Laryngoscope最新文献

We report the case of a 34-year-old female with right-sided cholesteatoma and progressive left-sided conductive hearing loss. A cephalocele contacting the left incudomalleolar joint was suspected preoperatively and treated, but a facial nerve prolapse contacting the stapes was also discovered intraoperatively. This case emphasizes the importance of thorough and systematic evaluation to avoid satisfaction of search and anchoring bias, and illustrates the need for collaborative review of imaging findings among clinicians and radiologists to mitigate cognitive biases and improve diagnostic accuracy. Laryngoscope, 2025.

Objective: Human Papillomavirus (HPV) is a well-documented cause of cervical, oropharyngeal, vaginal, vulvar, anal, and penile cancers, largely preventable with the HPV vaccine. We aim to characterize the most popular TikTok videos pertaining to HPV-associated cancers and vaccination with a focus on oropharyngeal cancer.

Methods: Observational study of public social media content. The top 200 TikTok videos that appeared when searching for #HPVvaccine and #Gardasil individually were included and analyzed on the basis of creator characteristics, viewer reach, content, and accessibility. Characteristics of each video were counted if mentioned or listed in the caption.

Results: Forty-four percent of videos originated from creators self-identifying as health care professionals and had an average of 129,525 (SD: 59,997) views. 72.0% were pro-vaccination, and 17.5% were specifically anti-vaccination. Only 14.0% mentioned all six types of HPV-related cancer (including oropharyngeal). Other mentions included HPV prevention (62.0%), transmission (31.0%), infection risk factors (12.0%), and vaccine side effects (23.0%), while only 7.5% specifically regarded vaccines as safe. 35.5% of creators identified the Gardasil vaccine as appropriate for both men and women.

Conclusions: Medical professionals have a strong presence on TikTok and overwhelmingly support HPV vaccination for cancer prevention but miss the mark in associating high-risk HPV with non-cervical cancers, addressing vaccine safety, and clearly defining who is eligible for the HPV vaccine/Gardasil. Despite oropharyngeal cancer eclipsing cervical cancer as the most common HPV-related malignancy, there is still a dearth of online patient education about this disease and the potential treatment/prevention measures available.

Objective: The management of head and neck squamous cell carcinoma (HNSCC) has substantially changed over the past two centuries. This review explores the historical progression of HNSCC management focusing on the multidisciplinary treatment paradigm.

Data sources: This review synthesizes data from historical and current clinical trials, books, scientific reports, public documents, and other written material relevant to HNSCC management.

Review methods: Historical review.

Results: Although surgery was initially the only treatment available, radiation, chemotherapy, and immunotherapy have expanded the treatment landscape for HNSCC. Despite continuous evolution, modern treatment of HNSCC remains rooted in a multidisciplinary, personalized approach. This review highlights the clinical pioneers who established the standards of care and the landmark trials that progressed it. The optimal timing, application, and extent of different treatments, including the role of neoadjuvant therapy, remain under study. Immunotherapy has improved outcomes for recurrent/metastatic mucosal HNSCC and cutaneous malignancies, although its role in the curative management of mucosal HNSCC is still materializing.

Conclusions: Surgery and radiotherapy have made continued gains in reducing morbidity and treatment sequala. Platinum-based chemotherapy remains the mainstay of systemic therapy for HNSCC, but there has been accelerated growth in the application of immunotherapy and targeted therapy. Comprehensive head and neck cancer care depends on multidisciplinary management, usually requiring multiple treatment modalities while individualizing both the therapies and treatment goals. Additional phase III trials are needed to further define the optimal treatments for HNSCC.

Objective: Acquired laryngotracheal stenosis (LTS) is notorious for recurrence and the need for repeated procedures to achieve a satisfactory outcome. This limitation is, at least partly, due to the suboptimal healing process of the airway following trauma. Consequently, innovative interventions are required to improve wound healing, which would reflect on improving the outcome of the management of LTS. The objective of this study is to examine the effect of the application of BM-MSCs in preventing subglottic acute stenosis following trauma.

Methods: Twenty-four Sprague-Dawley rats were divided into three equal groups (n = 8): two intervention groups and one control group. Subglottic trauma was performed in the three groups. In the intervention groups, bone marrow-derived mesenchymal stem cells (BM-MSCs) were applied either systemically (TS group) or via local injection (TL group). Subglottic specimens from the three groups were compared by histopathological appearance, lamina propria (LP) thickness, and luminal anteroposterior (AP) diameter.

Results: An intense inflammatory reaction was observed in the control specimens, while a mild inflammatory reaction was detected in the two intervention groups. The LP thickness and the AP diameter were significantly different between the control group and the two intervention groups.

Conclusions: In the present animal model, stem cell application, either systemic or local application, can mitigate subglottic inflammation and stenosis after trauma.

Objective: Music, like all forms of art, seeks to communicate emotional content to its audience. The signal provided by cochlear implants (CI) does not faithfully represent the psychophysical relationships inherent in music; however, it is unknown whether targeted musical emotions are conveyed through electric only stimulation with a cochlear implant.

Methods: Twenty musical excerpts for which there was concordance among normal hearing (NH) listeners as to the emotion conveyed: (1) happy, (2) sad, (3) scary, or (4) peaceful were presented to cochlear implant (CI) subjects (n = 20) and age-matched NH controls (n = 8) through a specifically designed iPad application. The musical clips were original recordings of western music from various musical genres but not widely familiar to participants. Subjects also completed a music background questionnaire.

Results: CI users identified the target emotion in only 57% of excerpts compared with NH listeners who correctly identified the target emotion in 76.9% of excerpts. Musical excerpts with the target emotion of happy were recognized in 84% of cases by CI users compared with 75% among NH controls while the remaining target emotions were much more difficult for CI users compared with NH raters. Length of CI experience, speech perception scores, and musical training or listening habits did not correlate with performance on this task.

Conclusions: Current CI technology and processing strategies do not convey the range of emotions conveyed in music as recognized by normal hearing subjects. This difficulty may explain the reported lack of interest many patients have in music after CI despite a passion for music before onset of hearing loss.

Level of evidence: 3 Laryngoscope, 2025.

Background: This study aimed to evaluate the correlation between the number of examined lymph nodes (eLNs) and postoperative residual lateral LN disease in patients with papillary thyroid cancer (PTC) and lateral nodal metastasis (N1b) and determine the minimal threshold for the eLNs.

Methods: Patients diagnosed with unilateral N1b PTC who underwent total thyroidectomy with therapeutic LN dissection of the central and lateral compartments between January 2012 and December 2022 were included. Multivariate logistic regression analyses were performed to identify the threshold number of eLNs that independently influenced the risk of residual lateral LN disease.

Results: Residual lateral LN disease was identified in 56 (5.4%) of 1042 T1-2 patients and 74 (12.3%) of 602 T3-4 patients. When analyzed as a continuous variable, the number of eLNs in the lateral neck was independently associated with a reduced risk of residual lateral LN disease in both T1-2 (OR: 0.93; 95% CI: 0.90-0.97; p < 0.001) and T3-4 patients (OR: 0.94; 95% CI: 0.91-0.97; p < 0.001). As a categorical variable, the risk of residual lateral LN disease continued to decrease significantly until the number of eLNs reached 34 in T1-2 patients and 46 in T3-4 patients.

Conclusion: Comprehensive preoperative imaging for LN status and systematic compartmental dissection of the affected levels are critical in managing N1b PTC. To minimize the risk of residual lateral LN disease, the minimum recommended number of eLNs in the lateral neck is 34 for T1-2 patients and 46 for T3-4 patients.

Level of evidence: 4-retrospective cohort study.

Objective: Effective implementation of timely postoperative radiation therapy (PORT) as a quality metric for head and neck squamous cell carcinoma (HNSCC) care may reduce survival disparities in subgroups with the highest risk of mortality-advanced stage and Black race. We sought to determine if the association between timely PORT and survival varies among clinical and demographic high-risk subgroups.

Methods: In this retrospective cohort study using the National Cancer Database 2004-2020, patients with HPV-negative HNSCC treated with surgery and PORT were identified. The association between PORT delay greater than 6 weeks with overall survival was assessed by Cox proportional hazards models with interaction effects for race, overall stage, and PORT delay.

Results: Among 54,035 patients included in the study, 62% (33491) had PORT delays. Black patients were more likely to have PORT delays (aOR 1.19, 95% CI: 1.10-1.27). Timely PORT was only associated with improved survival for all stage I patients and White stage IV patients (predicted mortality risk 2.53, 95% CI: 2.34-2.74 versus 2.88, 95% CI: 2.67-3.09, referenced to White, stage I). After adjusting for covariates, timely PORT was estimated to be associated with inferior overall survival in Black patients with stage IV disease although with low precision (predicted mortality risk 3.24, 95% CI: 2.87-3.66, versus 2.71, 95% CI: 2.47-2.98, referenced to White, stage I).

Conclusion: Timely, guideline-adherent PORT may not reduce survival disparities in Black patients, especially those with advanced stage disease, suggesting other interventions are needed to address this disparity.

Level of evidence: 3:

Hypoglossal nerve stimulation (HGNS) is an effective surgical treatment for many patients with moderate-to-severe obstructive sleep apnea (OSA) who are unable to tolerate continuous positive airway pressure. Patients with neuromuscular disorders (NMD) are particularly vulnerable to more complex sleep-related breathing disorders due to respiratory muscle weakness and the associated risk of hypoventilation. In this study, we present five patients with myasthenia gravis (n = 2), muscular dystrophy, Charcot-Marie-Tooth, and advanced multiple sclerosis who underwent HGNS therapy for OSA. At time of surgery, the mean patient age was 54 ± 18.7 years and mean BMI was 24.6 ± 4.6 kg/m². Mean device adherence was 8 ± 1.1 h/night at three months and 7.2 ± 1.7 h/night at 12 months. Mean apnea-hypopnea index (AHI) improved significantly from preoperative baseline (34.9 to 8.5, p = 0.03) and 5/6 patients had a postoperative AHI <5. Epworth Sleepiness Scale scores significantly improved postoperatively (13.1-8.5, p = 0.03). Oxygen nadir trended upward (75.5-85.3, p = 0.84). Our limited findings demonstrate that HGNS was a safe and effective treatment for five patients with OSA and comorbid NMD. Prospective studies and larger sample sizes are warranted to support our findings and confirm whether HGNS is a potential therapeutic option for this unique patient population. Laryngoscope, 2025.

Objectives: Hearing loss is a prevalent factor contributing to reduced quality of life and has been linked to various comorbidities, with potential significant implications for psychosocial and cognitive health. The aim of this study was to give current information about the prevalence of hearing loss, loneliness and depression, and to examine the association between these.

Study design: Cohort study.

Methods: The Gutenberg Health Study, a large representative cohort study for the general population, was initiated in 2007 at the University Medical Center Mainz, Germany. Hearing loss was assessed using pure-tone audiometry, with severity graduated in percentages according to the World Health Organization (WHO). Loneliness and depressive symptoms were assessed using self-report measures: Loneliness Scale (≥2) for loneliness and the PHQ-9 (≥10) for depressive symptoms.

Results: Among 5,948 participants (25-86 years), the prevalence of hearing loss was 38.7%. Loneliness was reported by 9.5% of the participants and the prevalence of significant symptoms of depression was 9.9%. The risk of loneliness was found to be significantly higher in participants with severe to complete hearing loss (OR = 3.92, p = 0.011). In addition, the odds ratio (OR) for depressive symptoms was significantly higher in those with a mild to severe hearing loss compared to those with normal hearing (OR = 1.3; p = 0.025). There was no association with hearing aid use.

Conclusion: Hearing loss is associated with both loneliness and depressive symptoms. Longitudinal studies are required to clarify the causal relationships and to further investigate the direct impact of early hearing aid fitting on the progression of loneliness and depression.

Level of evidence: 2 Laryngoscope, 2025.