Laryngoscope最新文献

Objective: Automatic segmentation and detection of vestibular schwannoma (VS) in MRI by deep learning is an upcoming topic. However, deep learning faces generalization challenges due to tumor variability even though measurements and segmentation of VS are essential for growth monitoring and treatment planning. Therefore, we introduce a novel model combining two Convolutional Neural Network (CNN) models for the detection of VS by deep learning aiming to improve performance of automatic segmentation.

Methods: Deep learning techniques have been employed for automatic VS tumor segmentation, including 2D, 2.5D, and 3D UNet-like architectures, which is a specific CNN designed to improve automatic segmentation for medical imaging. Specifically, we introduce a sequential connection where the first UNet's predicted segmentation map is passed to a second complementary network for refinement. Additionally, spatial attention mechanisms are utilized to further guide refinement in the second network.

Results: We conducted experiments on both public and private datasets containing contrast-enhanced T1 and high-resolution T2-weighted magnetic resonance imaging (MRI). Across the public dataset, we observed consistent improvements in Dice scores for all variants of 2D, 2.5D, and 3D CNN methods, with a notable enhancement of 8.86% for the 2D UNet variant on T1. In our private dataset, a 3.75% improvement was reported for 2D T1. Moreover, we found that T1 images generally outperformed T2 in VS segmentation.

Conclusion: We demonstrate that sequential connection of UNets combined with spatial attention mechanisms enhances VS segmentation performance across state-of-the-art 2D, 2.5D, and 3D deep learning methods.

Level of evidence: 3 Laryngoscope, 2024.

Objective: There has been limited research on the influence of race and ethnicity on treatment decision-making for chronic rhinosinusitis (CRS). This prospective study aims to investigate potential factors linked to treatment modality choice among patients with medically refractory CRS, distinguishing between Chinese American and non-Chinese American patients.

Methods: CRS patients with persistent symptoms despite prior medical treatment were prospectively enrolled. These patients chose either to continue medical treatment or to undergo endoscopic sinus surgery (ESS) to alleviate CRS symptoms. Demographic and clinical characteristics were compared using bivariate analysis. The association between ethnicity and treatment modality choice was assessed using multivariable logistic regression.

Results: Among the 134 patients (29.1% Chinese Americans) included, 79 patients (59.0%) elected to undergo ESS. No significant differences in demographics, nasal polyp status, comorbidities, Sinonasal Outcome Test (SNOT-22), Lund-Mackay, or modified Lund-Kennedy scores were found between the treatment groups. After adjusting for age, income, and SNOT-22 score, non-Chinese American patients were more inclined to select ESS (OR = 7.92; 95% CI: 2.95-21.28; p < 0.001) as opposed to Chinese American patients. Chinese American patients who underwent ESS had a clinically significant improvement in SNOT-22 scores at 1 month (-11.29 points) and 3 months (-16.29 points) postoperatively.

Conclusions: Chinese American patients with refractory CRS are less likely to opt for ESS compared to non-Chinese American patients. Surgical treatment is effective in improving quality of life, as measured by the SNOT-22, among Chinese American CRS patients. Further investigations are warranted to identify factors contributing to surgical hesitancy.

Level of evidence: 3 Laryngoscope, 2024.

Objectives: To evaluate the impact of delayed postoperative radiotherapy (PORT) on overall survival (OS) in patients with head and neck cancers (HNC).

Data sources: A systematic review and meta-analysis were conducted by searching MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases.

Review methods: Studies assessing the impact of delayed PORT in adult HNC patients were included. A total of 11,171 titles and abstracts were screened, with 52 studies meeting the inclusion criteria. Data were extracted, and a pooled random-effects analysis was performed. The primary outcome was overall survival (OS), comparing patients receiving timely PORT (within 42 days) to those with delays.

Results: Of the included studies, 31 were conducted in the United States, with 16 using the National Cancer Database (NCDB). Patients who did not receive PORT within 42 days had a 4% increase in mortality (adjusted Hazard Ratio [aHR]: 1.04 [1.03-1.06]; I² = 78%; N = 254,189; 16 studies). Excluding time-overlapping NCDB-based studies, the OS benefit for timely treatment persisted (aHR: 1.10 [1.01-1.20]; I² = 39%; N = 52,003; 5 studies).

Conclusions: Initiating PORT within 42 days is significantly associated with decreased mortality in HNC patients, reinforcing CoC recommendations. However, more research is needed to understand the relationship between different time cutoffs and outcomes, and to identify factors contributing to PORT delays. Future studies should explore the impact of treatment delays on patient-centered outcomes, such as Quality of Life (QoL).

Level of evidence: NA Laryngoscope, 2024.

Objective: This systematic review seeks to evaluate the prevalence of local symptoms in patients with benign thyroid disease as described in the literature.

Data sources: A literature search was conducted across PubMed, Embase, Medline, and Cochrane databases.

Review methods: Crude symptom prevalence was obtained by addition of data across studies that reported local symptoms, and adjusted symptom frequency was calculated using a random effects model. Subgroup analysis was conducted to explore heterogeneity.

Results: The final review included 21 studies with 4063 patients, with adjusted symptom prevalence as follows: dyspnoea (29%), dysphagia (23%), dysphonia (18%). Globus and cosmetic concern were frequent in nodule subgroups (54% and 77%, respectively). Patients with goiter were significantly more likely to experience dyspnoea than those with solitary nodules. Symptom prevalence was qualitatively higher in studies that used questionnaires, as compared with studies containing clinician-derived data.

Conclusions: Local symptoms occur frequently in patients with benign thyroid disease, with dyspnoea being most common, followed by dysphagia and dysphonia. Additional large-scale studies with homogenous reporting of symptoms, and data pertaining to thyroid disease size and location, are required to further delineate the relationship between benign thyroid disease and local symptomatology. Furthermore, the disparity in symptom prevalence between questionnaire and clinician-derived data suggests the superiority of questionnaires as a means of symptom assessment, and their potential utility as an instrument to guide patient counseling and outcome expectations. Laryngoscope, 2024.

Objective(s): To compare the incidence of acute and chronic complications of temporal bone fractures, and identify predictors for post-injury, audiometrically confirmed hearing loss.

Methods: Retrospective cohort analysis of patients with acute temporal bone fractures who underwent both in-hospital and outpatient follow-up Otolaryngology evaluation at an academic, tertiary-care institution from January 2002 to January 2023. Otologic outcomes were compared between initial and follow-up evaluations. Logistic regression analysis was used to identify predictors of audiometric hearing loss.

Results: 577 subjects with acute injuries were reviewed; 220 met inclusion criteria. Compared with initial evaluation, the incidence of hemotympanum (57% vs. 5%, p < 0.001), external auditory canal injury (18% vs. 8%, p = 0.01), facial nerve weakness (7% vs. 4%, p = 0.016), and cerebrospinal fluid otorrhea (6% vs. 0%, p < 0.001) significantly decreased at follow-up. There were no differences in rates of subjective hearing loss, tympanic membrane injury, or ossicular disruption. Formal audiograms were performed in 82 subjects. 47 (57%) demonstrated hearing loss, almost half of which were pure sensorineural. Multivariate regression identified age (Odds Ratio [OR]: 1.03, p = 0.036), intracranial bleeding (OR: 7.49, p = 0.004), and lateral dural venous sinus thrombosis (OR: 10.5, p = 0.039) as predictors for audiometric loss.

Conclusions: Temporal bone fractures are complex injuries often associated with numerous intra-temporal and extra-temporal complications. Various otological sequelae persist upon hospital discharge. Yielding insight about the natural history of such injuries, these results aid in patient counseling, identifying subjects at risk for long-term problems, and necessitating follow-up.

Level of evidence: IV Laryngoscope, 2024.

Objective: Repositioning and fixation of the posterior septal angle (PSA) relative to the anterior nasal spine (ANS) is a well-known maneuver performed during rhinoplasty. Suture techniques through the periosteum along with transosseous drilling through the spine are the two most common fixation methods. We report on how nasal airway patency varies as a function of technique and patient demographic factors.

Methods: A retrospective analysis was performed on patients who underwent PSA repositioning and stabilization during rhinoplasty due to caudal septal deformities. Nasal Obstruction Symptom Evaluation (NOSE) scales were measured pre- and post-operation to evaluate functional outcomes.

Results: 207 patients with either mobile or immobile PSA underwent ANS fixation secured with either a suture passed through the periosteum of the ANS or with the creation of a drill hole through the ANS. In all patients regardless of clinical or demographic groupings, postoperative NOSE scores were significantly decreased when compared to preoperative scores (p < 0.05). Preoperative NOSE score, fixation method, sex, functional versus cosmetic, age, follow-up period, and graft site did not independently affect the postoperative NOSE score. Though the differences between primary and revision outcomes were statistically significant, patients in both groups reported significant improvements in postoperative NOSE scores that deescalated their symptoms from "severe" to "mild."

Conclusion: Repositioning and fixation of the PSA improve patient outcomes. However, there is no significant difference between fixation methods on final NOSE scores. Septal fixation with consideration for patient anatomy allows for effective treatment.

Level of evidence: 4 Laryngoscope, 2024.