Laryngoscope最新文献

Objective: The inflammatory role of female hormones has been garnering increased attention in the literature. Studies suggest a link between estrogen and inflammatory conditions of the airways and nasal mucosa. However, there remains a paucity of literature regarding the associations of hormones with rhinitis. Given the profound hormonal changes that occur during menopause, we sought to better understand the association between menopause and rhinitis.

Methods: Data from the All of Us Research Program regarding rhinitis diagnoses, menopause status, demographic variables, socioeconomic status, and comorbidities were extracted for female participants aged 40-60. Crude odds ratios (cORs) and 95% confidence intervals (CIs) were calculated for unadjusted associations between menopause and rhinitis. Variables were then included in multivariable logistic regression models, with separate models for allergic rhinitis (AR) and nonallergic rhinitis (NAR) as the outcome variables. Adjusted odds ratios (aOR) and 95% CI were calculated.

Results: We identified 40,875 female participants aged 40-60 without any missing data. Compared with participants without rhinitis, a greater proportion of those with AR (51.6% vs. 55.6%; cOR: 1.18; 95% CI: 1.11-1.25) and NAR (51.6% vs. 58.9%; cOR: 1.34; 95% CI: 1.11-1.63) had experienced menopause. However, after controlling for covariates, menopause was associated with a decreased odds of AR (aOR: 0.89; 95% CI: 0.82-0.96) and not associated with NAR (aOR: 0.98; 95% CI: 0.77-1.24).

Conclusion: Menopause was independently associated with a decreased odds of AR but was not associated with NAR. Research should aim to further examine these relationships and hormonal mechanisms underlying the observed protective associations.

Level of evidence: 3 Laryngoscope, 2025.

Objectives: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) categorizes fine needle aspiration and cytology (FNAC) results into 6 tiers and assigns a risk of malignancy (ROM) to each category. Its utility in submandibular gland lesions remains unclear. Our article aims to study (1) the utility of the MSRSGC in classifying FNAC of submandibular gland masses, (2) describe the demographics and incidence of submandibular gland malignancy in our population, and (3) analyze the accuracy of FNAC in diagnosis of benign and malignant submandibular gland tumors.

Methods: In this retrospective case series, the FNAC results of 92 patients who underwent pre-operative FNAC and excision of submandibular gland between May 2008 and December 2023 were reviewed and assigned to a MSRSGC category, and ROM was calculated based on histological diagnosis.

Results: 20/92 (21.7%) submandibular gland excisions with pre-operative FNAC were malignant. ROM is as follows: non-diagnostic 7.1%, non-neoplastic 12.5%, atypia of undetermined significance 35.3%, benign neoplasm 3.3%, salivary gland neoplasm of uncertain malignant potential 35%, suspicious for malignancy 100%, and malignant 100%.

Conclusion: Our study validates the usage of the MSRSGC in the work up of submandibular gland tumors.

Level of evidence: 4 Laryngoscope, 2025.

Background: Endoscopic techniques allow for improved visualization and tumor debulking of pituitary adenomas. More thorough tumor resection, however, can be associated with higher rates of CSF leaks. We set out to determine if CSF leaks influenced patient perceived quality of life outcomes.

Methods: This retrospective study included 152 patients who underwent endoscopic pituitary tumor resection over a 10-year period. QoL was assessed using the SF-36 questionnaire and completed before surgery, 6 weeks and 6 months post-operatively. Statistical analysis was conducted using a equivalence test and a two-way mixed model ANOVA to assess intraoperative CSF leak, postoperative CSF leak, redo surgery, and the use of a lumbar drain.

Results: Of the 152 patients, 98 had a potential intraoperative CSF leak. Intra- and postoperative CSF leaks did not significantly impact patient reported QoL outcomes at 6 months following surgery. There was clinical equivalence in mental scores as early as 6 weeks and 6 months for physical scores. There was no statistically significant difference in physical (p-value = 0.975) and mental (p = 0.204) scores for patients who experienced a postoperative CSF leak. There was no statistically significant difference in QoL in the mental and physical scores for patients that received a lumbar drain (physical score p = 0.832; mental score p = 0.915) or redo surgery (physical score p = 0.830; mental score p = 0.204).

