Laryngoscope最新文献

Minimally invasive skull base techniques are increasingly adopted for their reduced morbidity and improved cosmetic outcomes. This study presents an endoscopic transorbital approach (TOA) for skull base surgery and introduces a novel reconstruction technique using a pedicled deep temporalis muscle flap. Preclinical and clinical results demonstrate its feasibility, safety, and potential for broader surgical use.

Objective: This scoping review aims to explore the diagnostic value of Vestibular Evoked Myogenic Potentials (VEMPs) in people with Vestibular Neuritis (VN) with a specific focus on the differential contribution of ocular (oVEMPs) and cervical (cVEMPs) recordings.

Data sources: A comprehensive search was conducted in December 2024 across PubMed, Scopus, and the Cochrane Library. Studies published in English and involving adult patients with suspected or confirmed VN and assessing VEMPs were considered eligible.

Review methods: The PRISMA-ScR guidelines were followed. Data were extracted regarding methodology, patient characteristics, and diagnostic performance of VEMPs.

Results: Eighteen studies met all eligibility criteria. Included studies consistently demonstrated that VEMPs offer valuable diagnostic information in VN, particularly in identifying the affected branch of the vestibular nerve. Several studies supported the use of VEMPs in combination with other vestibular tests to enhance diagnostic accuracy. Methodological heterogeneity in stimulation parameters and recording techniques limits direct comparison across studies but underscores the need for protocol standardization.

Conclusion: VEMPs are a useful adjunctive tool in the diagnosis of VN, particularly for topographic localization of vestibular nerve involvement. Future research should focus on standardizing protocols and exploring correlations with clinical outcomes to refine their diagnostic utility further.

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.

Objective(s): Flexible nasolaryngoscopy (FNL) is a fundamental skill in otolaryngology. It is typically learned in clinical settings, with impacts on patient comfort and safety. Objective assessment, specific feedback, and a better understanding of learner trajectory in a simulation setting could improve the efficiency of FNL training and ultimately improve the patient experience. This study sought to employ a novel FNL model with trajectory tracking to identify metrics and critical steps that distinguish less and more experienced trainees and identify indicators of proficiency.

Methods: FNL trainees in an otolaryngology simulation course performed three FNL trials on a novel CT-based 3D-printed FNL model with embedded location and trajectory tracking. Participants were stratified by prior experience. Outcomes included procedure time, number of pauses or backtracks, and undesirable contact time with critical anatomic regions.

Results: A total of 29 trainees, ranging from medical students to fourth year residents, participated in this study. More experienced trainees demonstrated shorter procedure time, fewer pauses and backtracks, and less time in contact with the posterior nasopharynx (p < 0.05). There was a statistically significant difference between participant groups who had performed 1-5 and > 15 prior FNL.

Conclusions: Procedure time, pauses, backtracks, and contact with critical structures represent objective, measurable metrics of proficiency in FNL simulation training. Post hoc analyses suggest the threshold for procedural proficiency occurs with intermediate prior experience, overlapping with prior literature reports from video-rating of proficiency. Future study could examine how metrics change with FNL practice to optimize targeted feedback that improves efficiency and ultimately reduces patient risk and discomfort.

Level of evidence: N/A.

Introduction: Professional society guidelines recommend against routine diagnostic imaging for suspected Bell's palsy at initial presentation. This study examines national trends in imaging use, adherence to guidelines, and the utility of CT and MRI in treatment practices.

Methods: A retrospective cohort study of 35,942 adult Bell's palsy patients using ICD-9-CM and ICD-10-CM diagnosis codes from 2016 to 2021 was conducted. These patients were continuously enrolled for ≥ 1 year in the employer-sponsored MarketScan commercial or Medicare outpatient and prescription drugs claims data. The main outcomes of interest were CT and MRI scan usage at or after the diagnosis date.

Results: CT scans were performed in 27% of patients (median time: 3 days), while MRI was performed in 25% (median time: 36 days). Within 30 days of their index claim, 16% underwent CT scanning and 12% underwent MRI. Patients on combination therapy (steroids and antivirals) had significantly higher rates of early imaging (CT: 38% vs. 25%, p < 0.001; MRI: 19% vs. 17%, p < 0.001) compared to monotherapy. CT imaging within 30 days of index diagnosis was strongly associated with combination therapy (OR = 3.49, 95% CI = 3.28-3.73, p < 0.001), as was early MRI to a lesser extent (OR = 1.26, 95% CI = 1.17-1.35, p < 0.001). Imaging was most frequent in acute care settings, and median costs rose significantly with dual-modality imaging (p < 0.001).

Conclusion: CT and MRI are frequently used in Bell's palsy despite guideline recommendations, especially in patients receiving combination therapy. This study finds an association between diagnostic imaging for Bell's palsy and combination therapy, highlighting opportunities to reduce unnecessary testing and promote guideline-based care.

Level of evidence: 3:

Objective: With increased nationwide emphasis on high-value care and cost reduction, more attention has been paid to postoperative outcomes. In this study, we examined if diagnosis related group (DRG) classifications could be used to predict total laryngectomy (TL) length of stay (LOS) which could help with determining areas for improved resource allocation.

Methods: This is a retrospective study at a single tertiary academic center of TL patients between January 2013 and December 2020. For each DRG, we compared the primary outcome of LOS and secondarily examined perioperative outcomes, including complications and readmissions. We used Kruskal-Wallis tests to assess perioperative outcome and LOS differences among DRGs' correlation. Furthermore, we used public data to determine annual geometric means LOS (GMLOS) for TLs and compared this to institutional LOS.

Results: The 211 patients were included. Patients with more severe DRG classification had greater LOS (p = 0.004). Fistula complications occurred at higher rates in more severe DRG classification, with major complication or comorbidity (MCC) at 25.0%, CC at 16.9%, and without complication or comorbidity (CC)/MCC at 3.1%, p = 0.02. The 30-day readmission was more common in MCC (26%) compared to CC (8.4%) or without CC/MCC (9.4%), p < 0.01. We found higher GMLOS compared to institutional LOS for TLs.

Conclusion: TL patients with CC and MCC have longer LOS than those without CC/MCC, as well as higher fistula and readmission rates. DRGs can be used to identify areas to improve resource allocation for patients that may have poorer post-TL outcomes.

Level of evidence: 3: