -0.11 to -0.03, p > 0.1).

Conclusion: Higher socioeconomic status was associated with better VELO scores, underscoring the protective role of resources in health outcomes and caregiver perceptions. In contrast, caregivers with better health/environmental conditions reported worse outcomes, suggesting that higher health standards may influence perceptions of VPI severity.

Level of evidence: 3:

Objectives: During initial comparison of DaxibotulinumtoxinA-lanm (Daxi) to botulinum toxin A (BtxA) in adductor laryngeal dystonia (AdLD) (Phase 1), Daxi administration was found to be safe and efficacious. This study sought to determine the reproducibility of Daxi results (Phase 2) and safety/results for Daxi dose escalation (Phase 3) in patients who previously had been successfully treated with Daxi.

Methods: Thirteen AdLD patients with consistent benefit from BtxA were enrolled in an open-label prospective clinical trial involving repeat administration and/or up-titration of Daxi dose. Duration of voice benefit (DVB) and safety of dose escalation were primary outcomes. PROMs and voice recordings were obtained pre- and post-injection.

Results: Twenty-nine total injections (21 repeat dose, 8 dose escalation) were performed in 13 patients (85% female, mean age = 60.4). No adverse events occurred, and there was no difference in EAT-10 pre- to post-injection (repeated dose p = 0.08, dose escalation p = 0.12). In patients who experienced greater benefit with Daxi, average DVB was 112.75 days, 33.5% longer than their average BtxA duration (mean = 84.2 days, p = 0.003). 54% (7/13) had longer DVB with Daxi, and 46% (6/13) had equivocal DVB compared to BtxA DVB by the end of the study. Daxi DVB was comparable to an earlier study, demonstrating reproducibility of Daxi injection results (p = 0.332, SD = 13.6 days).

Conclusions: Our results were variable but showed reproducible results with Daxi, with overall longer DVB with Daxi in 42.8% of total injections, with an average of 33.5% longer DVB than BtxA in a cohort of known Daxi-responsive patients. Daxi dose escalation did not result in significant dysphagia or adverse events. Further studies are needed to determine the clinical utility of Daxi in the treatment of AdLD.

Level of evidence: 3:

Objective (s): Idiopathic and granulomatosis with polyangiitis (GPA)-related subglottic stenosis (SGS) are considered distinct immune-mediated inflammatory disorders. Limited data exist on serum inflammatory markers, specifically C-Reactive Protein (CRP), for SGS diagnosis, differentiation, and prognostication. The study objective was the characterization of CRP levels in idiopathic (iSGS) and GPA-SGS to assess CRP's ability to distinguish SGS subtypes and predict SGS progression and recurrence.

Methods: Retrospective review of patients with idiopathic or GPA-SGS from 2007 to 2024 at a single institution. Surgery-free interval (SFI) was calculated as the time between surgical interventions. Statistical analysis included independent t-tests, chi-squared, and univariate linear regression.

Results: 59 iSGS and 47 GPA-SGS patients were included. CRP was elevated in 36% of iSGS and 49% of GPA-SGS patients (0.0.6 mg/dL). Mean maximum CRP was 2.7 mg/dL lower in iSGS compared to anti-neutrophil cytoplasmic antibody (ANCA)-positive GPA-SGS (p = 0.035). The maximum CRP in iSGS was 3.6 mg/dL, while 10 (21%) GPA patients had CRPs greater than 3.6 mg/dL (max = 31 mg/dL). ANCA-negative GPA-SGS mean CRP was not significantly different than iSGS or ANCA-positive GPA-SGS. CRP and SFI did not correlate on univariate linear analysis.

Conclusion: Mild elevation of CRP is common in SGS patients. High CRP levels are more frequent in GPA-SGS, potentially aiding clinical differentiation of etiologies. However, CRP at presentation does not appear to correlate with disease recurrence in iSGS or GPA-related SGS, limiting its value as a biomarker and prognostic tool.

Level of evidence: 3:

Objectives: To describe how podcasts can be used to provide career guidance to medical students and otolaryngology residents. To demonstrate success metrics for a mentorship-based otolaryngology podcast.

Study type: Observational.

Category: Otolaryngology Status and Trends.

Methods: A podcast was developed and launched in 2019 by an otolaryngology academic faculty member. Each episode was assigned a theme, and a guest was invited to allow for an interview format. Audio files were recorded, edited, and uploaded to a free hosting platform for distribution. The impact of the podcast was assessed via multiple methods, including responses to a survey, medical student outreach, and episode analytics.

Results: Since publication of the first podcast episode in June 2019, 40 episodes have been released. Episodes have been listened to 23,308 times with a mean of 568 plays per episode. Plays were mostly within the US (84%). Ratings and comments about the podcast have been positive, and multiple mentorship and networking relationships have resulted from the podcast within the otolaryngology community.

Conclusions: Podcasting can be used as an alternative way to provide career guidance within otolaryngology, creating increased medical student awareness and interest in our specialty and filling in mentorship gaps based on a lack of local mentors. Based on the positive reception to this podcast, including total plays and direct communication with the author, it can be concluded that the podcast has completed its objective of providing simulated mentorship for students interested in otolaryngology and otolaryngology residents, with impact.

Level of evidence: NA.

Objective: To examine the association between marital status and post-CI speech recognition and hearing-related QoL in adult CI users, and to explore how this relationship interacts with key sociodemographic factors, including sex, employment, and residential location, and device usage (datalogging).

Methods: Retrospective cohort analysis of prospectively collected data (2018-2024) from 604 postlingually deafened adults undergoing unilateral cochlear implantation. Outcomes were speech recognition (AzBio, CNC) and hearing-related QoL (CIQOL), collected at 6 or 12 months post-CI.

Results: Unmarried users had significantly poorer speech recognition outcomes (CNC [95% CI -15.2 to -5.5], AzBio quiet (AzBioQ) [95% CI -15.2 to -2.8]) compared to married users when controlling for key clinical covariates. No significant differences were observed in CIQOL scores. There were positive nonsignificant interactions between marital status and sex (β, 9.33, [95% CI -3.44 to 22.12]), employment status (β, 8.52, [95% CI -6.47-23.51]), and residential location (β, 12.96, [95% CI -0.54-26.46]) on AzBioQ. The benefits of marriage were stronger among women, full-time employed individuals, and rural residents than among men, those not in full-time employment, and urban residents. Marital status also significantly interacted with device usage (β, 1.70, [95% CI 0.11-3.28]). The relationship between device usage and AzBioQ was stronger in married individuals, suggesting a greater protective effect of marriage in individuals with higher device usage.

Conclusion: Marital status predicts CI speech recognition outcomes through both its main effect and its interaction with three additional sociodemographic factors and device usage. Recognizing this significant impact can help guide clinical counseling and inform the importance of social relationships.

Level of evidence: 3:

Objective: Ear, nose and throat (ENT) is often underrepresented in undergraduate medical curricula. E-learning has emerged as a promising strategy to address this gap. This mixed-methods systematic review aimed to evaluate the effectiveness of e-learning in undergraduate ENT education.

Data sources: MEDLINE, Embase, Education Research Complete, and Web of Science were searched.

Review methods: The PRISMA guidelines were followed. Quantitative data were synthesized with a meta-analysis of normalized gain scores to assess knowledge improvement. Qualitative findings were analyzed using thematic synthesis. Due to substantial heterogeneity, a narrative synthesis was performed for skills and confidence.

Results: Twenty-nine studies fulfilled the inclusion criteria. Knowledge scores improved by 26.8% (95% CI 23.7%-30.0%, n = 13), which was considered low gain. Skill improvement was variable (n = 6), while confidence consistently improved (n = 5). Thematic synthesis identified four themes: (1) multimedia resources, (2) learner autonomy and self-directed engagement, (3) technical barriers, and (4) blended learning models.

Conclusion: Knowledge and learner confidence improved with e-learning. However, its impact on practical skills was limited. These findings support the integration of e-learning as a complementary adjunct to clinical teaching.