Laryngoscope最新文献

Objective: To examine the effects of globus pallidus interna (GPi) and ventral intermediate nucleus of the thalamus (VIM) deep brain stimulation (DBS) on patients with adductor laryngeal dystonia (ADLD).

Methods: Seven patients with ADLD underwent DBS (GPi = 4; VIM = 3) surgery. Postoperative voice testing was performed after stable DBS programming. Primary outcome measures included tremor rate, extent of fundamental frequency/intensity modulation, percentage of voicing, duration/number of voice breaks, and cepstral peak prominence. Linear mixed effects models tested voice improvement after GPi and VIM surgery, with significance determined after controlling for multiple comparisons.

Results: GPi-DBS showed trends for improved percentage of voicing, duration of voice breaks, number of voice breaks, and extent of intensity modulation pre-post within-group with large effect size. VIM-DBS showed trends for improved tremor rate within-group with large effect size. Between-group comparison showed greater improvement in percentage voicing and extent of intensity modulation in patients with GPi-DBS compared to VIM-DBS, whereas tremor rate showed greater improvement after VIM-DBS compared to GPi-DBS. Duration of voice breaks showed more improvement in GPi than VIM but it did not achieve statistical significance after multiple comparison adjustments.

Conclusions: Objective acoustic voice analyses provide preliminary, target-specific patterns that warrant confirmation of bilateral GPi-DBS for patients with ADLD and bilateral VIM-DBS for those with both ADLD and vocal tremor. Future research with larger sample sizes, along with investigations into the neuronal mechanisms underlying laryngeal neuromodulation, is needed to further evaluate the role of DBS in treating ADLD.

Level of evidence: 3:

Objective: Aspiration pneumonia is a major cause of morbidity and mortality in adults with swallowing impairment. Exosomes from mesenchymal stromal cells (MSCs) present a potential therapeutic for aspiration pneumonia. This study aimed to assess the potential of MSC exosomes to mitigate lung inflammation in a murine aspiration model.

Methods: Seventeen adult male rats were divided into three groups: Animals in the LPS-EXO group (n = 7) underwent intratracheal instillation of 2.5 mg/kg lipopolysaccharide (LPS) aspirate and 40 μL of MSC exosome therapeutic intravenously. The LPS-only group (n = 7) underwent LPS aspiration alone without exosome therapy. Three rats underwent instillation of air as sham controls. All animals were euthanized 6 h post instillation. Histopathologic lung injury severity was determined and gene expression of pro and anti-inflammatory cytokines was evaluated using quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR).

Results: The mean composite histologic lung injury score was 8.3 (±1.1) for the LPS-only group, 7.13 (±3.2) for the LPS-EXO treatment group, and 3.3 (±1.1) for the sham control group. One-way ANOVA showed a significant group effect (p = 0.02), and trend analysis revealed a significant linear improvement across groups (p = 0.006; η² = 0.43). qRT-PCR showed significantly lower Tnf expression in the LPS-EXO group versus the LPS-only group (p < 0.05). No other significant differences were found between the LPS-EXO and LPS-only groups on qRT-PCR.

Conclusions: Results of this preliminary investigation suggest that intravenous delivery of MSC exosomes reduces expression levels of proinflammatory cytokine Tnf and attenuates histopathological markers of lung injury in a murine model of aspiration-induced lung damage.

Level of evidence: NA.

Objectives: The electronic health record (EHR) has benefits but also adds documentation burden that is not equally shared between academic faculty. We hypothesize that male gender and senior academic rank are associated with decreased EHR burden compared to female and junior faculty.

Methods: Demographics from faculty at participating organizations were combined with 3 years of provider efficiency data. Multivariate analyses were performed to evaluate the differences in EHR burden between genders and academic ranks, clustering for otolaryngologist and institution.

Results: Forty-six institutions with 914 otolaryngologists (female, n = 283, 31%) were included for analysis. Median hours per day (h/d) spent in EHR tasks related to outpatient visits were 4.3, 3.5, and 3.4 h/d for female assistant, associate, and full professors, respectively; and 3.4, 2.7, and 2.3 h/d for males, likewise in ascending academic rank. These differences between median h/d in ambulatory time were significant across all six subgroups of gender and academic rank (p < 0.002). Academic seniority, but not gender, was associated with less time in ambulatory tasks after work and on days without scheduled appointments (p < 0.002). Males and otolaryngologists with higher academic rank were more likely to receive help with notes and orders (p < 0.002).

Conclusions: For a typical clinic day, female assistant professors in academic otolaryngology spent nearly twice as much time as their male full professor counterparts did in the EHR completing tasks related to ambulatory patient care. The differential likelihood of faculty receiving help with notes and orders may play a role in this disparity.

Level of evidence: 3:

Objective: Laryngomalacia diagnosis and subtype classification is typically based on flexible nasolaryngoscopy, but this can be challenging, particularly for clinicians who see it infrequently. Infant movement may also prolong the procedure. Automated computer vision (CV) assessment of video nasolaryngoscopy may improve diagnostic accuracy, shorten procedure time, and reduce infant discomfort. The aim was to develop a CV model to segment laryngeal anatomy, differentiate between normal and laryngomalacia cases, and classify laryngomalacia type (1, 2, or 3).

Methods: A total of 241 pediatric nasolaryngoscopy videos were obtained from The Hospital for Sick Children between August 2023 and March 2025 from participants < 1 year old. Videos were annotated and randomly assigned to a training set [192 (80%)] and testing set [49 (20%)]. Three binary classification models (fine-tuned for feature extraction) were developed to predict laryngomalacia and classify its type. CV predictions were compared with diagnoses made by three staff otolaryngologists.

Results: The CV model's Dice similarity coefficient for laryngeal anatomy segmentation was 0.86 (95% CI: 0.85-0.88). The model differentiated normal from laryngomalacia cases with an accuracy of 0.90 and predicted type 1 and type 2 laryngomalacia with accuracies of 0.86 and 0.90, respectively. A type 3 model was not developed due to insufficient cases.

Conclusion: The CV model successfully segmented laryngeal anatomy, differentiated normal from laryngomalacia cases, and classified type 1 and 2 laryngomalacia from pediatric video nasolaryngoscopy. With dataset expansion, further algorithm refinement, and external validation, this model may serve as a clinical decision support tool in the future.

Level of evidence: 3:

Objectives: To analyze the impact of COVID-19 infection on the diagnosis of chronic rhinosinusitis (CRS).

Methods: TriNetX, a large international database of anonymized health records, was queried for adults with either positive or negative SARS-CoV-2 polymerase chain reaction (PCR) tests between March 1, 2020 and December 31, 2024. Patients with cancer or immunodeficiency before the COVID-19 diagnosis were excluded. Propensity score matching was used to create comparable exposure and control groups. Relative risk ratios and Cox proportional hazards regression analysis of CRS diagnosis were calculated 3 months after PCR testing. Sub-analyses were completed to investigate the effects of prior COVID-19 infection on subsequent CRS development stratified by prior vaccination status and by variant-dominant time periods (pre-Delta, Delta, and Omicron).

Results: Propensity score-matched COVID-19+ and COVID-19- cohorts each consisted of 2,135,446 patients. Rate of diagnosis of CRS increased following a positive COVID-19 PCR test (RR = 2.13, 95% CI [2.10-2.16]) and varied across variant-dominant periods, with risk ratios of 1.44 (95% CI [1.41-1.47]) during pre-Delta, 1.20 (95% CI [1.15-1.25]) during Delta, and 2.10 (95% CI [2.07-2.13]) during Omicron. Prior COVID-19 vaccination did not modify the risk of CRS among patients with a positive COVID-19 PCR (RR = 0.98, 95% CI [0.92-1.05]).

Conclusions: COVID-19 infection was found to increase the risk of subsequent diagnosis of CRS. Further studies are needed to better understand the relationship between COVID-19 and the development of sinonasal inflammatory pathology.

Level of evidence: 3:

Objectives: Complete or relative voice rest is recommended following phonomicrosurgery. Primarily, adherence to rest has been measured using patient reports, but their validity is unknown. Instrumental measures of rest adherence are uncommon. Furthermore, to our knowledge, subjectively and instrumentally measured voice rest has not been compared in voice patients. We aimed to compare patient-reported voice use (daily and overall schedules) to concurrent dosimeter readings in postsurgical patients prescribed complete or relative voice rest.

Method: Sixteen women (M = 45.88 years, SD = 15.39, range: 21-69 years) and seven men (M = 46.43 years, SD = 13.43, range: 31-70 years) who underwent microflap phonosurgery for a primary benign vocal fold lesion were randomized to complete or relative rest, controlling for sex and lesion type. Postoperatively, they wore a VocaLog2 Vocal Activity Monitor for a 7-day voice rest period and used a visual analog scale to record daily and overall subjective adherence. Within-subjects (daily/overall report) and between-subjects (relative/complete rest) factors were compared using analysis of variance; dosimeter data were the outcome variable.

Results: For both groups, daily (F_1,42 = 4.34, p = 0.04) and overall (F_1,42 = 4.38, p = 0.04) subjective ratings significantly differed from dosimeter data. The least-squares-adjusted means indicated that both groups' subjective estimates were 79-83 standardized units lower than the instrumental data across both time points.

Conclusion: Subjective patient reports of adherence should be carefully considered. The duration of voice use did not differ by the type of voice rest recommended.

Level of evidence: 3:

Objective: The mainstay of treatment for full-thickness mandibular osteoradionecrosis (ORN) is segmental mandibulectomy followed by osteocutaneous free flap. We have found success in combining anterolateral thigh rescue flaps with iliac crest bone graft (ICBG) and spanning reconstructive plate for select patients. Our objective is to therefore describe the use, indications, and outcomes of this technique.

Methods: Retrospective chart review of patients at our institution from 1/1/2017 to 10/1/2025.

Results: Eight patients (median age: 67, 87.5% male) were included. Pre-operative fracture was noted in six patients; two patients had full thickness destruction evident after debridement. Following the procedure, the median length of stay was 3 days (range: 2-6). There were no episodes of flap takeback or failure. Cessation of symptoms of ORN at most recent follow-up was noted in most patients (n = 6, 75%), with most patients (n = 6, 75%) also demonstrating bony union on follow-up imaging. The median lengths of clinical and radiographic follow up were 25.4 months (range 12.9-84) and 25.2 months (range 6-57.1), respectively.

Conclusion: Early experience with ALT rescue flap, ICBG, and spanning plate appears to offer an alternative to osteocutaneous free flap reconstruction in select patients with full-thickness mandibular ORN, with low morbidity and abbreviated hospital stays.

Level of evidence: 4:

Objectives: Laryngeal chondrosarcoma (LC) is a rare tumor accounting for less than 1% of all laryngeal cancers. While surgery is the primary treatment, national trends in management and outcomes remain poorly defined. This study aimed to analyze incidence, survival, and treatment strategies for LC using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: Patients with LC diagnosed between 2000 and 2021 were identified from SEER. Demographic, treatment, and survival data were analyzed. Kaplan-Meier analysis and multivariate Cox regression were used to analyze survival outcomes.

Results: In total, 351 patients with LC were identified, representing 0.3% of all laryngeal malignancies. Among patients with treatment data, 53.3% underwent local excision or partial laryngectomy, 27.5% underwent total laryngectomy (TL), and 19.2% received no surgery. Ten-year disease-specific survival was 84.8%. Patients undergoing partial resection demonstrated significantly improved survival compared with TL (p < 0.05), although this finding is likely confounded by tumor size and stage. On multivariate analysis, advanced stage (HR 2.59, 95% CI 1.68-3.97), older age (HR 1.66, 95% CI 1.36-1.99), and TL (HR 2.95, 95% CI 1.88-4.62) were associated with worse survival.

Conclusion: LC remains rare but carries favorable long-term survival. National trends demonstrate a shift toward organ-preserving surgery, with partial resections increasingly favored over TL. Prognosis is most strongly influenced by age and stage, while radiation therapy appears to play a little role. These findings support organ preservation in appropriately selected patients and highlight the need for prospective studies integrating oncologic and functional outcomes.

Level of evidence: 4: