Laryngoscope最新文献

Objective: Limited English proficiency (LEP) has become increasingly recognized as an independent predictor of adverse health outcomes in the United States. We aim to examine trends and summarize current insights into LEP-related disparities in adult otolaryngology.

Data sources: Web of Science, PubMed, and Scopus.

Methods: A systematic review of US-based, peer-reviewed literature evaluating outcomes in adult otolaryngology across primary language or varying levels of English proficiency; results were analyzed for study design, subspecialty, cohort demographics, and outcomes; findings were further assessed with the Kilbourne conceptual framework for health care disparities.

Results: An initial search yielded 3886 articles. After removal of duplicates, 2906 articles were screened and 31 studies were included after full-text analysis. Head and Neck Oncology (25.8%) and Otology (16.1%) were the most highly represented subspecialty topics. Patients with LEP represented an average of 21.71% (Range 2.21% - 51%) of the study populations. Definitions of LEP were variable. Furthermore, studies specifying patient-reported LEP status reported significant findings more often than those using electronic health record-derived data (p < 0.01). Under the Kilbourne framework, all studies were "detecting" (N = 21, 67.7%) and "understanding" (N = 10, 32.3%) disparities. In outcomes-focused studies, patients with LEP presented with a higher burden of oncologic disease, more severe hearing loss, and disparities in treatment access/implementation.

Conclusion: Patients with LEP are adversely impacted across various otolaryngology subspecialties. Defining these inequities is vital to provide more targeted and comprehensive care for patients with LEP.

Level of evidence: NA Laryngoscope, 2024.

Objective: To evaluate and compare the readability and quality of patient information generated by Chat-Generative Pre-Trained Transformer-3.5 (ChatGPT) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) using validated instruments including Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, DISCERN, and Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P).

Methods: ENTHealth.org and ChatGPT-3.5 were queried for patient information on laryngology topics. ChatGPT-3.5 was queried twice for a given topic to evaluate for reliability. This generated three de-identified text documents for each topic: one from AAO-HNS and two from ChatGPT (ChatGPT Output 1, ChatGPT Output 2). Grade level and reading ease were compared between the three sources using a one-way analysis of variance and Tukey's post hoc test. Independent t-tests were used to compare DISCERN and PEMAT understandability and actionability scores between AAO-HNS and ChatGPT Output 1.

Results: Material generated from ChatGPT Output 1 and ChatGPT Output 2 were at least two reading grade levels higher than that of material from AAO-HNS (p < 0.001). Regarding reading ease, ChatGPT Output 1 and ChatGPT Output 2 documents had significantly lower mean scores compared to AAO-HNS (p < 0.001). Moreover, ChatGPT Output 1 material on vocal cord paralysis had a lower PEMAT-P understandability compared to that of AAO-HNS material (p > 0.05).

Conclusion: Patient information on the ENTHealth.org website for select laryngology topics was, on average, of a lower grade level and higher reading ease compared to that produced by ChatGPT, but interestingly with largely no difference in the quality of information provided.

Level of evidence: NA Laryngoscope, 2024.

In the present study, we presented the detailed procedure and experience of endoscope-assisted transoral procedure of accessory parotid gland (APG) tumor resection. The surgical steps and tips were described and summarized clearly in our video. Laryngoscope, 2024.

Objective: Type 1 Thyroplasty is a well-established procedure used for medializing an immobile vocal fold. Silastic and Gore-Tex are the two most common materials used to accomplish this, but comparative data on their relative efficacy are scarce. We sought to compare outcomes between Silastic and Gore-Tex implants via systematic review and meta-analysis for unilateral vocal fold immobility.

Methods: We collected available data from PubMed, Embase, and Web of Science on demographics, maximum phonation time (MPT), voice handicap index (VHI-10/30) score, and any other relevant metrics encountered before comparatively evaluating differences in outcomes.

Results: The search yielded 1,534 records with 55 manuscripts ultimately included. There were 41 unique studies that utilized Silastic for a total of 1038 patients. There were 13 unique studies that utilized Gore-Tex for a total of 245 patients. The pooled mean increase in MPT for Silastic patients was 7.8 s (+1.3 SMD) compared with 5.7 s for Gore-Tex (+1.6 SMD). There was significant publication bias present in both analyses. The pooled mean change in VHI-30 with Silastic was -45.4 (62.2%, -2.09 SMD) compared with -51.6 (73.5%, -1.1 SMD) with Gore-Tex. The pooled mean change in VHI-10 with Silastic was -15.6 (54%, -0.46 SMD) compared with -11.6 (43%, -0.86 SMD) with Gore-Tex. There was no significant publication bias present in VHI outcomes.

Conclusions: Silicone and Gore-Tex implants provide adequate and comparable results in TT1. The data supporting this conclusion are limited by follow-up, diversity in outcomes, limited data availability, and publication bias. Future research should be dedicated to comparing implants in a well-randomized environment. Laryngoscope, 2024.

Objective: Surgery for bilateral vocal fold immobility (BVFI) aims to establish a patent airway while maintaining voice and swallow function, a unique dilemma. Current techniques display unfavorable healing vectors, and exposed endolaryngeal tissue results in substantial airway granulation requiring postoperative care. We present a novel technique to improve glottic airway patency by preserving laryngeal mucosal lining and harnessing lateral retraction of glottic tissue to reduce revisions for granulation tissue and laryngeal scar.

Methods: Case-series analysis was performed on eight BVFI patients who underwent submucosal thyroarytenoid myectomy with arytenoidectomy for treatment from 2011 to 2021. Patient medical comorbidities and BVFI etiology were reviewed. Decannulation rates, revision procedures, requirement of emergency services, and pre- and postoperative status were assessed by laryngology and speech-language pathology using the following metrics: VHI, DI, Modified Medical Research Council (MMRC), GRBAS, jitter percentage, shimmer percentage, pitch range, maximum phonation time, and dysphonia severity index, and diet type. Pre- and postoperative distal-chip flexible laryngoscopy with stroboscopy was performed. Outcome measures were assessed using paired Student's t-test of pre- and postoperative categorical variables.

Results: Successful decannulation was achieved in all (four of eight) patients with previous tracheostomy. All patients reported improved respiratory symptoms without tracheotomy. There was no difference in long-term voice outcomes. All patients tolerated a mechanical soft or regular diet, without new or worsened dysphagia.

Conclusion: Submucosal thyroarytenoid myomectomy with arytenoidectomy represents an effective BVFI treatment, through utilizing natural vectors of scarring, preservation of endolaryngeal mucosa, and preservation of the superficial lamina propria and the vocal ligament.

Level of evidence: 4 Laryngoscope, 2024.

Objective: Infantile subglottic hemangioma (SGH) poses a risk of airway compromise if untreated. Traditionally, operative endoscopy (OH) diagnoses SGH, but since the discovery of beta-blockers' efficacy in treating infantile hemangiomas (IHs) in 2008, and advances in endoscopic technology, nonoperative methods have emerged. This review identifies endoscopic practices for diagnosing and monitoring infantile SGH during the oral beta-blocker treatment era.

Data sources: A comprehensive literature search in October 2022 and August 2023 covered PubMed, Embase, Cochrane Library, SCOPUS, and Web of Science.

Review methods: The search was limited to English-language studies published since 2008, considering this when propranolol was demonstrated as an effective treatment option for IH. The articles were screened for relevance based on predefined inclusion and exclusion criteria.

Results: After inclusion and exclusion criteria, sixty final studies were identified, describing 240 cases of infantile SGH. Most children were diagnosed using OE alone (73.3%; n = 176/240), 23.3% (n = 56/240) using office-based laryngoscopy procedures (OBPs) followed by OE, 3.3% using OBP alone (n = 8/240). There were no reported diagnostic endoscopy-related complications. Twenty-nine studies described using endoscopy plus diagnostic imaging to either confirm an SGH lesion, characterize the extent of disease spread, or rule out other causes of presenting symptoms. The proportion of infants diagnosed with OE alone decreased from 2008 to 2023.

Conclusion: Operative endoscopy remains the SGH diagnostic standard, but OBP adoption is increasing. Further research is needed to determine the optimal SGH diagnosis and management approach.

Level of evidence: NA Laryngoscope, 2024.

Objectives: After modified Wendler glottoplasty (mWG), close follow-up with laryngologist and speech-language pathologist (SLP) is thought to be essential to achieve best outcomes. This study presents a case series of patients undergoing mWG at a single institution to identify factors associated with trends in post-operative follow-up.

Methods: Retrospective review of trans women patients who underwent mWG between March 2018 and July 2023 was performed. Demographic data, pre-operative care, and post-operative course were reviewed. Lost to follow-up (LTFU) was defined as a failure to return to the office or schedule a follow-up appointment as recommended, for ≥2 months after last visit. Logistic regressions were utilized to identify possible factors associated with being LTFU.

Results: Eight (50%) of 16 patients met LTFU criteria. Patients were considered not LTFU if they completed care (n = 3, 19%) or were still undergoing care (n = 5, 31%). Patients with chronic diseases were less likely to become LTFU (p = 0.03). Those lost to follow-up had more no-show visits (p = 0.04). Total number of gender-affirming surgeries, distance from hospital, socioeconomic status of residential zip code, race/ethnicity, other psychological history, and patient-reported outcome measure scores did not affect LTFU rates.

Conclusion: Fifty percent of patients were LTFU after modified Wendler glottoplasty. Even one no-show visit increased risk of being LTFU, whereas the presence of chronic diseases was protective against this. This study illustrates that increased efforts are needed following mWG to better understand the factors associated with being LTFU and to facilitate patients' ability to complete post-operative care successfully.

Level of evidence: 4 Laryngoscope, 2024.

We presented the surgical procedures of full endoscopic total parotidectomy followed by the sternocleidomastoid muscle flap transplantation via a short postauricular hairline incision, and reported patient outcomes to evaluate the feasibility and efficacy of this novel approach. Laryngoscope, 2024.

Objectives: To investigate the relationship between pediatric obstructive sleep apnea (OSA) severity and quality of life (QOL).

Study design: This study was a cross-sectional survey.

Methods: Patients aged 2-18 years being evaluated for OSA were recruited from a pediatric otolaryngology clinic and sleep center. Participants completed the Obstructive Sleep Apnea Questionnaire (OSA-18) and the PedsQL™ Multidimensional Fatigue Score (MFS).

Results: Responses of 18 control participants without OSA, 26 participants with clinically resolved OSA, 19 with non-obstructive sleep disordered breathing (SDB), 29 with mild OSA, 21 with moderate OSA, and 27 with severe OSA were analyzed. OSA-18 scores for controls were lower (indicating higher QOL) than patients with SDB (mean difference [MD] = -31.1; 95% CI -42.7 to -19.5), mild OSA (MD = -30.4; 95% CI -40.1 to -20.7), moderate OSA (MD = -23.6; 95% CI -34.5 to -12.7), or severe OSA (MD = -40.1; 95% CI -50.0 to -30.2). Participants with resolved OSA also had lower OSA-18 scores than participants in the SDB and OSA groups. Few differences were observed between the SDB, mild OSA, moderate OSA, and severe OSA groups on either the OSA-18 or PedsQL MFS, and these did not demonstrate a clear pattern. Linear regression of apnea hypopnea index (AHI) and OSA-18 or PedsQL MFS scores revealed weak relationships (R² < 0.1).

Conclusion: Using both an OSA-specific measure and generic fatigue measure, no consistent differences in QOL scores were found between children with varying OSA severities. Therefore, disease burden in pediatric patients with mild OSA and SDB should not be underestimated.

Level of evidence: Level 3 Laryngoscope, 2024.

Objectives: To investigate demographic data and airway management techniques for patients with congenital tracheal stenosis (CTS) during the preoperative, intraoperative, and postoperative periods.

Study design: A retrospective chart review.

Methods: This study was a retrospective case series at a single tertiary care pediatric medical center. It encompassed all children diagnosed with CTS who underwent slide tracheoplasty from January 2001 through December 2018. Exclusion criteria were acquired stenosis, tracheomalacia, patients without a confirmed diagnosis of CTS, and those with missing data. Patient demographics and details of airway management were collected and analyzed.

Results: A total of 148 patients met the inclusion criteria. The most common etiology of CTS was congenital tracheal rings (90.5%). The median age at surgery was 9 months (interquartile range [IQR] 3.3-35.4), and the median stenosis length was 4.0 cm (IQR 3.5-5.4). The most frequent comorbidities were genetic diseases, prematurity, and preoperative intubation. The most common related cardiac comorbidities were pulmonary artery sling, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of Fallot. Most of the patients with CTS exhibited 50% to 80% stenosis. Most of the patients underwent thoracic approach slide tracheoplasty. Airway management was primarily accomplished using an oral or nasal endotracheal tube preoperatively, cardiopulmonary bypass during surgical repair, and an oral or nasal endotracheal tube during closure and the postoperative period.

Conclusions: Slide tracheoplasty is an effective treatment for congenital tracheal stenosis. Coordinated airway management between the anesthesia and surgical teams is crucial. Appropriate planning yields the best patient outcomes.

Level of evidence: 4 Laryngoscope, 2024.