Laryngoscope最新文献

Objectives: One principle of facial aesthetics is based on "facial thirds," and hairline recession/large foreheads disrupt this balance. Hairline lowering can improve harmonious aesthetics and often uses bioabsorbable implants. This study seeks to establish the outcomes and stability of hairline lowering using the Endotine Forehead-mini in a single-surgeon cohort in the United States.

Methods: This is a retrospective review of a single-surgeon cohort from 2011 to 2024 that underwent hairline lowering. Patient demographics, outcomes, and complications were documented. Upper facial third ratios were measured preoperatively and postoperatively and compared using paired t tests. The stability of the upper facial third ratio was assessed over time using paired t tests between the first postoperative visit and subsequent visits.

Results: 100 patients were included, with 58 having images available for analysis. 100% of patients had a statistically significant reduction in upper third percentage medially (μ = 3.5% lower, 95% CI = 3.1%-3.8%, p < 0.001) and laterally (μ = 3.1% lower, 95% CI = 2.7%-3.6%, p < 0.001) at their first postoperative visit. As patients travel for this procedure, follow-up varied; however, hairline lowering was stable from first follow-up to 3-6 months, 6-12 months, and past 12 months. Patient satisfaction appeared high but was not formally assessed. Complications occurred in 26% of patients: transient alopecia in 14% (all resolved with minoxidil), 10% required additional surgery (scar revision, further hairline lowering, or hematoma evacuation), 2% had hematomas managed nonsurgically, 5% had scalp irritation, and 1% had a postoperative infection (treated with antibiotics).

Conclusion: Use of the Endotine Forehead-mini was associated with substantial, sustained hairline lowering with minimal risks.

Level of evidence: 4:

Objective: Laryngeal cancer is a significant head and neck malignancy, whose prevalence is increasing. Radiomics consists of high-dimensional and reproducible quantitative data which can serve as biomarkers with strong correlations to tumor staging, prognosis, and survival outcomes. The aim of this scoping review is to summarize the knowledge from the existing literature regarding the value of radiomics in laryngeal cancer management.

Data sources: Eligible articles were identified by a search of the Medline and PubMed bibliographical databases for the period up to May 2025.

Review methods: This scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the included studies was assessed using the Radiomics Quality Score (RQS) framework.

Results: Thirty studies were deemed eligible, including a total of 3503 patients with laryngeal cancer. Primary objectives were the development of predictive models for overall survival, progression-free survival, local control, treatment response, and staging. Across studies, radiomics-based models consistently outperformed clinical or conventional imaging-based models in predicting key outcomes. Models combining radiomic features with clinicopathological variables achieved the highest accuracy. Recent advances include the use of deep learning, which further improved predictive performance compared to traditional radiomics. However, common limitations include heterogeneity in imaging protocols, feature extraction software, and model development algorithms, as well as a lack of external validation.

Conclusion: Despite several limitations that currently hinder routine clinical adoption of radiomics, this rapidly evolving field demonstrates significant potential to improve staging accuracy, prognostication, and personalized management in laryngeal cancer.

We report the first case of tonsillar olfactory neuroblastoma with cervical lymph node involvement. The patient underwent induction chemotherapy followed by concurrent chemoradiotherapy, achieving complete remission. This case highlights the diagnostic challenges and therapeutic approach for this rare ectopic ONB.

Objective: Injection laryngoplasty is a common procedure to improve glottic closure following unilateral vocal fold paralysis (UVFP) or vocal fold atrophy. Allograft adipose matrix (AAM, Renuva, MTF Biologics) supports neoadipogenesis making it a potentially permanent solution. Given the known favorable properties of vocal fold lipoinjection, we hypothesize AAM to be a useful injection material with possible durable results following injection laryngoplasty.

Materials and methods: A prospective clinical trial of patients with UVFP underwent injection augmentation laryngoplasty with AAM. Blinded independent laryngologists and expert listeners used pretreatment and 3-month postinjection videostroboscopy and CAPE-V assessments to evaluate glottic closure, pliability and voice quality changes. Patient-reported outcome measures (PROMs) were evaluated.

Results: A total of 21 patients underwent AAM injection; 16 had a diagnosis of unilateral vocal fold paralysis and were included for analysis. There were no adverse reactions. The raters observed an improvement in post-treatment voice in 81.3% of cases, and CAPE-V scores showed an average reduction of 32.3 points (p < 0.01). There was an average reduction in VHI-10 scores of 11.3 (p = 0.02). The raters perceived the post-AAM treatment videostroboscopy exams to be better in 68.8% of cases. Thirty-seven percent of incomplete glottic closure was considered complete, and there was no change in pliability at 3 months post-AAM injection.

