Laryngoscope最新文献

Objective: To evaluate stoma placement accuracy using computed tomography (CT) in patients undergoing open surgical (OST) versus percutaneous dilational (PDT) tracheostomy, and identify factors associated with high placement.

Methods: We retrospectively reviewed adults who underwent OST or PDT at a tertiary center (July 2012-July 2024) with CT imaging ≤ 30 days post-procedure. The primary outcome was vertical distance from the inferior cricoid border to cannula center (mm). Placement was classified as high (≤ 10 mm) or non-high (> 10 mm). Multivariate regression identified predictors. Subgroup analysis was performed for otolaryngology cases.

Results: Of 503 patients (mean age 59.5 ± 18 years, 69.2% male), 421 (83.7%) underwent PDT and 82 (16.3%) OST. Mean distance was 12.6 ± 9.3 mm, shorter in PDT than OST (mean difference -2.4 mm; 95% CI: -4.6 to -0.2; p = 0.03), with no difference in high placement rates (37.1% vs. 31.7%; p = 0.36). Independent predictors of shorter distance were older age, higher BMI, general surgery team, and larger cannula diameter. Female gender was associated with greater distance. Predictors of high placement included older age, higher BMI, and larger cannula diameter. In the otolaryngology-only subgroup (n = 189), no differences in distance (mean difference 1.6 mm; 95% CI: -0.9 to 4.2; p = 0.22) or high placement rates were observed between groups; BMI was not associated with placement.

Conclusions: Technique alone did not determine high placement; patient factors, team, and cannula size were more influential. When performed by otolaryngologists, PDT achieves placement comparable to OST.

Level of evidence: 3:

Objectives: In recent years, a growing number of Otolaryngologists have incorporated the management of sleep disorders into their practice. We aim to assess the downstream impact of a Sleep Surgery division within a department of Otolaryngology.

Methods: We assess all new patients with a diagnosis of sleep apnea presenting to our division of Sleep Surgery, consisting of two surgeons, from January 1, 2021 through December 31, 2021. Our outcome measures included testing and procedures that occurred because of our workup of new patients presenting to our program. We exclusively assessed professional reimbursement of our patients insured by Centers for Medicare and Medicaid Services (CMS) through the Physician fee schedule website and modeled professional reimbursement of those with private insurance.

Results: Six hundred and seventeen new patients were seen during the study period. One hundred and sixty-six of these were insured through CMS. In evaluation and treatment of these patients, 298 sleep studies were performed on our study cohort. Three hundred and thirty-three patients underwent Drug Induced Sleep Endoscopy (DISE). Two hundred and twenty-eight patients underwent a surgical procedure for the management of their OSA. Four hundred and ninety consultations with other subspecialists were completed. One hundred and sixty-one patients elected not to pursue surgical intervention and were referred to sleep medicine where they returned to CPAP. Using the CMS physician fee website, we found $129,589.77 in professional reimbursements. Financial modeling estimated $901,504.63 in professional reimbursements for those with private insurance.

Conclusion: The establishment of a robust Sleep Surgery program with the ability to offer patients alternative options to CPAP provides significant downstream benefits to both patients and an institution.

Level of evidence: N/A.

Objectives: Vocal fold (VF) injury and instillation are emerging techniques to study laryngeal pathologies in mouse models. Most approaches require high-tech visualization and lengthy anesthesia. Intraperitoneal (IP) naphthalene (NAPH) and topical polidocanol (PDOC) are two chemical methods of injuring murine lower airways. Oropharyngeal aspiration (OA) is used for murine lung instillation. We assessed whether these simple low-tech methods could injure and instill mouse VFs, and whether injury increased in vivo VF epithelial permeability.

Methods: Mouse VFs were injured using IP NAPH at 200, 250, 300, or 350 mg/kg, or OA of PDOC at 0.5% or 2% w/v. Twenty-four hours later, mice received Evans blue (EB) dye OA instillation, then were sacrificed after 30 min. Coronal larynx sections were assessed for VF injury. Permeability was measured by imaging EB autofluorescence and quantifying percent positive area and signal intensity. VFs were immunostained for basal cells (p63), tight junctions (ZO-1), and basement membrane (laminin).

Results: VF injury was 100% with 350 mg/kg NAPH or high-volume 2% PDOC and 0%-40% with other treatments. EB bound VF lamina propria in up to 100% of mice in a volume-dependent manner. Permeability did not differ by injury. Basal cells and tight junctions were decreased in injured VFs. Basement membrane was largely intact.

Conclusions: High-dose NAPH consistently injures mouse VFs. OA reliably instills mouse VFs. Uninjured murine VF epithelium is highly permeable to low molecular weight dye in vivo. Inherent permeability of mouse VFs may facilitate targeted genetic engineering approaches and studies of environmental hazards and drug treatments.

Level of evidence: n/a.

Objective: This study aims to develop and validate prognostic models for predicting overall survival (OS) and disease-specific survival (DSS) in patients with head and neck rhabdomyosarcoma (HNRMS), providing a practical tool for clinical decision-making.

Methods: A retrospective cohort of patients diagnosed with HNRMS between 2000 and 2021 was analyzed. Prognostic factors were identified through Cox regression, and nomograms were constructed for survival. Model performance was rigorously assessed using the concordance index (C-index), time-dependent ROC curves, calibration curve, and decision curve analysis (DCA).

Results: A total of 1271 patients with HNRMS were included, with 889 patients in the training set and 382 in the validation set. The median OS was 16.9 months, and the median DSS was not reached. Advanced age, alveolar histology, para-meningeal tumor location, distant metastasis, and lack of radiotherapy emerged as key adverse prognostic factors. The constructed nomograms demonstrated strong predictive performance, with C-index values of 0.759 for OS and 0.743 for DSS in the training cohort, and 0.743 for OS and 0.730 for DSS in the validation cohort. Time-dependent ROC analysis further confirmed the superior accuracy of the nomograms compared to traditional staging systems. Risk stratification classified patients into low-, medium-, and high-risk groups, with 5-year OS rates of 81.7%, 40.2%, and 12.0%, respectively, highlighting the model's clinical utility.

Conclusion: Our nomograms provide a highly accurate and clinically actionable tool for individualized prognostication in HNRMS, addressing the limitations of conventional staging systems. This advancement holds significant promise for personalized treatment strategies and improved patient outcomes.

Level of evidence: 3:

Objectives: Otolaryngology trainees often have limited opportunities to practice microlaryngeal surgeries, so there is a need for high-quality simulation activities to aid in developing these skills. To address this gap, we created a low-cost, reusable, 3D-printed microlaryngeal simulator that can be used with various animal/human larynges to practice microlaryngeal surgery.

Methods: The simulator was developed through computer-aided design, iterative prototyping with 3D-printing, and repeated use in educational activities to guide improvements. Upon completion, a study was performed to evaluate educational value. Porcine larynges were used as a tissue model and study participants included medical students, otolaryngology residents, and laryngologists at the University of Colorado. Participants were instructed to raise a submucosal microflap on the vocal fold. Their simulated operations were video recorded and evaluated by a blinded reviewer to assess construct validity. Participants completed a Modified Michigan Standard Simulation Experience Scale Laryngeal Simulator Questionnaire and answered questions about their confidence performing the procedure to assess face and content validity.

Results: The average participant ratings for self-efficacy, fidelity, educational value, and teaching quality of the simulation experience were above 4/5 for the trainees The average confidence rating for performing microflap surgery increased from 1.8/5 before the simulation to 3.0/5 postsimulation. Experts performed statistically significantly better than novices as determined by blinded review of the procedures.

Conclusions: This novel, low-cost, 3D-printed surgery trainer allows for the successful practice of microlaryngeal surgery. User-reported ratings and a blinded review suggest the simulator achieves content, face, and construct validity when used in simulated surgery.

Level of evidence: N/A.

Objectives: Browlift is a common procedure to treat brow ptosis and provides lasting esthetic results with minimal morbidity. This study aimed to investigate long-term retention of brow elevation and complication rates following endoscopic versus pretrichial browlift.

Methods: A retrospective chart review was conducted to collect demographic, intraoperative, and postoperative complication data on patients who underwent endoscopic or pretrichial browlift between May 2019 and February 2024 at a tertiary care institution. ImageJ Software was used for photographic assessment to calculate preoperative and postoperative brow height ratios.

Results: Fifty patients underwent endoscopic browlift; 22 underwent pretrichial browlift. There was no significant difference in the incidence of postoperative ecchymosis, erythema, numbness, hematoma, seroma, brow weakness, scarring, or alopecia between the cohorts (p > 0.05). Percent change in brow height ratio at the first postoperative visit was greater in the endoscopic (21%) versus pretrichial group (13%) (p < 0.01). Of 72 patients, 45 had follow-up beyond 6 months (mean 429 days, range 180-984). In this subgroup, mean brow elevation ratios were 1.4 for endoscopic and 1.3 for pretrichial brow lifts, with a percent change (-2.6% vs. -2.9%) indicating no significant difference between groups from the prior visit (p > 0.05). Multivariate analysis revealed that technique was not a significant predictor of long-term brow height (p > 0.05).

Conclusion: While both browlift techniques provide adequate brow elevation, the endoscopic technique results in significantly greater elevation in the immediate postoperative period. Given similar long-term brow height retention and complication rates in both groups, factors such as hairline position and forehead length should guide the technique used.

Level of evidence: 3:

Objective: Alzheimer's Disease (AD) is associated with reduced laryngeal sensation, decreased pharyngeal strength, and silent aspiration. Aspiration pneumonia is a leading cause of death in advanced AD. Superior laryngeal nerve(SLN) dysfunction is hypothesized to be responsible for poor laryngeal sensation and aspiration pneumonia. The purpose of this study was to compare SLN neurophysiology in an AD rat model to control animals.

Methods: SLN-evoked studies were performed via stimulation of the main trunk in 4-month-old adult apolipoprotein-E4 (ApoE4-KI) rats (n = 8) versus wild-type rats (n = 10). Recording electrodes were placed on the internal branch of the SLN (iSLN) and cricothyroid muscles. Stimulated swallow force measurements from hyoid elevation were compared between groups. Outcome measures included both sensory and motor evoked responses. Additionally, force and frequency of electrically and tactile stimulated swallow reflexes were analyzed.

Results: Sensory nerve action potential duration was significantly longer in APOE-KI rats than controls with a mean difference (95% CI) of 2.24 ms (1.08-3.41). Both compound motor action potential latency and total duration were significantly longer in the APOE4-KI rats than controls with a mean difference (95% CI) of 0.22 (0.115-0.33) and 2.18 (0.90-3.4) respectively. Tactile-stimulated swallow frequency was significantly lower in the AD cohort vs. controls with a mean difference of -5.4 swallows/10 s (-7.6, -3.2).

Conclusions: SLN evoked responses were significantly longer with a decrease in swallow frequency in an AD rat model compared to age-matched controls. This work suggests differences in SLN signaling between the cohorts. This work may provide a mechanistic understanding of SLN dysfunction and a tractable model to test new treatments for swallow dysfunction.

Level of evidence: N/A.

Objectives: Urbanization-related air pollution may be associated with olfactory dysfunction (OD) in China, yet population studies are lacking.

Methods: We conducted a cross-sectional study of 1500 participants in urbanizing Yancheng, China (2023-2025). Olfactory function was assessed via Sniffin' Sticks. Machine learning (XGBoost, k-means clustering) was used to analyze risk factors and phenotypes.

Results: Head trauma (OR = 163.04) and chronic rhinosinusitis (CRS, OR = 161.39) were the dominant risk factors for OD (p < 0.001). Rural residence was associated with a 99% lower OD risk compared to urban residence (OR = 0.011, p < 0.0001). Four OD subtypes emerged: (1) sinusitis-linked generalized impairment; (2) age-related threshold deficit; (3) neurological disorder-associated identification loss; (4) child-specific mild dysfunction. Olfactory ability peaked at the age of 23 years, remained stable among individuals aged 40-60 years, and declined sharply in those aged over 63 years. Anosmia quadrupled from childhood to elderly (7.1% → 28.2%, p < 0.0001).

Conclusion: In urbanizing China, head trauma and sinusitis are the most potent risk factors for olfactory dysfunction (OD). Additionally, long-term exposure to air pollution-proxied by urban residence-and the natural aging process are significant contributing factors. Phenotypic stratification enables targeted interventions, thereby urging reforms in environmental policies and enhanced clinical management of high-risk conditions (e.g., head trauma, sinusitis).

Level of evidence: 3:

This study describes practical needle handling techniques for endonasal endoscopic surgery, focusing on controlled suturing movements adapted to incision orientation and anatomical constraints. Emphasis is placed on single-motion needle advancement, proper reorientation, and precise force application, particularly for skull base suturing where tactile feedback is limited. These techniques enable reliable and efficient closure in endoscopic surgery without the need for specialized instruments.