Conclusion: This article demonstrates that CSF leaks do not impact patient-reported QoL outcomes at 6 months post-surgery. This will allow surgeons to better provide insight and counsel patients regarding the relevance of CSF leaks in the setting of pituitary procedures.

Level of evidence: III Laryngoscope, 2025.

Pharyngitis is commonly caused by the gram positive bacteria, streptococcus. Given the potential morbid complications of untreated streptococcal pharyngitis, antibiotics are critical. One of the rarer complications is pulmonary-renal syndrome (PRS), defined as rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage. PRS is associated with high rates of morbidity and mortality, making swift diagnosis and treatment imperative for survival. More common causes of PRS are tied to autoimmune diseases. This case describes a novel progression of PRS caused by streptococcus. A 26-year-old male with no significant medical history presented to our emergency department with streptococcal group A-positive sore throat. After discontinuing amoxicillin due to pruritus, the patient returned one month later with persisting hematuria and dysuria, diagnosed with post-streptococcal glomerulonephritis. Despite receiving another antibiotic prescription, it was not filled. He returned six days later with worsening symptoms, leading to ICU admission due to hemoptysis requiring subsequent intubation. Diffuse alveolar hemorrhage was confirmed with bronchial washings. Negative autoimmune laboratory results and clinical symptoms suggest streptococcal pharyngitis induced pulmonary-renal syndrome. Although only the sixth case of streptococcal induced PRS, it is imperative to consider when treating patients with diffuse alveolar hemorrhage, due to its possible mortality. Prompt recognition and treatment with pulse steroids and plasmapheresis is crucial for PRS resolution. Laryngoscope, 2025.

Objectives: To investigate hearing aid utilization rates among populations with varying hearing aid insurance benefits.

Methods: A retrospective cohort study was performed. A total of 377 patients were included in the study after being identified through consecutive, hearing loss-related otology clinic visits. With respect to hearing aid benefits, patients were separated into full, partial, and no coverage populations. Chart reviews identified if a patient underwent hearing aid evaluation and fitting. Audiometric data were collected. Chi-square tests of independence and two-sided Z-tests were used for statistical analysis. ANOVA single-factor analysis testing was used to analyze pure tone averages (PTA) and word recognition scores (WRS) data.

Results: The 377 patients who met criteria included: full insurance coverage (n = 210, mean age = 45 years), partial coverage (n = 82, mean age = 65 years), and no coverage (n = 85, mean age = 54 years). The full- and partial-coverage populations each had significantly higher hearing aid utilization rates (78% and 79%, respectively) than the no-coverage population (49%, p < 0.001). No statistical difference in mean PTA or WRS was noted among the three coverage categories.

Conclusion: Patients with at least partial financial coverage are more likely to acquire hearing aids than those without despite similar degrees of hearing loss. This implies that the out-of-pocket cost of hearing aids is a primary impediment to hearing aid adoption and provides a useful road map for public and private insurers considering hearing aid coverage.

Level of evidence: Level III (retrospective cohort study) Laryngoscope, 2025.

Objective: Prior studies have highlighted the risk of perioperative mortality due to catastrophic bleeding in patients receiving transoral surgery (TOS) for oropharyngeal squamous cell carcinoma (OPSCC). Although the 30-day mortality and morbidity remain low, understanding the risk factors associated with complications is still required. The goal of this study is to identify risk factors associated with complications after TOS for OPSCC using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Methods: A multi-institutional retrospective cohort analysis of the ACS-NSQIP database identified 3,489 patients undergoing TOS for OPSCC between 2010 and 2021. Preoperative risk factors were collected. The primary outcomes were 30-day readmission, reoperation, hemorrhage, and death. Univariate and multivariate analysis was used to identify preoperative risk factors associated with the primary outcomes.

Results: The mean age was 60.6 years, and 81.5% were male. There were 24 deaths (0.7% 30-day mortality rate). The rates of readmission and reoperation were 8.9% and 5.8%, respectively. Smoking (OR = 1.440, 95% CI = 1.097-1.890) and CHF (OR = 3.525, 95% CI = 1.320-9.414) were associated with readmission. Diabetes and ASA 3+ increased the risk of both reoperation (diabetes: OR = 2.679, 95% CI = 1.110-6.468, ASA: OR = 1.701, 95% CI = 1.233-2.346) and hemorrhage (diabetes: OR = 3.488, 95% CI = 1.020-11.926, ASA: OR = 2.290, 95% CI = 1.394-3.764).

Conclusion: This study redemonstrated the safety of TOS for OPSCC, with low 30-day readmission and reoperation rates. Smoking, diabetes, CHF, and ASA 3+ were important preoperative risk factors for complications.

Level of evidence: 3: Laryngoscope, 2025.

Objective: To provide evidence to use an extended frequency pure tone average to screen for cochlear implant evaluation candidates as recommended by the American Cochlear Implant Alliance. Additionally, to determine whether traditional low frequency, high or low frequency, high frequency, or extended frequency pure tone average most accurately predicts cochlear implant candidates based on speech perception scores from aided AzBio sentence testing or aided consonant-nucleus-consonant (CNC) testing.

Method: Adults from a tertiary care center who completed aided sentence testing during cochlear implant evaluation between 2014 and 2024 were assessed. Pure tone averages at low, high, low or high, and extended frequency ranges were evaluated with individual ear's aided AzBio or aided CNC scores as an outcome. Sensitivity, specificity, negative predictive value, and positive predictive value were assessed and compared using a paired study design.

Results: There were 675 observations from 363 patients with AzBio as an outcome variable and 665 observations from 364 patients with CNC scores as an outcome variable. High or low frequency achieved the highest sensitivity at 96.3% AzBio as an outcome and 95.6% with CNC as an outcome, which was significantly better than low frequency (p < 0.001). Low frequency achieved the best specificity at 63.6% with AzBio as an outcome 76.9% with CNC as an outcome.

Conclusion: Extended frequency pure tones resulted in greater sensitivity in predicting CI candidates compared with the traditionally used low frequency pure tone average. Screening with wider frequency values will lead to a greater number of patients being identified for a cochlear implant evaluation.

Level of evidence: Level 3 Laryngoscope, 2025.

Introduction: Therapy is a common treatment for dysphonia attributable to vocal fold atrophy and chronic cough with the goal of decreasing procedural intervention. We compared the rates of therapy adherence and the factors associated with therapy adherence across groups.

Methods: Retrospective chart review at a single institution since 2019. Groups were compared with chi-square and relative risk.

Results: Across both diagnoses, 263 patients were identified; 131 (49.8%) with vocal fold atrophy and 132 (50.2%) with chronic cough. 173 patients (66%) were referred to speech therapy (81/131 atrophy, 61.8%; 91/132 cough, 69.7%; p = 0.207). Patients were evaluated in a multidisciplinary setting 30.1% of the time. Among those referred to therapy, patients who underwent their initial evaluation the same day within a multidisciplinary clinic were more likely to complete their course (30.7% vs 10.7%, p = 0.001). This association held on multivariable analysis (relative risk [RR] 2.39, 95% confidence interval 1.13-5.07, p = 0.02). Patients with atrophy and cough had similar therapy completion rates (22.2% vs 11.9%, p = 0.07). Male patients were more likely to complete therapy on multivariable analysis (RR 2.35, 1.16-4.47, p = 0.017). Patients who completed a procedure prior to therapy were not more likely to complete their course (p = 0.52).

Conclusions: Multidisciplinary clinic with a speech pathologist and laryngologist is associated with an increased rate of therapy adherence in both vocal fold atrophy and chronic cough, regardless of diagnosis. Pre-therapy procedural interventions were not associated with increased therapy adherence.

Level of evidence: 3 Laryngoscope, 2025.

We present a simple and innovative sialendoscopy basket stone retrieval (BSR) simulator model composed mainly of a 1.0-mL insulin syringe with detachable needle whose lumen mimics a dilated salivary duct. Dried Guava seeds are used to imitate small-sized floating sialoliths. The BSR simulator is evaluated by sialendoscopy trainees to ensure its realism and efficiency. Laryngoscope, 2025.