Laryngoscope最新文献

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:

Objective: There is a paucity of information on the uptake of Medical Assistance in Dying (MAiD) for patients with head and neck cancer (HNC). Our study reports the prevalence, disease characteristics, and nature of the desire for MAiD in patients with HNC who underwent the process in Ontario. The aim is to better understand this population and identify gaps in our current system of care.

Methods: This is a retrospective cross-sectional analysis for the period June 17, 2016 to December 31, 2022. Data were received from the Office of the Chief Coroner Ontario, Canada.

Results: Three hundred and fifty-six persons received MAiD. The average age was 72.4 years (SD 12.22) with 260 of the patients being men (73.03%). The most common HNC primary tumor site was the oral cavity 109 (30.6%). The most reported reason was inadequate control of symptoms other than pain (79.21%) followed by inadequate pain control or concerns about it (75%). The patient's private residence (55.62%) was the most common setting. Patients were more likely to live in wealthier neighborhoods and in large urban centers. Future prediction of MAiD uptake shows a linear year-by-year increase.

Conclusion: The use of MAiD in HNC has been steadily increasing since its legalization and is projected to continue increasing. There is a male predominance that is aligned with the incidence and prevalence of HNC nationally. Overall, MAiD is an increasingly employed choice for HNC patients receiving treatment for disease without curative intent.

Level of evidence: 4:

Objective: To evaluate anatomical and structural parameters of the lacrimal sac and nasolacrimal duct system measured through dacryocystography with computed tomography (Dacryo-CT) in relation to restenosis after endoscopic dacryocystorhinostomy (DCR) in a cohort of patients.

Methods: This retrospective study included patients undergoing endoscopic DCR with preoperative Dacryo-CT imaging. Parameters analyzed included the dimensions of the lacrimal sac (vertical and horizontal axes), the thickness of the bone anterior to the lacrimal sac, the thickness of the sac walls, the ratio of nasolacrimal duct length to the extent of contrast medium descent, and the ratio of sac width to wall thickness. Restenosis was defined clinically and confirmed endoscopically within 18 months postoperatively. Multivariate logistic regression was performed to assess the association between Dacryo-CT parameters and restenosis.

Results: Of 100 patients, restenosis occurred in 28 (28%). Restenosis was significantly associated with a reduced vertical axis of the lacrimal sac (mean, 7.8 vs. 10.2 mm, p < 0.01) and increased sac wall thickness (mean, 1.5 vs. 1.2 mm, p = 0.02). A higher ratio of sac width to wall thickness correlated with a lower restenosis rate (p = 0.04). The thickness of the anterior bone and the nasolacrimal duct length/contrast descent ratio showed no significant correlation with restenosis risk.

Conclusion: Preoperative Dacryo-CT-derived parameters, particularly lacrimal sac dimensions and wall thickness, may predict restenosis risk after endoscopic DCR. These findings highlight the importance of detailed anatomical evaluation to optimize surgical outcomes.

Level of evidence: 3:

Objective: The head mirror was invented by Friedrich Hoffmann in 1841 and popularized by Anton von Troeltsch in 1855, whose design is still used today. Though it was primarily used by otolaryngologists, it is used ubiquitously as a symbol to represent doctors in the popular press and media. This investigation examines how the role of the head mirror throughout history has influenced medical symbolism in popular culture.

Data sources: Literature review was conducted including primary references exploring the history and development of the head mirror, followed by a secondary search of references cited by retrieved articles.

Review methods: The National Library of Medicine was used to search for historical texts. A Boolean search using "head mirror" AND "manual" was conducted. Primary sources such as cartoons and newspapers with depictions of the head mirror were also utilized.

Results: Doctors wearing head mirrors appear in a wide range of comic strips, television shows, paper and digital advertisements, as well as children's media and video games from the early 20th century up through the current day.

Conclusion: While history often leads us to understand how symbols arise, we can only postulate the cultural reasons why certain symbols persist. Perhaps it is the striking appearance, the visual humor, or the nostalgic aspect of the head mirror in combination with its historical significance that has been permanently etched into the image of the physician. While the everyday use of the head mirror has declined, its use in mainstream media is as pervasive as ever.

Objective: There is no consensus on blood thinner management in the perioperative period for head and neck free flap reconstructions. This study evaluated head and neck free flap outcomes in patients on baseline blood thinners, aspirin flap prophylaxis, and deep venous thrombosis (DVT) prophylaxis regimens.

Methods: Patients undergoing head and neck free flap reconstruction at a single tertiary, academic institution were included. Patients were grouped according to baseline blood thinners, aspirin flap prophylaxis, and DVT prophylaxis regimens. The primary outcome was overall complication rate, while secondary outcomes included flap compromise, flap failure, bleeding, venous thrombotic events, and arterial thrombotic events. Statistical analysis was performed with Fisher's exact test and risk ratio (RR) regression analysis, using propensity score-adjusted models.

Results: Of 470 patients, 16.6% experienced postoperative complications. Longer preoperative holds (odds ratio [OR] = 1.81, p = 0.04) and delayed resumption of baseline blood thinners (OR = 1.56, p = 0.04) were associated with increased complication risk, particularly flap compromise. Unfractionated heparin was associated with higher complication rates compared to sequential compression devices (RR = 3.10, p = 0.018) and low molecular weight heparin (RR = 2.79, p < 0.001) for DVT prophylaxis. No other perioperative blood thinner regimens were significantly associated with postoperative complications.

