Laryngoscope最新文献

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:

Objective: To evaluate procedure-related complications after ACSS and identify key influential factors that increase or decrease the risk of perioperative complications.

Methods: This single institution retrospective cohort study included 3401 patients who underwent ACSS by spine-surgeons at a single institution from January 2015 to August 2023. Our main outcome of interest was perioperative complications after ACSS, divided into objective and subjective outcomes. Covariates included patient, procedure, surgeon, and institutional factors. Univariable and multivariable logistic regression were used to identify factors associated with complications.

Results: Our cohort included 3401 patients averaging 55 ± 12 years and 50% (n = 1689) were male. The objective complication rate was 4.44% (n = 151) and subjective complications were 6.70% (n = 228). Otolaryngologists were involved in 17% (n = 591) of cases. On multivariable logistic regression, high volume (≥ 15 annual cases) surgeons (OR: 0.58, 95% Cl: 0.35-0.95, p = 0.030), and otolaryngologist involvement in revision surgeries (OR: 0.31, 95% Cl: 0.12-0.77, p = 0.011) were independent predictors of decreased odds of objective complications. Advanced age (OR: 1.04, 95% Cl: 1.02-1.05, p < 0.001) and surgeries involving multiple (≥ 3) spinal levels (OR: 1.70, 95% Cl: 1.23-2.34, p = 0.001) independently predicted an increased odd of subjective complications. Otolaryngologist involvement in upper (C1-4) cervical spinal cases (OR: 0.28, 95% Cl: 0.08-0.96, p = 0.042) independently decreased odds of subjective complications.

Conclusion: Adopting a multidisciplinary approach with otolaryngologists as co-surgeons in complex procedures and increasing surgeons' case volume may improve surgical outcomes, decrease complication rates, and improve quality of care.

Level of evidence: 4:

Objective: To identify factors associated with secondary surgery for velopharyngeal insufficiency in children following primary palatoplasty.

Methods: A retrospective review was conducted of children with cleft palate who were seen at a single academic center between August 2014 and April 2024 and underwent primary palatoplasty. Demographic and clinical data were collected, and the need for and number of secondary velopharyngeal surgeries were recorded. Univariate analyses and multivariate logistic regression were used to identify associated factors.

Results: Of 251 children who underwent primary palatoplasty, 27 (10.8%) required secondary velopharyngeal surgery. Univariate analyses revealed no association between secondary surgery and cleft type, presence of a syndrome, or timing of palatoplasty. Multivariate logistic regression controlling for race, insurance type, age at primary palatoplasty, and presence of 22q11.2 microdeletion syndrome revealed private insurance was associated with decreased odds of secondary velopharyngeal surgery (OR = 0.230, 95% CI: 0.069-0.765, p = 0.017), whereas Asian race was associated with increased odds (OR = 5.853, 95% CI: 1.105-30.998, p = 0.038). Among those requiring velopharyngeal surgery, 74.1% underwent one procedure and 25.9% underwent two. The presence of 22q11.2 microdeletion syndrome was significantly associated with needing two surgeries (p = 0.042), while female sex was associated with requiring only one surgery (p = 0.006).

Conclusions: Clinical and sociodemographic factors were predictive of secondary velopharyngeal surgery following primary palatoplasty, with different risk factors associated with the need for more than one procedure. Larger studies are warranted to corroborate these findings and guide risk stratification and family counseling.

Level of evidence: 4:

Objective: As our understanding of autoimmune laryngotracheal stenosis (LTS) evolves, distinguishing patients who may benefit from systemic immunosuppression versus those needing only local treatment is increasingly important. In this study, we identify a distinct subset of autoimmune LTS characterized by edema of the inferior true vocal folds that extends to the superior aspect of the cricoid cartilage, termed "infracordal stenosis." The objective of this study is to characterize the clinical presentation and treatment outcomes of infracordal stenosis and compare it to typical autoimmune-related subglottic stenosis (AI-SGS).

Methods: We conducted a retrospective review of patients with autoimmune laryngotracheal stenosis evaluated by both rheumatology and otolaryngology at our institution to identify two groups: patients with infracordal stenosis and those with typical AI-SGS. Data on immunosuppressive treatments and airway dilation procedures were collected. Time to first dilation was compared between groups.

Results: Among 49 patients with autoimmune LTS, 11 had infracordal involvement. Six patients had isolated infracordal stenosis while five had concomitant subglottic involvement. Kaplan-Meier analysis showed longer time to first dilation in patients with infracordal involvement (median 792 vs. 44 days; p = 0.048). Four out of six patients with isolated infracordal stenosis required no dilations during their entire follow-up period.

Conclusion: Among autoimmune LTS patients referred to rheumatology, those with infracordal involvement experienced longer time to first dilation compared to those with typical AI-SGS. These findings suggest that infracordal stenosis may represent a distinct, glucocorticoid-responsive phenotype within autoimmune laryngotracheal stenosis, with implications for treatment selection and multidisciplinary care.

Level of evidence: 4: