Laryngoscope最新文献

Treatment for Zenker's diverticulum has evolved to include flexible endoscopic approaches to septum division and cricopharyngeal myotomy. Here we demonstrate flexible endoscopic septum division using the blue light laser with attention to laser parameters, laser-tissue interactions, and procedural technique.

Objectives: Endoscopic resection and mucosal reconstitution with epidermal grafting (i.e., ER, known as the Maddern procedure) is a minimally invasive surgery introduced 10 years ago to treat subglottic stenosis (SGS). Here we describe a multi-institutional case series to answer questions about durability, patient selection, and complications.

Methods: A retrospective review of idiopathic SGS patients who underwent ER at four institutions since 2016. Patients were stratified by primary definitive (only had previous dilations) and rescue (performed for recurrence after laser wedge resection, open surgery, or previous ER) procedures. Outcomes included complications, disease recurrence, need for tracheostomy, peak expiratory flow rates, and surgery-free period following the operation.

Results: Thirty-six ER procedures were performed in 33 females and 1 male. Average participant age was 49 (30-72) years and BMI 28.5 (19.1-41.5) kg/m². Seven patients underwent tracheostomy with ER surgery, and five were confirmed to be decannulated afterwards. Recurrence was 21% (6/29) and 71% (5/7) in the primary definitive and rescue cohorts, respectively. Successful ER cases had a long-term post-ER surgery free interval of 61.6 months compared to 8.4 months pre-ER (p < 0.05), and peak expiratory flow rates of 97% expected post-ER compared to 55% expected pre-ER (p < 0.0005). These peak expiratory flow rates were maintained at 87% expected at last patient follow-up (p < 0.0005).

Conclusion: This multi-institutional series demonstrates that the minimally invasive ER procedure, when used as primary definitive surgery, provides durable outcomes for iSGS with a recurrence rate similar to that of open cricotracheal resection over the course of an 8-year follow-up period.

Level of evidence: 4:

Objective: Endoscopic intervention is a common approach to improve airway patency and breathing outcomes in patients with subglottic stenosis, but effects on voice are underreported. This review aims to assess the current evidence on how endoscopic intervention influences voice outcomes in individuals with subglottic stenosis.

Data sources: A systematic review was conducted by searching PubMed and Cochrane for studies published through June 2025 on voice outcomes following endoscopic airway surgery for subglottic stenosis.

Review methods: Studies were reviewed by three authors, and data related to patient-reported outcome measures, auditory-perceptual characteristics, and acoustic and aerodynamic analysis were extracted and analyzed.

Results: A total of 2351 abstracts were screened, with 8 meeting inclusion to be included in the final analysis. All studies employed observational designs, primarily retrospective chart reviews and prospective cohort studies, with notable heterogeneity in outcome measures. Among 829 subjects, the mean age was 50.9 years, and 96.5% identified as female. Patient-reported outcome measures (VHI, VHI-10, V-RQOL, and GFI) demonstrated improvement of inconsistent statistical significance. Auditory-perceptual ratings assessed using GRBAS or CAPE-V scales were generally mild in dysphonia severity preprocedure and were generally preserved postprocedure. Acoustic measures of perturbation and aerodynamic laryngeal resistance suggested improvement postprocedure.

Conclusion: Endoscopic dilation shows potential in improving voice outcomes, though definitive conclusions are hindered by current evidence limitations in a heterogeneous disease process. Future research should focus on utilizing comprehensive, validated voice outcomes, controlling for surgical technique variability, and strengthening methodological rigor to support more robust analysis and facilitate patient counseling.

Objectives: Obesity is an established risk factor for asthma, which shares common inflammatory pathways with chronic rhinosinusitis (CRS). However, the link between obesity and CRS remains poorly understood. By identifying trends in the structured histopathology (SHP) of obese patients with CRS, we aim to better understand how changes in the tissue architecture of obese patients may contribute to CRS.

Methods: Retrospective chart review was conducted on 476 patients with CRS with and without nasal polyps who underwent functional endoscopic sinus surgery. Data were collected on SHP, demographics, and comorbidities. Chi-squared, logistic analyses, and multivariate analysis were performed.

Results: The patient cohort was 53.8% female. Mean age was 52.01 years and mean BMI was 29.74. A total of 290 (60.9%) patients were nonobese (BMI < 30), 100 (21.0%) were Class I obese (BMI 30-34.9), 40 (8.4%) were Class II obese (BMI 35-39.9), and 46 (9.7%) were Class III obese (BMI ≥ 40). It was found that class III obesity was associated with statistically significant increases in several histopathological markers, including hyperplastic/papillary changes (17.4% vs. 5.6%, p < 0.026), Charcot-Leyden crystals (17.4% vs. 6.6%, p < 0.037), and squamous metaplasia (26.1% vs. 17.6%, p < 0.028). Multivariate analysis was performed, controlling for asthma, smoking, CRS subtype, and diabetes mellitus status. None of the variables were identified as confounders.

Conclusion: Several SHP variables are significantly more prevalent in obese patients who underwent functional endoscopic sinus surgery. This may serve as a predictor of CRS severity and suggests CRS in Class III obese patients follows a non-type 2 inflammatory pathway.

Level of evidence: 4:

Trial registration: ClinicalTrials.gov Identifier: NCT03816891.

Objectives: Idiopathic subglottic stenosis (iSGS) is an unexplained fibrosis of the proximal airway that predominantly impacts Caucasian women. Clinically, premenopausal patients suffer from higher recurrence rates, potentially implicating ovarian hormone 17B-estradiol (E2) in disease pathogenesis. Despite its relationship with disease phenotype and severity, the mechanistic role of E2 in subglottic fibrosis has not been investigated.

Methods: Primary human cell lines derived from the airway scar of iSGS patients were utilized for in vitro study to assess the impact of E2 on proximal airway cells (fibroblasts, epithelial cells, and endothelial cells). Alterations in RNA and extracellular matrix protein expression were assessed in fibroblasts (n = 5 primary cell lines) following E2 exposure. The impact of E2 on epithelial barrier function was assessed via transepithelial electrical resistance measurement (TEER) in iSGS-patient-derived epithelial primary cell lines (n = 3) grown via air-liquid interface (ALI) culture. The impact of E2 on iSGS-patient-derived endothelial lines was assessed using a Matrigel-based tube formation assay.

Results: There were no significant transcriptional changes induced in fibroblasts after exposure to E2 when compared to controls, nor was a difference in collagen production observed after E2 exposure. There was no significant difference in TEER measurements in airway epithelial cells grown at ALI following E2 exposure. Endothelial cells showed a significant increase in tube formation following E2 exposure.

Conclusion: In vitro models suggest E2 may have limited direct impact on fibroblasts and epithelial cells in iSGS. Instead, estrogen acts directly on airway endothelial cells to drive vascular remodeling, potentially contributing to mucosal fibrosis.

Level of evidence: NA.

Objective: Transoral swallowing surgery (TOSS) based on endoscopic cricopharyngeal myotomy (ECPM) in combination with fat injection laryngoplasty (FIL) and/or pharyngeal flap surgery (PFS) is a useful treatment option for pharyngeal dysphagia. However, no quantitative evaluation method has been established to predict surgical outcomes. This study aimed to clarify swallowing pressure conditions that affect the outcome of TOSS for pharyngeal dysphagia.

Methods: Twenty-two patients with pharyngeal dysphagia who had undergone high-resolution manometry before and after TOSS were enrolled. TOSS procedures included ECPM alone in 8 patients, ECPM+FIL in 5, and ECPM+FIL + PFS in 9. Good surgical outcome (GS) was defined as achieving a functional oral intake scale (FOIS) level of ≥ 4 on a 7-point scale or an improvement in FOIS level by ≥ 2 for those with a preoperative level of 4 or 5. Manometric data in the nasopharyngeal, oropharyngeal, hypopharyngeal, oro-hypopharyngeal, and upper esophageal sphincter (UES) zones were compared between patients with and without GS (GS and non-GS groups, respectively) and by procedure.

Results: Mean pre- to postoperative FOIS levels in the GS group (n = 14) and non-GS group (n = 8) ranged from 2.6 to 5.7 and 3.3 to 3.8, respectively. There were significant differences between the GS and non-GS groups in distal contractile integrals (DCIs) of the oropharynx and oro-hypopharynx. All postoperative pharyngeal pressures and DCIs of the pharynx were increased, whereas those related to the UES were decreased.

Conclusion: Our manometric analysis revealed that preoperative oropharyngeal pressure is a factor influencing the outcome of TOSS, regardless of UES pressure. TOSS can produce efficient postoperative pressure changes.

Level of evidence: 3:

Objectives: Olfactory evaluation beyond conventional domain testing may inform how olfactory impairment presents among the general population. Recently reported assessments based on odor matching (NOST) and intensity sorting (ODS) may provide additional insight into olfactory function. Characterizing performance of these simple and self-administered tasks among a community-based population offers a valuable benchmark for subsequent evaluation in aging and cognition-impaired cohorts.

Methods: Seventy community-based individuals completed Sniffin' Sticks TDI testing, NOST, and ODS. NOST is an odor matching task among twelve pairs of odorants, and ODS is an odor intensity scaling task. Scores were compared to TDI using Spearman correlations and Wilcoxon signed-rank tests.

Results: NOST median score was 6 (IQR: 4, 9) while ODS was 0.80 (0.70, 0.85). NOST correlated with TDI (r; [confidence interval]: 0.640, [0.47, 0.76]), threshold (0.342; [0.11, 0.54]), discrimination (0.556; [0.36, 0.70]), and identification (0.297, [0.06, 0.50]), but not with ODS. Participants performed significantly better on the ODS-Eugenol trial than on the ODS-PEA trial, with median scores of 0.90 (IQR: 0.80, 1.0) and 0.70 (0.50, 0.80), respectively (p < 0.001).

Conclusions: NOST correlates strongly with odor discrimination in this community-based population, while ODS shows no significant correlations with any TDI subdomains. The lack of several strong correlations on either assessment with overall TDI suggests these assessments may evaluate domains of smell and cognition not previously captured by standalone TDI testing. Continued validation of NOST and ODS across a broad population with ranging olfactory and cognitive statuses is needed to fully characterize the utility of these well-tolerated, self-administered olfactory tests.

Level of evidence: 2:

Objective: Cochlear implantation often requires frequent post-operative programming visits which can disrupt daily life, impose financial burdens, and delay access for new cochlear implant (CI) candidates. This study evaluated the feasibility of a de-escalated schedule of four programming appointments within the first year after surgery.

Methods: A retrospective review was completed for 236 patients aged 0-100 years who received CI from July 2022 to December 2023. Explants, reimplants and second CI within the study window were excluded. Collected data included demographics, schedule adherence, additional visit reason, and Consonant-Nucleus-Consonant (CNC) word scores for adults.

Results: A total of 201 CI recipients (mean age 46.9 years; 72.6% adults) met inclusion criteria. Most were male (53%), White (88%), Non-Hispanic (54.7%), and privately insured (56.2%). Overall, 53% adhered to the 4-visit protocol, 35% required 1-2 additional visits, and 12% required 3-6. Among those requiring additional appointments (n = 95), 28.4% followed the prior protocol of up to 10+ visits. Adherence to the new streamlined protocol improved by 43% over the study period. On multivariate analysis, each additional year of age at surgery reduced the odds of adherence by 3.4% (p < 0.05). No statistical or clinical differences were observed in 12-month CNC scores between patients with ≤ 4 versus > 4 visits.

Conclusions: A de-escalated post-CI programming schedule of four visits in the first year is feasible and does not compromise adult speech perception outcomes. Older patients may require closer follow-up. Successful implementation may require time for workflows and provider adoption.

Level of evidence: 3:

Objective: Studies have shown balloon dilation of the Eustachian tube (BDET) to play a beneficial role in the treatment of obstructive Eustachian tube (ET) dysfunction in adults. This analysis was undertaken to clarify this role.

Data sources: Cochrane Central Register of Controlled Trials, PubMed, Embase Ovid, ClinicalTrials.gov, WHO-ICTRP, EU Clinical Trials Register, and Google Scholar.

Review methods: This review analyzed randomized controlled trials published through 29 February 2024, updated on 11 January 2025, comparing the effects of BDET with no treatment, medical treatment, or auto-inflation exercises. Outcomes included improvement in tympanogram, decrease in air-bone gap on audiometry, new ability to perform Valsalva, otoscopic confirmation of improvement in tympanic membrane retraction, or new documented mobility of the membrane on pneumatic otoscopy.

Results: Eleven trials were analyzed, four excluded with reasons and seven included in the analysis. On analysis of 315 participants from three trials who underwent BDET in comparison to control, the relative risk of benefit of post-operatively reaching Type A tympanogram was 4.68 (2.88-7.51) in comparison to control. BDET was also seen to offer significantly more closure in air-bone gap when performed along with tympanoplasty in patients with adhesive otitis media at both 3-month (air-bone gap closure of 3.82 dB [0.47-7.17 dB]) and 6-month (air-bone gap closure of 4.06 dB [1.78-6.34 dB]).

Conclusion: In adults with chronic ET dysfunction, BDET increased the chance of achieving a Type A tympanogram curve and significantly improved air-bone gap closure when performed along with cartilage tympanoplasty.

Level of evidence: 1a.