Laryngoscope最新文献

Objectives: This study aimed to investigate the long-term auditory and speech outcomes in children with Incomplete Partition Type I (IP-I) who underwent cochlear implantation (CI) and compared their progress to implanted children with normal cochlea.

Methods: This study tracked 17 children with IP-Ι for an average of 3.5 years post-implantation. A control group with normal cochlea was also tracked. Regular assessments, including aided hearing threshold, categories of auditory performance (CAP), and speech intelligibility rating (SIR), were conducted every 6 months for the first 2 years post-CI and annually thereafter. Speech recognition was tested for children who could cooperate with it.

Results: The aided hearing threshold of IP-I children had improved significantly from 90.51 dB HL before CI to 47.02 dB HL in the sixth-month post-CI, and it had further improved to 26.27 dB HL after more than 48 months post-CI. Meanwhile, their median CAP scores had improved from 0 to 6.5 and median SIR scores from 1 to 4 over the same period. There was no significant difference in the improvement of mean aided hearing thresholds over time between the IP-I and control groups postoperation. However, IP-I children showed slower progress in CAP and SIR scores and had lower recognition rates for monosyllabic and disyllabic words compared with the control group.

Conclusion: Children with IP-Ι showed continuous but slower improvement in auditory and speech capabilities post-CI compared to those with normal cochlea. Their speech recognition ability was also inferior.

Level of evidence: III Laryngoscope, 2025.

Objective: Peripheral bilateral vestibular hypofunction (BVH) is a rare condition that is well-studied in the adult population, whereas characterization in children has been limited. We report a pediatric cohort of patients with BVH at a multidisciplinary, tertiary care pediatric vestibular clinic.

Methods: A record review of 832 patients with balance-related complaints in our center was conducted. Multidisciplinary evaluations in Otolaryngology, Physical Therapy (PT), and Audiology were reviewed for each subject, and data were entered into a REDCap database for further analysis.

Results: Twenty-six individuals met diagnostic criteria for BVH. The cohort consisted of 17 females and nine males, with a mean age of 5.24 years (1.41-17.35; SD 3.97). Thirteen subjects had diagnoses of one or more concurrent neurodevelopmental syndromes. Sensorineural hearing loss (SNHL) was present in 21 (80.8%) subjects, of which 17 were profound in severity and 14 had undergone cochlear implant surgery. Seventeen (65.4%) children were able to complete vHIT testing, revealing reduced lateral semicircular canal (SCC) gains bilaterally in 11 cases. Twenty-one (80.8%) patients received recommendation for PT services, of which 15 were for vestibular therapy specifically. Patients who completed their course of vestibular PT achieved improved functional goal outcomes and discharge from therapy in nine of 11 (81.8%) cases.

Conclusion: We present a case series of pediatric patients with bilateral vestibular hypofunction. BVH in this population is often associated with SNHL and comorbid congenital or neurodevelopmental diagnoses. Vestibular physical therapy may provide a significant improvement in quality of life for patients.

Level of evidence: Level 4 Laryngoscope, 2025.

Objective: To investigate the impact of county-level social vulnerability on patients' decision to refuse recommended surgical treatment.

Methods: Retrospective cohort analysis conducted on HNSCC cases documented in the latest available SEER databases from 2000 to 2020; various demographic, including county of residence, and disease-related variables were collected. CDC's Social Vulnerability Index (SVI) was assigned based on patients' county of residence, and patients were subsequently categorized into four SVI quartiles. Pearson chi-square tests and binomial logistic regression was conducted to determine the impact of variables on patients' refusal of surgical treatment.

Results: Among 83,184 patients, 2.6% (2,165) refused surgical intervention recommended by their physician as part of treatment. Social vulnerability (higher SVI), male sex, older age, more advanced disease stage, belonging to non-Hispanic Black or Native Hawaiian/Asian Pacific Islander Race and Origin, and single marital status were associated with higher likelihood of refusing surgery.

Conclusion: SVI is a significant factor in the refusal of recommended surgical treatment in HNSCC patients. Advanced disease stages and social vulnerability appear to interplay, influencing treatment decisions. Culturally competent care and support for socially vulnerable patients may mitigate disparities in treatment acceptance, potentially improving survival outcomes.

Level of evidence: 3 Laryngoscope, 2025.

Objectives: One-third of older adults suffer from dizziness and vertigo. Benign positional paroxysmal vertigo (BPPV), which occurs due to otoconia moving into the semicircular canal, is the most common vestibular disorder. We evaluated the connection between BPPV and geriatric symptoms.

Methods: A comprehensive geriatric evaluation included daily living activities, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale tests for all patients. Patients' nutritional status was assessed using the Mini-Nutritional Assessment. Body weight and fat free mass were determined from the bioimpedance analyzer. Hand grip strength was measured using an electronic hand dynamometer to determine muscle strength. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People-2 recommendations. The patients were divided into three groups as BPPV-positive, BPPV-negative, and healthy (control).

Results: Obesity, low muscle mass, dynapenia, gait speed, low gait speed, and history of falling statistically significantly differed between the three groups, but age, gender, smoking, alcohol consumption, body mass index, MMSE, depression, number of falls, and comorbid diseases did not differ. The BPPV-positive group had greater rates of obesity, low muscle mass, dynapenia, and sarcopenia than the control group (p = 0.008, 0.007, 0.01, 0.03). In the unadjusted univariate analysis, low muscle mass, sarcopenia, and obesity were risk factors for "BPPV" (Odds Ratio [OR]: 3.43, Confidence Interval [Cl]: 1.25-9.37, p = 0.016; OR: 3.47, Cl: 1.32-9.13, p = 0.011; OR: 2.71, Cl: 1.09-6.70, p = 0.031).

Conclusions: Obesity, sarcopenia, and low muscle mass are risk factors for BPPV, and we urge the older population to adopt healthy diet and exercise regimens to reduce BPPV-related falls.

Level of evidence: Level 3 Laryngoscope, 2025.

Background: Laryngeal squamous cell cancer (LSCC) accounts for around one-third of head and neck cancers, with smoking and alcohol as major risk factors. Despite advances in organ preservation, survival rates have stagnated globally over recent decades. The impact of socioeconomic deprivation on LSCC outcomes in the West of Scotland remains underexplored. We hypothesized that survival outcomes in the West of Scotland are poorer than cohorts from other developed nations.

Aim: To evaluate characteristics and survival outcomes for LSCC patients in the West of Scotland and identify predictors of survival.

Methods: A retrospective cohort study of 867 LSCC patients in the West of Scotland (2014-2020) analyzed demographics, tumor staging, performance status, treatments, and socioeconomic status (Scottish Index of Multiple Deprivation, SIMD). Subgroup differences were assessed using chi-squared tests. Survival analysis was performed with Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling.

Results: The cohort had a male-to-female ratio of 3.2:1, with a mean age of 65.5 years, with 56% presenting with advanced disease. Most patients (70.7%) lived in the most deprived areas. Supraglottic cancers were the most common subsite (51%). Five-year overall survival (OS) was 46%, with a median OS of 52 months. Glottic cancers had better outcomes (64% OS) compared to supraglottic cancers (36%). Predictors of survival included age, subsite, performance status, alcohol use, treatment modality, and deprivation.

Conclusion: LSCC survival in the West of Scotland is lower than in other European nations, influenced by advanced-stage presentation, deprivation, and frailty. Addressing these factors is vital to improving outcomes.

Level of evidence: III Laryngoscope, 2025.

Lower lip malposition can occur after anterior mandibular resection as a result of the loss of soft tissue lip attachments. We report our technique of cranial suspension of the lower lip with fascia lata slings to improve lip position. Correction of lip ptosis results in cessation of drooling, improved oral intake, and restoration of facial aesthetics. Laryngoscope, 2025.

Objectives: The aim of this study was to investigate the role of lymph node yield (LNY), lymph node ratio (LNR), and neutrophil to lymphocyte ratio (NLR) as prognostic factors, their impact on survival in patients with advanced laryngeal squamous cell carcinoma (LSCC).

Methods: This multicentric retrospective study included 195 patients with clinical N0 advanced laryngeal carcinoma who underwent total laryngectomy and/or total pharyngolaryngectomy over 5 years. The number of lymph nodes extracted (LNY) and the number of positive nodes were counted. The lymph node ratio "LNR" was calculated as follows: (positive nodes /LNY). Moreover, neutrophil to lymphocyte ratio (NLR) was calculated and documented for analysis.

Results: The mean 5-years DFS and overall survival (OS) was 33 and 35 months. The following were statistically significant factors negatively associated with overall survival; LNR (p = 0.047), NLR > 7 (p = 0.05), preoperative tracheostomy (p = 0.016), infiltrated safety margin (p = 0.01), postoperative radiotherapy (p < 0.001), N stage (p = 0.019), and unilateral neck dissection (p = 0.03). On the other hand, DFS was negatively associated with LNR (p = 0.001), N stage (p = 0.001), and infiltration of the surgical margins (p = 0.001).

Conclusion: LNY and LNR are both linked to survival outcomes following neck dissection in patients with clinical N0, locally advanced laryngeal carcinoma, where higher LNY and lower LNR correlated with improved survival and could be easily incorporated into cancer staging systems to aid in the prognostic stratification of patients. Additionally, NLR could act as a cost-effective inflammatory biomarker predicting poor prognosis in LSCC.