Conclusions: Most regimens, including baseline blood thinners, aspirin flap prophylaxis, and DVT prophylaxis, can be managed safely in the perioperative period. However, unfractionated heparin was associated with higher complication rates than other DVT prophylaxis regimens. While baseline blood thinners did not increase most complications, prolonged preoperative holding and delayed resumption may jeopardize flap viability-highlighting a modifiable point of intervention.

Level of evidence: 3:

The treatment of upper airway obstruction in newborns with Robin sequence (RS) is challenging. We report our experience implementing the minimally invasive Tübingen palatal plate in a pediatric tertiary care center, detailing a step-by-step protocol and clinical outcomes from our first patient series. Despite a learning curve and need for multidisciplinary coordination, the palatal plate can be safely and effectively integrated outside its center of origin.

Objective: Otitis media with effusion (OME) is frequently observed in patients with severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)-yet it remains underrecognized. Both conditions are debilitating and may share type 2 inflammatory mechanisms. This study investigates the prevalence of OME (measured by tympanometry) in patients with CRSwNP and evaluates the effect of biologic treatment with mepolizumab, with or without combined FESS, on hearing outcomes as well as otologic symptoms.

Methods: Secondary analysis of a randomized controlled trial (RCT) (n = 58) comparing FESS and mepolizumab versus mepolizumab alone in patients suffering from severe CRSwNP. Tympanometry, audiometry, and patient-reported outcomes (SNOT-22 and COMOT-15) were assessed at baseline and after 6 months.

Results: At baseline, 22.8% (13/57) of patients had pathological tympanometry (OME), consistent with previous prevalence estimates. After 6 months, the proportion decreased to 14% (p = 0.07). No significant changes were observed in pure tone averages (PTA). In contrast, self-reported outcomes improved significantly, with reductions in both COMOT-15 and SNOT-22 scores (p < 0.05), independent of baseline tympanometry status.

Conclusion: Mepolizumab treatment was associated with a trend toward reduced middle ear symptoms and significant improvement in self-reported otologic symptoms, supporting the concept of global type 2 airway inflammation and the clinical relevance of assessing ear disease in CRSwNP.

Level of evidence: 2:

Objective: To develop and evaluate a deep learning object detection system for identifying vocal fold polyps in stroboscopic video frames using You Only Look Once (YOLO), and to assess the added benefit of temporal tracking on detection performance.

Methods: A retrospective dataset of 12,742 annotated frames from 55 laryngoscopy video recordings was annotated with bounding boxes identifying vocal fold polyps. Pretrained YOLO11 and YOLO12 models were fine-tuned to detect the polyps in the frames. A temporal tracking algorithm was further developed to propagate missed detections across adjacent frames.

Results: YOLO12 outperformed YOLO11 across all metrics. On the hold-out test set, YOLO12 reached a precision of 83.1% and an F1 score of 67.6%, with a mean average precision at 0.5 (mAP@0.5) of 64.1%. By comparison, YOLO11 achieved a precision of 67.3% and an F1 score of 56.2%, with a mAP@0.5 of 56.0%. Incorporating temporal tracking increased mAP@0.5 to 70.4% with YOLO 12, while maintaining a detection speed of 21.4 frames per second (fps), close to real time (30 fps).

Conclusions: Using YOLO 12 for vocal fold polyp detection in stroboscopy was enhanced with temporal tracking, achieving a mAP@0.5 of 70.4% with near real time performance. These results demonstrate the potential of real-time AI-assisted detection of vocal fold lesions.

Level of evidence: 4:

Introduction: The most common genes responsible for autosomal recessive nonsyndromic hearing loss (AR-NSHL) are GJB2 and STRC. STRC mutations are associated with mild-to-moderate sensorineural (SNHL) hearing loss and a lack of progression. However, our institutional experience suggested otherwise, prompting this review.

Methods: A 10-year retrospective chart review was performed at a tertiary children's hospital after the University of Iowa added STRC to its OtoSCOPE^R panel in 2013. Subjects with positive OtoSCOPE^R results underwent audiologic review. Hearing progression was defined based on pure-tone average changes, and mutation subtypes were categorized.

Results: Of 354 subjects undergoing OtoSCOPE^R testing, 181 (51.1%) carried a pathogenic mutation; GJB2 (28.7%) and STRC (16.6%) were most common. The STRC cohort included 30 subjects (21 males, 9 females) with hearing loss severity classifiable in 26 subjects and the highest proportion in the mild-to-moderate range (n = 46 ears; 88.5%). Hearing progression was observed in 12/24 subjects (20 ears: 8 bilateral, 4 unilateral). Median annual progression was 1.1 dB (range -3.5 to 18.7 dB). Two STRC subjects had substantial progression requiring cochlear implantation (one performed, one recommended). Genetic subtyping revealed seven categories, including six males with STRC/CATSPER2 deletions (deafness-infertility syndrome). No association between subtype and severity or progression was identified.

Discussion: STRC is the second most common cause of childhood NSHL and the leading contributor to mild-to-moderate SNHL. Unlike most published literature, 50% of our STRC cohort exhibited progression, and 17.6% of progressing subjects had substantial unilateral loss. We recommend long-term audiometric monitoring and standardized genomic reporting for this population.

Level of evidence: 4: