Laryngoscope最新文献

Objective: To evaluate perioperative changes in olfactory bulb volume (OBV) and olfactory function in patients with eosinophilic chronic rhinosinusitis (ECRS) using 3T magnetic resonance imaging (MRI) with fast imaging employing steady-state acquisition (FIESTA) sequence and to assess their associations.

Methods: This single-center, retrospective observational study included 32 patients with ECRS who underwent functional endoscopic sinus surgery. Olfactory function was assessed pre- and postoperatively using the Alinamin test, T&T olfactometer, Open Essence (OE), Odor Stick Identification Test for Japanese (OSIT-J), Visual Analog Scale (VAS), and Self-Assessment Olfactory Questionnaire (SAOQ). OBV was manually measured from FIESTA images. Logistic regression was used to identify preoperative predictors of OBV change.

Results: Postoperative OE, OSIT-J, VAS, and SAOQ scores improved significantly. Mean OBV increased by 10.3% postoperatively, although not statistically significant (p = 0.095). OBV change correlated with improvements in olfactory identification (OE: r = 0.404, p = 0.022; OSIT-J: r = 0.402, p = 0.022), which should be interpreted as exploratory. Multivariate analysis revealed that longer odor duration on the Alinamin test (≥ 50 s) and higher SAOQ scores predicted smaller OBV increases.

Conclusion: OBV measurement using 3T MRI with FIESTA may provide a structural correlate of olfactory changes in ECRS. The observed correlation between OBV changes and olfactory identification suggests a potential relationship with postoperative functional recovery.

Level of evidence: 4:

Objectives: While maxillary sinus fungal balls (MSFB) can be associated with odontogenic conditions (MSFBO), MSFBO clinical and dental features have not been compared to odontogenic sinusitis (ODS). This multicenter study aimed to compare characteristics of MSFB, MSFBO, and ODS.

Methods: A multicenter international retrospective cohort study was conducted on adults with MSFBs and ODS who underwent sinus surgery. First in MSFBs, it was determined whether different dental conditions were more likely in FB versus non-FB sides. Second, clinical features and dental pathologies were compared between MSFBO and ODS. For analyses, dental conditions were considered individually and as two groups: infectious pathologies and dental/oral procedures with indwelling metallic materials.

Results: After exclusions, there were 203 MSFBs and 163 ODS. Among MSFBs, 141 were MSFBOs. FB sides were associated with sinus protrusion of root canal treatment (RCT) materials (p = 0.040) and dental implants (p = 0.040). Compared to MSFBO, ODS patients were younger, more likely to have MS purulence (OR = 40.9, p < 0.010), more likely associated with apical periodontitis (OR = 2.59, p = 0.010) and oroantral fistulas (OR = 6.94, p = 0.020), and less likely associated with extruded RCT materials (OR = 0.01, p = 0.010) and protruded midface screws (OR < 0.01, p = 0.010). Comparing purulent MSFBO and ODS, ODS was more associated with infectious dental pathologies (p < 0.009).

Conclusion: Compared to MSFBs, MSFBOs were associated with RCT extrusion and implant protrusion. Compared to MSFBOs, ODS was more likely purulent and associated with infectious dental pathologies. While ODS is often distinct from MSFBO, the two conditions can coexist, and surgeons must determine whether patients have infectious dental pathology requiring treatment with both conditions.

Level of evidence: 4:

Objective: Transverse cordotomy with medial arytenoidectomy (TCMA) for bilateral vocal fold immobility (BVFI) can optimize a patient's respiratory status and promote tracheostomy decannulation, but has the potential to adversely affect voice and swallow function. We present the largest cohort to date evaluating the procedure's effectiveness and compare functional outcomes by etiology of BVFI.

Methods: Retrospective case series of consecutive patients treated at a tertiary care center from April 2014 to 2024. All patients who underwent TCMA for posterior glottic stenosis (PGS) or bilateral vocal fold paralysis (BVFP) were included. Exclusion criteria were multi-level stenosis and prior airway resection or reconstruction. We assessed rate of decannulation, Voice handicap index (VHI), dyspnea index (DI), eating assessment tool (EAT-10), and cough severity index (CSI) scores and compared outcomes by surgical indication.

Results: Forty-five patients were included and the majority had PGS (64%). Seventy six percent of tracheostomy dependent patients were decannulated. Surgical indication did not impact time to decannulation or number of interventions required for decannulation. DI was improved at 1-month post-operation and last clinic visit (p < 0.0001). DI was slightly improved for the PGS cohort at last clinic visit, compared to the BVFP cohort (p = 0.04). There were no differences in VHI, EAT-10, or CSI after surgery compared with baseline, or differences based on BVFI etiology.

Conclusions: TCMA is an effective surgical intervention for BVFI that provides a reliable rate of decannulation and improves respiratory function without compromising voice or swallowing outcomes, regardless of the BVFI etiology.

Level of evidence: 4:

Objective: To provide an overview on auricular molding and to investigate whether breastfeeding is associated with greater cartilage malleability or improved perinatal auricular molding outcomes.

Data sources: Embase, MEDLINE, and CENTRAL databases.

Methods: Three databases were comprehensively searched for treatment of congenital auricular malformations or deformations with auricular molding. Extracted data included study design, patient demographics and auricular anomalies, interventions and outcomes measures, and references to the effect of estrogen and breastfeeding on cartilage malleability and ear molding.

Results: Out of 1018 unique articles, 67 were included in this review. The articles included a total of 3645 patients and 5384 ears, of which helical rim abnormality (20.6%), lop/lidding/cup ear (20.2%), and prominent ear (11.1%) were the most represented. Of the 67 articles referencing estrogen levels, 49 supported the claim that estrogen increases auricular cartilage malleability. Fifteen articles (22.4%) referenced the effect of breastfeeding on infant circulating estrogen levels and molding outcomes, while 8 (53.3%) of those articles supported the claim. Notably, only 4 primary sources were referenced regarding the effect of breastfeeding among all reviewed literature.

Conclusions: There is insufficient evidence to suggest that breastfeeding leads to increased circulating estrogen levels in infants, increased auricular cartilage malleability, or improved ear molding outcomes. The direct impact of hyaluronic acid on the mechanical properties of auricular cartilage in vivo remains unclear.

Objective(s): Vestibular rehabilitation therapy (VRT) is an efficient treatment for dizziness and vertigo, but its accessibility remains limited. This study evaluates the feasibility and performance of a machine vision-based automated alternative-the Automated Vestibular Rehabilitation System (AVRS)-as a more accessible approach to delivering VRT.

Methods: Forty age- and sex-matched adults without balance disorders or recent head injury completed one standard VRT exercise, X1, in seated and standing positions using the AVRS, which tracked real-time head and eye movements. Gain, the ratio of eye to head velocity near the neutral head position, was calculated using median values and interquartile ranges. Test-retest reliability (TRTR) was assessed in a subset of 20 participants using intraclass correlation coefficients (ICCs) with 95% confidence intervals.

Results: All participants successfully completed the AVRS-guided vestibular exercises. The n = 20 person test-retest reliability subset returned after 27 ± 9 days. Mean VOR gain approximated the expected physiologic norms (~-1.0) across sessions irrespective of frequency (Session 1: -0.98 ± 0.04; Session 2: -0.99 ± 0.03). Overall reliability between sessions was moderate (ICC (3, 1): 0.59 [95% CI: 0.37-0.75], p < 0.001).

Conclusion: The AVRS demonstrated moderate reliability and accurate VOR gain measurement in healthy adults, supporting its potential as a scalable, accessible tool for VRT delivery, with normative data to guide therapeutic progression in clinical populations.

Level of evidence: 4:

Objective: A "Code Blue" is a term to activate an alarm for the resuscitation team for a patient who has a cardiopulmonary arrest. The role of a pediatric otolaryngologist in a tracheostomy-related code blue case is not clearly defined. We aim to describe the role of pediatric otolaryngologists in pediatric tracheostomy code blue (PTCB) cases.

Methods: This retrospective study analyzed pediatric code blue cases in a tertiary care hospital from January 2019 to December 2022, before and after the implementation of a standardized PTCB that includes a pediatric otolaryngologist in the resuscitation team. Primary outcome variables included response time and survival-to-discharge of patients.

Results: The most common reason for code activation was reduced oxygen saturation. The leading cause for the otolaryngology consultation was tube blockage. Tracheostomy tube change was the most common intervention performed. The mean time of otolaryngology arrival was significantly decreased from 14.0 min pre-implementation to 4.0 min post-implementation (p < 0.001). While including all 48 PTCB events, pediatric otolaryngologist involvement was significantly associated with higher survival-to-discharge (94.4% vs. 66.7%, p = 0.028). While comparing post-PTCB protocol implementation versus pre-implementation, mortality declined from 23.8% to 3.7% with increased discharge rates, although this did not reach statistical significance (p = 0.073).

Conclusion: Inclusion of a pediatric otolaryngologist in the resuscitation team reduces time-to-arrival of the pediatric otolaryngologist to the code blue activation site. Reduced time to pediatric otolaryngologist arrival and completion of interventions by pediatric otolaryngologist are associated with reduced mortality in PTCB events.

Level of evidence: 3: