Laryngoscope最新文献

Objective(s): To characterize utilization patterns of laryngeal injection procedures (augmentation and therapeutic) and medialization thyroplasty from 2012 to 2022, with particular attention to practice setting, bilateral procedures, and impact of the 2017 Healthcare Common Procedure Coding System (HCPCS) update.

Methods: The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset from 2012 to 2022 was utilized in this analysis. HCPCS codes specific for vocal fold injections (e.g., 31513, 31570, 31571, 31573, 31574) and thyroplasty procedures (e.g., 31588, 31591) were evaluated. The number of procedures performed, place of service, and specialty were recorded.

Results: Total laryngeal procedures increased by 44.7% from 2012 through 2022, including a 52.3% increase in injections and an 11.9% decrease in thyroplasty. Laryngeal injection procedures increased across all practice settings, with a notable trend toward office-based procedures (20% to 28%). In contrast, the proportion of laryngeal injection procedures in the hospital and ambulatory surgical center settings decreased from a height of 70%-60% and 17%-13%, respectively. Bilateral procedures increased by 165%, including a 121% increase in bilateral injection augmentation (code 31574).

Conclusion: Between 2012 and 2022, total laryngeal procedures increased across all practice settings, with a trend toward more injection laryngoplasty, particularly in the office setting. The growth of bilateral procedures, particularly injection augmentation, suggests a growing demand to treat bilateral presbylarynx.

Level of evidence: 4:

This transtracheal technique for cricopharyngeal botulinum toxin injection is a safe and effective option for chemodenervation of this muscle in the awake patient. Its advantages include reduced risk of toxin spread to intrinsic laryngeal muscles, the ability to administer higher doses of botulinum toxin, improved access to the entire length of the cricopharyngeus, and avoidance of general anesthesia.

Objectives: To evaluate the impact of pediatric adenotonsillectomy (T&A) on sleep architecture, related sleep factors, and respiratory parameters in children with obstructive sleep apnea (OSA), stratified by disease severity.

Methods: We analyzed 300 consecutive children who underwent full-night polysomnography (PSG) before and after T&A between January 2021 and March 2022. Patients were stratified into severe (apnea-hypopnea index [AHI] > 10 events/h or SpO₂  < 80%) and very severe (AHI > 30 events/h) OSA groups. Correlations were assessed using Spearman analysis.

Results: The cohort included 233 (78%) severe, with a mean age of 6.85 years (SD = 4.83), BMI 103% of the 95th percentile (SD = 47.4), 61% male, and 55% Hispanic. T&A reduced the mean AHI from 23.51 to 6.25 (p < 0.001). Persistent severe OSA was observed in 23% of patients, who demonstrated significantly shorter total sleep time (TST) (350.54 vs. 413.73 min, p < 0.001), less Stage N3 sleep (89.54 vs. 109.63 min, p = 0.001), less Stage R sleep (69.56 vs. 91.43 min, p < 0.001), and a higher arousal index (15.65 vs. 10.34, p < 0.001) compared with those without persistent severe OSA. Changes in TST strongly correlated with changes in Stage N2 sleep (r = 0.74; 95% CI, 0.68-0.79; p < 0.001) and Stage R sleep (r = 0.68; 95% CI, 0.61-0.74; p < 0.001).

Conclusions: T&A significantly improves sleep architecture and respiratory outcomes in pediatric OSA. However, deficits in restorative sleep stages persist in a subset of patients.

Level of evidence: 4:

Objective: Determine if tinnitus is a potential confounding variable in the study of hearing loss and depression in older populations.

Methods: This is a retrospective cross-sectional study using data from the 2005 to 2006, 2009 to 2010 and 2017 to 2020 National Health and Nutrition Examination Survey. The subpopulation (n = 2352) was aged > 69 years. We selected a cutoff of 69 years to focus specifically on elderly adults; as a result, these findings are not generalizable to younger adults with tinnitus and hearing loss. A logistic regression model used depression as the binary response variable and tinnitus burden and speech frequency hearing loss as predictor variables. "Tinnitus burden" was determined via subjective responses from survey participants. Multiple covariates were used for the adjusted regression model.

Results: Hearing loss was not associated with an increased risk of depression in this cohort. Surprisingly, mild speech frequency hearing loss showed a potential protective effect [Adjusted OR (95% CI) = 0.55 (0.31-0.97), p = 0.039]. A high tinnitus burden was a significant risk factor for depression in both crude and adjusted models [Adjusted OR (95% CI) = 7.05 (3.42-14.55), p < 0.001]. This effect was consistent when stratifying for hearing loss as well.

Conclusion: The burden of tinnitus appears to have a significant association with depression even while accounting for measured hearing loss. Most studies outlining the impact of hearing loss on depression have not adequately controlled for tinnitus. These findings suggest that tinnitus should be controlled for in future studies examining the relationship between hearing loss and depression.

Level of evidence: 3:

Objective: The aim of this scoping review is to characterize the incidence of vocal fold paralysis (VFP), dysphonia, dysphagia, and aspiration in patients undergoing cardiothoracic transplantation and to summarize current literature within this domain.

Data sources: PubMed, Embase, and Ovid MEDLINE databases.

Review methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR).

Results: Of 99 identified studies, 15 met eligibility criteria, comprising 13 clinical studies and two reviews. VFP was reported in 11 studies, dysphagia was reported in seven studies, dysphonia was reported in four studies, and aspiration was reported in six studies. Only seven studies reported diagnostic methods for VFP, and otolaryngology involvement varied across studies, with most diagnoses made by nonotolaryngologists. Long-term follow-up was largely underexplored, with most studies reporting only inpatient outcomes.

Conclusions: VFP and related voice and swallow outcomes have been understudied in the cardiothoracic transplant population, with inconsistent documentation and long-term data. Future work into the standardization of diagnostic protocols, routine otolaryngology involvement, and longitudinal follow-up will allow for a better understanding of risks to improve outcomes in this vulnerable population.

Objective: To characterize the pressure-volume (P-V) behavior of two common endotracheal tube (ETT) cuffs across three airway models of increasing anatomic realism: rigid, elastic, and cadaveric, and to quantify the narrow volume threshold separating safe from potentially injurious cuff pressures.

Methods: We tested TaperGuard and Sheridan reinforced ETTs (sizes 6.0-8.0 mm) in a rigid manikin, elastic synthetic, and cadaveric tracheas. Cuff pressure was recorded after 0.2 mL incremental inflation up to 120 cmH₂O. Polynomial and power-law models were fitted to the P-V curves. Key metrics included ΔV from 20 to 30 cmH₂O, curve slope, and model fit accuracy.

Results: All cuffs demonstrated nonlinear P-V behavior. Cadaveric tracheas exhibited the steepest pressure escalation, with ΔV (20 → 30 cmH₂O) as small as 0.25 mL. Elastic models showed delayed pressure rise, while rigid models escalated rapidly once wall contact was reached. Polynomial models (R² ≥ 0.93-0.99) better captured high-pressure transitions than power-law fits. Tapered cuffs achieved effective seals with lower volumes than cylindrical cuffs but demonstrated similarly steep pressure increases when overinflated.

Conclusion: ETT cuff behavior is highly sensitive to airway compliance. Cadaveric airways showed a narrower inflation margin than synthetic models, underscoring the limitations of manikin-based training. Across designs, small additional volumes can precipitate unsafe pressures, highlighting the need for precise pressure-guided cuff management over volume estimation.

Level of evidence: N/A.

We present a reproducible, stepwise middle fossa approach for facial nerve decompression focused on the labyrinthine segment, geniculate ganglion, and meatal foramen, with consistent anatomical landmarks to preserve hearing. The article and video detail patient setup, safe corridor creation, and retrograde drilling with practical tips to avoid cochlear or semicircular canal injury, aiming to lower the learning curve for facial nerve decompression.

Objectives: Functional nasal surgery reliably alleviates nasal obstruction and improves quality of life. However, functional nasal surgery's effect on craniofacial pain (CFP) has been incompletely studied. This study analyzed CFP outcomes following functional nasal surgery.

Methods: A prospective cohort study was conducted with patients who underwent functional nasal surgery for nasal obstruction over 18 months by two surgeons. Nasal Obstruction Symptom Evaluation (NOSE, 0-20) and facial pain scores (FPS, 0-5) were collected preoperatively and postoperatively. NOSE and FPS changes were compared between patients with FPS ≥ 2 versus FPS < 2 (i.e., with vs. without preoperative CFP).

Results: Of 91 patients, mean age was 45.6 years and 62.6% were male. Preoperatively, 36 patients had bothersome CFP, and 12/36 (33.3%) had primary headache disorders. Preoperative mean FPSs were 3.2 and 0.2 for those with versus without preoperative FP, respectively. Mean durations to second and third postoperative visits were 47.7 and 203.1 days, respectively. Across all patients, mean NOSE scores were significantly reduced at each follow-up (-9.5, p < 0.0001). Patients with preoperative CFP achieved significantly greater reductions in FPSs at second (-1.74 vs. +0.24, p < 0.0001) and third (-2.20 vs. +0.04, p < 0.0001) postoperative visits, and this was not affected by presence of headache disorders or allergic rhinitis (p > 0.05). The relative risk (RR) of having FPS ≥ 2 was also significantly reduced at second (RR = 0.44, p = 0.0002) and third (RR = 0.33, p = 0.003) postoperative visits.

Conclusion: In patients with nasal obstruction and CFP preoperatively, functional nasal surgery led to significant improvements in both nasal obstruction and CFP, and these improvements persisted at about 6 months postoperatively.

Level of evidence: 2:

This case describes the successful treatment of persistent globus pharyngeus in a patient refractory to a multitude of traditionally used, mainstay interventions. This report is the first in the English literature of cervical plexus block to not only be used for globus, but to also provide immediate relief to a patient.