Laryngoscope最新文献

Objective: To evaluate the diagnostic accuracy of 18F-FDG-PET/CT compared to conventional imaging modalities (CIM) to detect recurrence of primary salivary gland cancers (SGCs).

Data sources: Review performed on December 26, 2024, using Embase, CINHAL, MEDLINE, and PubMed.

Review methods: Two blinded reviewers selected studies reporting diagnostic accuracy of PET/CT in identifying locoregional recurrence and/or metastasis in patients with SGCs. The analysis was performed adhering to PRISMA guidelines using R 4.3.3. Pooled analysis with 95% confidence intervals (CI) were analyzed.

Results: A total of 12 studies were retained from the systematic review, including 264 patients evaluated in the meta-analysis. For local recurrence, there was a pooled sensitivity of 0.86 (95% CI 0.73-0.93) and a pooled specificity of 0.95 (95% CI 0.92-0.97) for PET/CT, and a pooled sensitivity of 0.89 (95% CI 0.80-0.94) and a pooled specificity of 0.91 (95% CI 0.79-0.97) for CIM (p = 0.90). For regional metastasis, there was a pooled sensitivity of 0.90 (95% CI 0.73-0.97) and a pooled specificity of 0.96 (95% CI 0.92-0.98) for PET/CT, and a pooled sensitivity of 0.80 (95% CI 0.62-0.91) and a pooled specificity of 0.95 (0.90-0.98) for CIM (p = 0.26). For distant metastasis, there was a pooled sensitivity of 0.96 (95% CI 0.90-0.99) and a pooled specificity of 0.95 (95% CI 0.85-0.98) for PET/CT, and a pooled sensitivity of 0.80 (95% CI 0.71-0.86) and a pooled specificity of 0.97 (95% CI 0.87-0.99) for CIM (p = 0.018).

Conclusions: 18F-FDG-PET/CT imaging is accurate for the detection of SGC recurrence, particularly for the detection of regional and distant metastases.

Level of evidence: Not applicable Laryngoscope, 2025.

Objectives: The aim of the present study was to investigate the oncological and functional prognostic implication of perioperative risk factors in the elderly patient who underwent open partial horizontal laryngectomy (OPHL).

Study design: A single institution, retrospective case-cohort study.

Methods: The present study retrospectively reviewed the clinical charts of a cohort of 100 elderly laryngeal squamous cell carcinoma (LSCC) patients who underwent OPHL at our institution. Oncological and functional results were evaluated through univariate analysis.

Results: The overall recurrence rate was 19%. The 2 years overall and disease-specific survivals were 72% and 90%, respectively. No perioperative deaths were reported. A postoperative complication was reported in 20 cases (20%). Fifty-four patients (54%) were decannulated during the hospitalization. A percutaneous endoscopic gastrostomy procedure was performed in 12 patients (12%) due to persistent dysphagia. Twenty-six patients experienced postoperative late sequelae (26%), in terms of postoperative laryngeal obstruction (POLO) in 17 cases. A total of 80 patients (80%) were finally successfully decannulated. A functional total laryngectomy was performed in 6 cases.

Conclusions: The indication to OPHL should be carefully evaluated in the elderly. In appropriately selected patient, OPHL represents a safe and effective therapeutic option. Cervical positive nodes and an incomplete resection of the tumor with positive surgical margins remain in such population the main prognostic factors for the oncological outcome, these factors have a negative impact on the functional outcome too, due to the need for adjuvant treatment. Hence, OPHL should be offered as a single-modality treatment especially in the elderly.

Level of evidence: 4 Laryngoscope, 2025.

Background: Regional metastasis occurs in 5% of cutaneous squamous cell carcinoma (cSCC). The aim of this study is to assess the impact of margin status of regional metastases on survival.

Methods: A retrospective review of 401 patients with nodal metastases from cSCC. Margin status of nodal metastases was classified as clear (>1 mm), close (<1 mm), or involved. Cox regression and Kaplan-Meier methods were used to assess associations with overall and disease-specific survival (OS and DSS).

Results: Of the 401 patients with nodal metastases (median age 75, 85.3% male), 43.6% had involved margins, 27.4% had close margins, and 28.9% had clear margins. Involved margins were significantly associated with reduced OS and DSS on univariable analysis. Multivariable analysis confirmed that involved margins independently predicted worse DSS (HR 1.92, 95% CI 1.15-3.19, p = 0.01). Other independent prognostic factors included size of deposit (HR 1.02, 95% CI 1.01-1.04, p < 0.001), number of deposits (HR 1.05, 95% CI 1.02-1.08, p < 0.001), and the presence of perineural invasion (HR 1.84, 95% CI 1.14-2.98, p = 0.01).

Conclusions: Clear surgical margins during the removal of regional metastases of cSCC improves survival outcomes. This study highlights the importance of careful preoperative evaluation to achieve a complete (R0) surgical resection.

Level of evidence: Level 3 Laryngoscope, 2025.

Objective: Identify differences in Medicare reimbursement changes for general otolaryngology, pediatric otolaryngology, head and neck oncology, laryngology, rhinology, otology, facial plastic and reconstructive surgery, and sleep surgery subspecialties from 2013 to 2024.

Methods: Subspecialty-based procedures' facility prices and relative value units (RVUs) were sourced from the Centers for Medicare & Medicaid Services' Physician Fee Schedule. Prices were adjusted for inflation, and the average percent change in facility price and RVUs for each subspecialty was calculated. Each subspecialty's average inflation-adjusted, facility price change was compared to general otolaryngology using t-tests, and differences between subspecialties were assessed using Dunn's test.

Results: From 2013 to 2024, general otolaryngology's average percent change was -29.9% and significantly differed from facial plastic and reconstructive surgery (-26.4% [-5.5 to -0.7%]; p = 0.011) and sleep surgery (-23.7% [-19.2 to -2.2%]; p = 0.016). Rhinology (-32.5% [-1.3 to 6.1%]), otology (-30.2% [-6.5 to 7.6%]), laryngology (-29.3 [-4.2 to 2.1%]), head and neck (-27.4% [-5.7 to 0.2%]), and pediatric otolaryngology (-25.8% [-14.6 to 3.8%]) also decreased drastically but were not significantly different from general otolaryngology. For the multiple comparisons test, rhinology was statistically different from sleep surgery and facial plastic and reconstructive surgery.

Conclusion: General otolaryngology and rhinology were more negatively affected due to changes in work and practice expense RVUs. Universal decreases were due to inflation and legislative reductions to the conversion factor. Medicare's budget constraints, potential effects on access to otolaryngology services, and continuing inflation warrant lobbying efforts to address these changes to maintain financial viability.

Level of evidence: NA Laryngoscope, 2025.

Alegre Edo B, Rojas-Lechuga MJ, Quer-Castells M, González-Sánchez N, Lopez-Chacon M, Hopkins C, Alobid I. Quality of life in symptomatic septal perforation. Laryngoscope 2024;134(11):4480–4487. https://doi.org/10.1002/lary.31557

The authors have identified the following errors in Tables II and III and would like to correct them.

In Table II, titled “Comparison of the Mean SNOT-22 Questionnaire Score by Domains in CRSwNP and SP,” in the data in the top row, second column, the value “46.5 (22.0)*” should be replaced with “42.4 (24.4)*” and in the data in the top row, third column, the value “42.4 (24.4)*” should be replaced with “46.5 (22.0)*.” Also, the p-Value in the fourth column of the top row, “p < 0.001,” should be replaced with “p = 0.264.”

In Table III, “Comparison of the SNOT-22 Questionnaire Score by Items Between the Three Groups Expressed as a Percentage,” in the first column, the text “3. Think nasal discharge” should be replaced with “3. Runny nose” and the text “6. Runny nose” should be replaced with “6. Thick nasal discharge.”

We apologize for this error.

Objective: To identify the most effective treatment modality for achieving favorable outcomes in early glottic tumors with anterior commissure involvement (ACI).

Data sources: PubMed, Embase, Web of Science, and ScienceDirect.

Review methods: Random-effects proportional meta-analysis model is used to evaluate the oncological and functional outcomes of transoral laser microsurgery (TLM) versus radiation therapy (RT) in early glottic (T1-T2) cancer with ACI.

Results: From a total of 736 studies, 40 studies were included, comprising 2666 early glottic tumor patients with ACI. TLM (52%) and upfront RT (48%) were the primary treatment groups. TLM had better 5-year overall survival (OS) (84.5% [80.3%-88.0%] vs. 79.4% [75.7%-82.7%]). Similarly, TLM-treated patients had better 3-year pooled disease-free survival (DFS) compared with RT-treated patients (82.7% [77.1%-87.1%] vs. 73.3% [23.8%-96.0%]). TLM exhibited a better 5-year local control rate (LCR) than RT (77.2% vs. 71.6%). In our temporal analysis, TLM had a higher 5-year LCR than RT (78.2% vs. 63.5%) in 2001-2012, with similar rates in 2013-2024 (76.8% vs. 78.4%). TLM-treated patients had higher laryngeal preservation rates compared with RT patients (93% [90.6%-94.8%] vs. 87.6% [82.8%-91.2%]).

Conclusions: Our meta-analysis is the first in the literature to compare the outcomes between TLM and RT-treated patients with ACI in early glottic tumors. TLM-treated patients appear to have superior 5-year OS and laryngeal preservation compared with upfront RT-treated patients. However, both TLM and RT exhibited comparable oncological outcomes in early glottic tumor patients with ACI during the recent period from 2013 to 2024. Laryngoscope, 2025.

Background: Incidence data on Facial Nerve Disorders (FND) and Bell's palsy are currently limited. Prior epidemiological studies have estimated the incidence rate of Bell's palsy to be between 11 and 53/100,000 individuals, although the most cited incidence data are from single regions or municipalities, many of which are outdated from several decades ago.

Methods: This was a retrospective cohort study of US adults from 2007 to 2022 using the Merative™ Marketscan® Research Databases. Trends in the incidence of FND were described overall and by specific sociodemographic groups, including age, sex, region, and insurance plan type. Chi-squared and simple logistic regression analyses were performed.

Results: From 2007 to 2022, the total adult incidence of all FND was 30.5/100,000, and the total incidence of Bell's palsy alone was 24.5/100,000. Over the study period, there was a significant annual increase of 2.1 cases of FND/100,000 adults (95% Confidence Interval [CI] 1.8, 2.3; p < 0.001), and a significant total increase of 1.5 cases of Bell's palsy/100,000 adults (95% CI 1.2, 1.7; p < 0.001). The total incidence of FND was higher in males (33.1/100,000) than in females (28.4/100,000, p < 0.001), and greater in older age groups (p < 0.001). Additionally, the incidence of FND varied significantly by region (p < 0.001) and insurance plan type (p < 0.001).

Conclusions: This study provides up-to-date incidence rates for Bell's palsy and facial nerve disorders, based on national administrative claims data. Incidence rates of FND and Bell's palsy alone have been increasing in the United States from 2007 to 2022.

Level of evidence: III Laryngoscope, 2025.

Objective: Endolymphatic sac tumors (ELSTs), as rare low-grade neoplasms, are primarily treated with surgery. This study analyzes the characteristics of tumor-infiltrating leukocytes (TILs) in ELSTs and their relationships with clinical features to explore the potential for immunotherapy in ELSTs.

Methods: Clinical data and tumor specimens of 10 ELSTs patients who underwent surgery were retrieved. Immune expression levels of CD3, CD4, CD8, and CD66b were assessed by immunohistochemical staining and expressed as the integral optical density (IOD). Hematoxylin and eosin (HE) staining were performed to define the tumor nest and stroma of ELSTs.

Results: There were no significant differences in the IOD of CD3, CD4, CD8, and CD66b between the tumor nest and stroma or between von Hippel-Lindau (VHL) and non-VHL patients. The IOD of CD3, CD4, CD8, and CD66b appeared relatively higher in patients with endolymphatic hydrops (EH) than those without. Additionally, CD4 expression in the tumor stroma was significantly higher in patients with EH (p = 0.0381).

Conclusion: TILs were present in both ELSTs nest and stroma with significant individual heterogeneity observed among patients. Patients with VHL disease showed a similar immune pattern to those with sporadic ELSTs. Notably, the ELST-related EH may be associated with lymphocytes infiltration. Combined with surgical intervention, immunotherapy may serve as an effective adjuvant therapeutic strategy.

Level of evidence: 4 Laryngoscope, 2025.

Objective: The efficacy of the transcanal endoscopic approach in tympanoplasty, cholesteatoma removal, and stapedotomy is detailed. This study reviews evidence on the feasibility of endoscopic ossiculoplasty as a suitable alternative to traditional microscopic ossiculoplasty.

Data sources: PubMed, Embase, and Cochrane Library were searched from inception to 19 June 2024 for articles comparing endoscopic and microscopic ossicular chain reconstruction.

Review methods: This systematic review was conducted in accordance with PRISMA guidelines. The primary outcomes assessed include air bone gap closure, pre-operative and post-operative air bone gap, pure tone audiometry, and word recognition scores. The secondary outcomes include operation time, surgical success, and surgical complications. These outcomes between microscopic and endoscopic techniques were pooled and compared as mean differences using a random-effects model. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) and Cochrane Risk-of-Bias Tool for Randomized Trials (RoB2) scale were adopted to assess for study bias in observational studies and randomized controlled trials, respectively.

Results: This study included five studies comprising 504 patients. While endoscopic ossiculoplasty had shorter operating durations (95% CI -42.97 to -1.57), it conferred comparable air bone gap closure (95% CI -0.34 to 3.76), post-operative pure tone audiogram (95% CI 10.97-18.77), and surgical success. Additional qualitative strengths identified in endoscopic ear surgery include improvements in visualization, decreased need for supplemental incisions, excellent ergonomics, and reduced post-operative pain.

Conclusion: Overall, endoscopic ossiculoplasty may confer comparable audiological outcomes to microscopic ossiculoplasty and may serve as a reasonable alternative surgical approach. Laryngoscope, 2025.