Level of evidence: III Laryngoscope, 2025.

Introduction: Unilateral sphenoid sinus opacification on computed tomography is caused by a variety of pathologies including inflammatory and infectious sinusitis, benign and malignant tumors, and encephaloceles. The purpose of this study was to report craniofacial pain locations and outcomes in inflammatory unilateral sphenoid sinusitis (USS) patients who underwent endoscopic sinus surgery (ESS).

Methods: A multi-institutional retrospective cohort study was conducted on all adult patients who had ESS for USS from 2015 to 2022. Patient demographics, presenting symptoms and nasal endoscopy findings, extent of surgical dissection, and craniofacial pain locations and outcomes were recorded. Exclusion criteria included age <18 years, non-inflammatory etiology, immunodeficiency, invasive fungal sinusitis, lack of follow-up, lack of preoperative pain location, and neoplasia. Descriptive statistics were calculated.

Results: Of 57 patients with USS, 44 (77.2%) reported craniofacial pain at one or more locations. Retrobulbar (n = 19, 43.2%) was the most common pain location followed by frontal (n = 17, 38.6%) and occipital (n = 10, 22.7%). Surgical intervention resulted in pain resolution in 33/44 patients (75%), with a mean follow-up of 83.7 (±97.8) days. There were no significant associations between presenting symptoms, imaging findings, endoscopy, surgical extent, or final pathology and the presence or resolution of facial pain (p > 0.05).

Conclusion: In USS patients, the most common craniofacial pain locations were retrobulbar, occipital, and frontal, with a minority being vertex. Based on short-term follow-up, ESS resolved the craniofacial pain in 75% of cases. There were no clinical variables that predicted the presence or resolution of craniofacial pain.

Level of evidence: IV Laryngoscope, 2025.

Objectives: To assess the use of occipital vessels for microvascular anastomosis in head and neck free tissue transfer reconstruction.

Methods: A literature search was undertaken to identify studies utilizing the occipital vessels for microvascular anastomosis in free tissue transfer. Following literature review, 30 anatomic cadaveric dissections on 15 fresh unfixed cadavers were performed to evaluate the occipital artery and identify a reliable vein within reasonable proximity. In addition, vessel caliber pre- and post-dilation was recorded, along with vessel geometry.

Results: The mean (SD) artery diameter was 2.0 (0.4) mm pre-dilation and 2.8 (0.56) mm post-dilation. An accompanying occipital vein was identified in 20% of dissections (n = 6), with a mean (SD) vein diameter of 1.85 (0.85) mm pre-dilation and 3.5 (0.93) mm post-dilation. When an accompanying occipital vein was not present, the external jugular vein was identified as a suitable vessel for venous outflow. This vessel was identified from 1.0 to 5.0 cm from the mastoid tip, with a mean of 3.3 cm.

Conclusions: The occipital artery may be reliably identified using a limited post-auricular incision. An accompanying occipital vein may be present in a minority of cases; however, the external jugular vein may be easily identified by extending this incision. The occipital vessels may be useful in reconstruction of posterior scalp defects or for use in vessel-depleted necks.

Level of evidence: N/a Laryngoscope, 2025.

Objective: To examine implementation of virtual reality (VR) and Fitbit wearable activity devices in postoperative recovery.

Methods: This was a prospective, 4-arm, randomized controlled trial of patients undergoing inpatient head and neck surgery at a tertiary academic center from November 2021 to July 2022. Patients were randomized to Control, VR, Fitbit, or combined VR + Fitbit groups. Patients in the VR groups were brought VR headsets to use throughout each day, and patients in the Fitbit groups wore Fitbit devices and were encouraged to achieve 2,000 daily steps. The primary outcome was average daily opioid use, measured as milligram morphine equivalents (MME).

Results: There were 80 patients included. The majority of patients were male (68.8%), and mean age was 58.8 ± 14.4 years. Only the combined VR + Fitbit cohort was associated with reduced average daily opioid use (VR + Fitbit: 8.8 [20.6] MME vs. Control: 26.4 [37.4] MME, p = 0.02). Patients in intervention groups also had higher hospital satisfaction (p = 0.02). VR was utilized 26% of the time it was provided, with mean use time of 23.8 ± 7.8 min. Mean post-VR subjective pain reduction was 1.0 ± 1.3, and there were three mild adverse events of neck or nasal discomfort. Among the Fitbit groups, there were no adverse events and daily step counts ≥2,000 steps were achieved 45% of the time.

Conclusion: Implementation of VR and wearable activity devices in postoperative recovery appears well tolerated and may facilitate further development of Enhanced Recovery After Surgery (ERAS) protocols, though there are challenges to maximizing device usage.

Level of evidence: II. Laryngoscope, 2025.