Conclusions: This is the first study on AAM as an injection material in the vocal fold for augmentation laryngoplasty in unilateral vocal fold paralysis. It appears to be safe and effective on early follow-up. Additional studies with longer follow-up are needed.

Level of evidence: 4:

Objective: The aim of this study was to investigate the influence of type of anesthesia on audiometric results, surgery duration, quality-of-life and complications associated with stapes surgery in patients with otosclerosis.

Data sources: A comprehensive literature search was conducted in five databases, including PubMed, Embase, SCOPUS, WoS, and Google Scholar.

Review methods: We have identified studies comparing the outcomes of stapes surgery under local-anesthesia (LA) versus general-anesthesia (GA) and published up to 30 May 2025. All analyses were performed using Comprehensive-Meta-Analysis-software and Review-Manager.

Results: Operating room occupancy was significantly lower in surgery under LA than GA (MD = -17.27 min, 95% CI [-24.72, -9.83], p < 0.001,I ² = 0%). Moreover, stapes surgery had a significantly shorter duration under LA compared to GA (MD = -8.79, 95% CI [-15.69, -1.88], p = 0.01,I ² = 0%). The meta-analysis on changes in AC, BC, SR thresholds, and ABG showed no significant difference between patients who underwent LA or GA (AC: MD = 0.704, 95% CI [-3.344, 4.752], p = 0.733; BC: MD = 0.191, 95% CI [-2.231, 2.612], p = 0.877; SR: MD = 0.103, 95% CI [-3.621, 3.827], p = 0.957; ABG: MD = 0.451, 95% CI [-0.788, 1.689], p = 0.476). The meta-analysis on ABG closure also showed no significant difference (< 10 dB: OR = 1.066, 95% CI [0.718, 1.582], p = 0.752; 10 to 20 dB: OR = 1.151, 95% CI [0.778, 1.705], p = 0.481; > 20 dB: OR = 0.833, 95% CI [0.537, 1.293], p = 0.416). Complications were the same for both types of anesthesia, but nausea and vomiting showed a marginally significant difference between LA and GA (OR = 2.578, 95% CI [0.988, 6.732], p = 0.053, I ² = 0%).

Conclusion: Stapes surgery under LA is associated with shorter surgical and operating room times while demonstrating non-inferior audiometric and safety outcomes compared to GA. These findings suggest that LA represents a safe and efficient alternative to GA for stapesplasty procedures.

Level of evidence: NA.

Objective: The aim of this study was to determine whether the body roundness index (BRI) differs between older adults with endoscopically defined presbylarynx and age-matched subjects and to examine its relationship with patient-reported outcomes and acoustic measures.

Methods: This prospective, cross-sectional study included adults aged ≥ 60 who were classified into a presbylarynx group and control group using videolaryngostroboscopy. Anthropometric measurements of height, weight, body mass index (BMI), and BRI were recorded. Patient-reported scales (T-VHI-10, T-RSI, and T-EAT-10) were applied and acoustic analyses were performed using standardized protocols. Group comparisons were performed using the Mann-Whitney U-test and χ ² Fisher's exact test.

Results: No significant difference was determined between the two groups of a total of 167 study participants (presbylarynx group n = 87; control group n = 80), in respect of the anthropometric indices (all p ≥ 0.113). Among symptomatic participants (T-VHI-10 > 7), a lower waist circumference (p = 0.016) and a significantly lower BRI (median 5.06 vs. 6.80; p = 0.003) were recorded for the presbylarynx group. The acoustic analysis results of the whole sample revealed higher shimmer (%), lower HNR, lower CPPS, and higher AVQI-3.0 in the case group (all p < 0.05).

Conclusion: Although conventional anthropometric measures were similar in the whole population, a lower BRI was a notable finding among symptomatic individuals with presbylarynx, who also presented with a noise-dominant acoustic profile. Integrating body composition markers, such as BRI, with acoustic biomarkers may help to refine phenotyping and inform targeted rehabilitation strategies for the aging voice.

Level of evidence: 3:

Objectives: The U.S. Preventive Services Task Force (USPSTF) recommends annual lung cancer screening for adults aged 50-80 years who have a smoking history of at least 20 pack-years and are current smokers or have quit within 15 years. We hypothesized that many patients with T1 and T2 glottic carcinoma who meet lung cancer screening criteria are not being screened secondary to a lack of awareness among laryngologists.

Methods: This retrospective, cross-sectional review evaluated lung cancer screening implementation for T1N0 and T2N0 glottic cancer patients at our institution from 1996 to 2023. We compared chest CT utilization based on USPSTF lung cancer screening criteria. A survey was distributed to laryngologists to evaluate provider practice patterns and lung cancer screening awareness.

Results: A total of 133 patients met the inclusion criteria. Of these, 56 met USPSTF lung cancer screening guidelines, and 48% (27/56) received a chest CT. For those who were ineligible for screening, 61% (47/77) received a chest CT. A total of 66 laryngologists completed the survey. Of these, 75% answered that they were "somewhat familiar" or less with USPSTF lung cancer screening guidelines. Thirty-nine percent responded that they never or rarely order imaging for lung cancer screening.

Conclusions: The incidence of SPLC in patients with early glottic cancer is high (5.6%). Patients with laryngeal cancer who meet USPSTF screening guidelines should undergo chest screening for early detection and reduced mortality in this high-risk population. Increased education and awareness among laryngologists are critical to bridge the gap in screening implementation.

Level of evidence: 3:

Objectives: Residency exposures help shape trainees' decisions to pursue further academic training. In pediatric otolaryngology, the care of complex patients requires advanced training and expertise beyond general residency training. The aim of this study was to determine if specific characteristics of the pediatric experience in residency are related to pursing a pediatric otolaryngology fellowship.

Methods: Web based analysis of all 128 ACGME Otolaryngology residency programs and graduates from 2017 to 2022 utilizing individual program websites and the Doximity Residency Navigator. Characteristics obtained included program size, location, and pediatric rotation characteristics (free-standing children's hospital, associated accredited fellowship, pediatric fellowship trained faculty). Each individual graduate listed in program websites was profiled on the basis of their google webpage to identify those listing pediatric otolaryngology training. Multivariate and univariate analysis were employed for statistical analysis.

Results: Residency programs with rotations at children's hospitals with pediatric fellowships had significantly more graduate's complete pediatric otolaryngology fellowships (25.6% vs. 63.6%, p = 0.001). This held true on multivariate analysis (OR = 5.0 (1.5-18.0), p = 0.010) when controlling for program location, rotation at a Children's hospital, and rotation at a Children's hospital with fellowship. Programs in the Midwest region were 4.4 times more likely to produce graduates pursuing pediatric fellowship training versus other regions (p = 0.038). Program size did not associate with graduates seeking fellowship.

Conclusion: Exposure to hospitals with pediatric otolaryngology fellowships increased the likelihood of trainees who pursue pediatric otolaryngology fellowships. Future studies further investigating resident perceptions of their pediatric experience and their motivation to pursue pediatric otolaryngology fellowship will be beneficial.

Level of evidence: N/A.

Objectives: Disturbance of hearing or olfaction is known to be associated with cognitive impairment. Multisensory impairment-simultaneous dysfunction in multiple senses-is common among older adults. This study examined the relationship between cognitive impairment and the co-occurrence of olfactory and auditory dysfunctions in older adults.

Methods: Data were obtained from a population-based survey. Of 1346 randomly selected residents, 527 participated; after excluding 22 with incomplete data, 505 residents aged 65-84 years were enrolled. Cognitive function was assessed using the Japanese Quick Mild Cognitive Impairment Screen (Qmci-J). Olfactory and auditory function, assessed using the Open Essence test and pure-tone audiometry, respectively, were classified as normal, moderate, or severe, yielding nine combined groups. Associations with cognitive impairment (Qmci-J ≤ 60) were examined using modified Poisson regression to estimate the prevalence ratio (PR), adjusting for demographic, health-related, and socioeconomic covariates.

Results: Among 505 participants, 225 (44.6%) had cognitive impairment. Severe dysfunction in either olfaction or audition, combined with at least moderate dysfunction in the other, was significantly associated with cognitive impairment. The highest PR was observed in participants with severe dysfunction in both senses (PR = 1.90, 95% CI: 1.16-3.10). These associations remained significant even after adjustment for all covariates. Although no significant additive or multiplicative interaction was observed, the co-occurrence of severe olfactory and auditory dysfunctions showed the highest PR, consistent with an additive effect.

Conclusion: Olfactory and auditory dysfunctions are additively associated with cognitive impairment, highlighting the importance of considering multisensory impairment in older adults.

Technical efficacy: The technical efficacy of this study is high. The study design, data collection procedures, and statistical analyses are clearly described and reproducible. In addition, all key assessments used in this study, including the Quick Mild Cognitive Impairment Screen (Qmci), the Open Essence Test, and pure-tone audiometry, are standardized, validated, and widely accepted measures, as detailed in the manuscript.

Level of evidence: 3: