Laryngoscope最新文献

Objectives: (1) To determine whether perception of pharyngeal residue severity differs by view plane on videofluoroscopy. (2) To explore whether the Bolus Clearance Ratio (BCR) can be reliably applied in the anterior-posterior (AP) plane. (3) To investigate the relationship between perception of residue severity and BCR measures across view planes.

Methods: Images of the same bolus condition in lateral and AP were rated using a simple 5-point ordinal descriptive scale (none, trace, mild, moderate, severe) by 225 speech-language pathologists via electronic survey. BCR measures were obtained for the same set of images from four trained raters. Wilcoxon signed-rank tests and cumulative mixed modeling were used to compare ratings by plane. BCR reliability was calculated using intraclass correlation coefficients. Perceptual ratings were compared with BCR measures using Spearman correlations.

Result: (1) Perception of residue severity was not consistent across plane in 9/10 image pairs (p < 0.05), with a significant fixed effect of plane on severity rating (β = 0.41; z = 7.27; p < 0.001). The directionality of differences varied by case. (2) Inter-rater reliability for BCR measures was good across lateral (intraclass correlation coefficient [ICC] = 0.82) and AP (ICC = 0.87) planes, with superior intra-rater reliability in AP (lateral ICC = 0.85; AP ICC = 0.98). (3) There was a strong positive correlation between perceptual ratings and BCR measures in both planes.

Conclusions: Perception of pharyngeal residue severity differs between lateral and AP planes with inconsistent directionality raising important questions about the clinical implications of single plane studies. The BCR shows good-excellent reliability and strong correlation with perception across planes, offering a promising method for cross-plane quantification.

Level of evidence: Level III, diagnostic study with a gold standard Laryngoscope, 2024.

Objectives: The frequency of paranasal sinus fungus balls, a common form of rhinosinusitis, has increased. Although treatment and causative factors have been well investigated, the evolving nature of the fungal balls remains unelucidated. This study aimed to investigate and analyze the changing patterns of fungus balls.

Methods: This retrospective study analyzed data from 35 participants selected from a pool of 41,497 patients who underwent brain magnetic resonance imaging (MRI) at a large health care center. The extent of the fungus balls was evaluated by grading them from 1 to 4 based on the MR images. The changing process of the fungus ball was analyzed based on demographics, interval between the MRI scans, comorbidities, and specific dental interventions.

Results: The fungus ball grades showed significant progression over time. In the analysis of 29 sinuses with initially low-grade (grades 0, 1, and 2) fungus balls, 15 sinuses showed a grade change <2 (no/minimal change group), whereas 14 sinuses showed grade changes of ≥2 (substantial change group). Intergroup comparison showed that only the interval between the initial and final MRI scans differed significantly (p = 0.008). However, factors, such as age, sex, comorbidities, and history of dental procedures, did not differ significantly between the two groups.

Conclusion: This study shows the extent of change in fungus balls, primarily over time. These results offer critical insights into the natural course and progression of the maxillary sinus fungus ball.

Level of evidence: 4 Laryngoscope, 2024.

Objectives: Nasal septal deviation can cause nasal breathing issues, contribute to obstructive sleep apnea (OSA) development, and often hinders successful CPAP therapy. We hypothesized that although prevalent in the general population, nasal septal deviations differ structurally between OSA and non-OSA patients. This study evaluated nasal septal deviation morphology in OSA versus non-OSA patients using computed tomography (CT).

Methods: We consecutively enrolled 128 adult patients undergoing septoplasty for nasal obstruction between April and September 2019. Seven with trauma/surgery history were excluded. Polysomnography was performed preoperatively for those with significant sleep complaints. Using identical preoperative sinus CTs routines, we measured anterior, superior, and posterior deviation angles, comparing OSA and non-OSA groups.

Results: We studied 121 septoplasty patients (37 females, 84 males, mean age 45.73 ± 1.29 years), with 34 OSA and 87 non-OSA. Anterior deviation angle was significantly greater in OSA (mean 9.1 ± 0.7°) versus non-OSA (mean 6.5 ± 0.5°) groups (p = 0.001). However, no significant superior or posterior deviation differences existed between groups (p = 0.266 and 0.231, respectively). Multiple logistic regression showed anterior deviation as the only significant independent OSA predictive factor.

Conclusion: Among the nasal septal deviations, only the anterior deviation was associated with the presence of OSA. Thus, the selection of a surgical technique for anterior deviation is an important consideration in patients with OSA.

Level of evidence: 3 Laryngoscope, 2024.

Objectives: Allergic fungal rhinosinusitis (AFRS) is an eosinophilic subtype of chronic rhinosinusitis with nasal polyposis (CRSwNP). This study aimed to investigate the transcriptome of AFRS nasal polyp epithelium.

Methods: Sinonasal epithelial cells were harvested from healthy nasal mucosa and polyp tissue collected from participants undergoing elective sinonasal surgery. Primary epithelial cells were subsequently grown in air/liquid interface and subjected to RNA-seq analysis, RT-qPCR, immunoblotting, and immunostaining.

Results: A total of 19 genes were differentially expressed between healthy and AFRS sample epithelium. The second top candidate gene, ranked by adjusted p-value, was prostaglandin E receptor 2 (PTGER2). The upregulation of PTGER2 was confirmed by RT-qPCR and immunoblot. The presence of the EP2 receptor, encoded by the PTGER2 gene, was confirmed by immunocytochemistry.

Conclusion: PTGER2 is a potential novel therapeutic target for AFRS. EP2 dysregulation is associated with aspirin-exacerbated respiratory disease, potentially giving insight into common mechanisms of disease in severe CRSwNP.

Level of evidence: NA Laryngoscope, 2024.

Objective: Currently no data exist on what distance from facial nerve (FN) it is safe to perform bipolar cautery (BC) in parotid surgery, although frequently performed.

Methods: The degree of damage was measured using continuous intraoperative neuromonitoring (cIONM, NIM™ 3, Medtronic) in 16 Wistar rats. Amplitude drop of at least 50% (A₅₀) or a loss of signal (LOS) in the cIONM was defined as harmful; BC was performed in power range 20-60 W.

Results: BC ≤30 W did not cause LOS (0/14 nerves). When applying 35 W, A₅₀ occurred at 4 mm from FN and LOS was noted in 1 of 5 nerves. BC at a power of 40 to 60 W demonstrated LOS in all nerves (12/12) at a 5 mm distance.

Conclusion: BC up to 30 W can be safely applied up to 3 mm distance from FN. 40 to 60 W should be avoided and used only at a distance of over 6 mm from FN.

Level of evidence: NA/animal study. Laryngoscope, 2024.

Objectives: Microlaryngeal surgeries require unique considerations for airway management to facilitate patient safety and adequate surgical exposure. Small-diameter endotracheal tubes (ETTs) are widely used but have raised concerns regarding patient safety, including questions about the potential for barotrauma, effective ventilation, and adequate oxygenation. We hypothesize that small ETTs will prove to be safe in a variety of cases.

Methods: We conducted a case series analyzing the safety of 5.0 ETTs in microlaryngeal surgeries at Washington University School of Medicine from November 2020 to November 2023. Outcome measures included intraoperative desaturations (SpO₂ < 90% for >2 min), high peak inspiratory pressures (PIPs) (>40 cm H₂O), and prolonged extubation times (>15 min). Univariate regression models were used to analyze associations of sociodemographic and clinical variables with these outcome measures.

Results: This study included 76 small-ETT microlaryngeal surgeries. There were 5 instances of desaturations, no reported incidents of barotrauma, and no cases in which intraoperative tube exchange was required due to issues with oxygenation or ventilation. Median PIP was 38 cm H₂O, with a range of 17-78 cm H₂O. 46% of patients had a PIP above 40 cm H₂O. There were prolonged extubation times in 14% of procedures. No association was shown between sociodemographic and clinical variables with risk of desaturations, high PIPs, or prolonged extubation times.

Conclusion: Our study suggests that 5.0 ETTs are safe for microlaryngeal surgery in a variety of patients. Otolaryngologists and anesthesiologists should consider this information when choosing between the multiple available options for airway management during microlaryngeal surgery.

Level of evidence: Level 4 Laryngoscope, 2024.

Objective: Superior laryngeal nerve (SLN) injection is performed for a variety of upper aerodigestive tract-related indications. Existing literature examines the efficacy of SLN injection for specific indications. However, there is a paucity of insight into overall practice patterns and a lack of standardization, particularly with regards to medication and dosing, treatment time frame, and circumstances. The goal of this study is to elucidate the practice patterns of SLN injection and allow for broader understanding of its utilization.

Data sources/methods: This is a descriptive study of results from an electronic survey disseminated via email to US-based and international otolaryngologists and laryngologists.

Results: 80 responses were collected. 53.8% responders endorsed utilizing SLN injection in their practice, including 39/43 laryngologists (90.7%). Responders perform SLN injection for an array of indications, using a variety of anesthetic and steroid combinations and dosages. The most used steroid is triamcinolone (81.4%). The most used anesthetic is lidocaine (53.5%). 43% of respondents endorse willingness to perform bilateral injections simultaneously. Follow-up after initial injection is highly inconsistent, as are time intervals between injections and number of injections performed. With regards to side effects and complications discussed prior to the procedure, 95% counseled patients on pain/discomfort while roughly half of responders discussed bleeding/hematoma, aspiration risk, vasovagal response, and/or globus sensation, respectively.

Conclusions: This is the first known study investigating the practice patterns of SLN injection. The substantial variability of responses reflects a lack of standardization of this procedure despite its widespread use. Further study is needed to optimize protocols.

Level of evidence: Levels 5 and 6 Laryngoscope, 2024.