Laryngoscope最新文献

Objective: Animal models of vocal fold (VF) surgical injury and scar formation provide insight into the wound healing process. The purpose of this study was to establish an alternative model of surgical injury to the mouse VF using materials commonly available in most research laboratories or for purchase and to investigate wound healing of the epithelium (EP) and lamina propria (LP).

Methods: Mice were anesthetized by isoflurane gas delivery and positioned on a platform so that the larynx could be observed using a laryngoscope and dissection microscope. Unilateral VF injury was created using a wire brush. Mice were euthanized and the larynx evaluated 1-, 3-, 5-, 7-, 14-, and 28-days following injury. Histological and immunofluorescent analysis was used to evaluate thickness of the EP, LP area, proliferative (Ki67+) and basal cells (p63+) in the EP, and collagen III content in the LP.

Results: The depth of injury reached the superficial thyroarytenoid muscle on Day 1. The thickness of the EP of the injured VF was increased on Days 3 and 5, and the LP area was increased on Days 3, 5, and 7 as compared with the uninjured VF. Ki67+ and p63+ cells were increased on Day 3 and collagen III content was increased on Days 5 and 28 as compared with the uninjured VF.

Conclusion: We successfully established an alternative method of creating unilateral VF injury in the mouse. This method will be useful for future research regarding VF surgical injury and wound healing.

Level of evidence: N/A Laryngoscope, 2024.

Objective: To analyze the clinical features and surgical outcomes of patients with endolymphatic sac tumors (ELSTs).

Study design: Single institution retrospective cohort study.

Methods: The clinical data of 29 patients with 30 ELSTs who underwent surgery were retrospectively reviewed. Information on patient demographics, tumor size and grade, intraoperative blood loss volume, hearing and facial nerve outcomes, and follow-up data was collected and analyzed.

Results: The main symptoms were hearing loss in 26 ELSTs (86.7%) and tinnitus in 17 (56.7%). Twenty-four (80%) ELSTs were in advanced stages (Grade III). The median tumor volume was 6.35 cm³. The median intraoperative blood loss volume was 300 mL. Facial nerve function was well preserved in 21 patients. Among all patients with Grade III tumors, 12 patients underwent tension-free anterior facial nerve rerouting, and 11 patients (91.7%) maintained good facial nerve function postoperatively (HB I and HB II). Only one patient exhibited permanent vocal cord paralysis, and no patients experienced cerebrospinal fluid (CSF) leakage postoperatively. Gross total resection was achieved in 22 patients (73.3%), 5 patients (16.7%) experienced tumor recurrence, and 3 (10%) had residual tumors.

Conclusions: Most ELSTs tend to be diagnosed in the advanced stage. Tension-free anterior facial nerve rerouting could maximally preserve facial nerve function. The intraoperative blood loss volume was associated with tumor size and stage. Tumor recurrence tends to occur at the posterior edge of the petrosal bone, internal auditory canal, and surface of the posterior fossa. Given the relatively high recurrence rate of ELSTs, long-term follow-up is recommended.

Level of evidence: 4 Laryngoscope, 2024.

Objectives: To evaluate epidemiological trends of pediatric esophageal foreign body (EFB) ingestion over two decades.

Methods: A retrospective analysis was performed using data from the National Electronic Injury Surveillance System (NEISS) database for children <18 years who presented to a United States Emergency Department (ED) with EFB between 2003 and 2022. Number of cases and type of EFB were recorded. Rates of EFBs over time were analyzed via linear regression.

Results: A total of 52,315 EFB cases were identified over the 20-year period, with a national estimate of 1,589,325 cases. The most frequently ingested objects were coins (37.6%), toys (13.5%), and batteries (6.8%). Overall incidence of EFB ingestion increased from 7.3 to 14.2/10,000 children from 2003 to 2022 (R² = 0.8, p < 0.0001). Incidence of coin ingestion increased from 3 to 4.5/10,000 children (R² = 0.06, p = 0.335) but represented a smaller proportion of all EFB over time (66% in 2003 versus 43% in 2022). Incidence of magnet, battery, and toy ingestion have increased from 0.3 to 1.0/10,000 (R² = 0.9, p < 0.0001), 0.3 to 1/10,000 (R² = 0.7, p < 0.0001), and 0.6 to 2.3/10,000 (R² = 0.8, p < 0.0001) children, respectively, between 2003 and 2022. The proportion of magnet, battery, and toy ingestion have increased over time (3.2%, 6.5%, and 11.8%, respectively, in 2003 to 11.4%, 11.7%, and 22.2%, respectively, in 2022).

Conclusion: Magnet, battery, and toy ingestion have increased significantly in the past two decades, while the proportion of coin ingestion has decreased. This trend may reflect shifts within the consumer market and increased availability of electronics concurrent with the adoption of digital currency.

Level of evidence: 4 Laryngoscope, 2024.

Objective(s): The objective of this study was to characterize the level of agreement between three manometers: (1) Iowa Oral Performance Instrument (IOPI)-the reference standard for tongue, lip, and cheek strength assessments; (2) MicroRPM Respiratory Pressure Meter (MicroRPM)-the reference standard for respiratory strength assessments; and (3) Digital Pressure Manometer (DPM)-an alternative, low-cost pressure testing manometer.

Methods: Manual pressures were simultaneously applied to the IOPI and DPM, and to the MicroRPM and DPM, within a controlled laboratory setting. Agreement in pressure readings were analyzed using descriptive statistics, Lin's concordance correlation, and Bland-Altman Plots. Agreement was interpreted as "poor" if ρ_c < 0.90, "moderate" if ρ_c = 0.90 - < 0.95, "substantial" if ρ_c = 0.95 - < 0.99, and "excellent" if ρ_c ≥ 0.99.

Results: Differences in pressure readings between the DPM and clinical reference standards were consistently present yet highly predictable. There was a median absolute difference of 2.0-3.9 kPa between the IOPI and DPM, and 4.5-9.8 cm H₂O between the MicroRPM and DPM. Lin's concordance revealed "substantial" agreement between the IOPI and DPM (ρ_c = 0.98) and the MicroRPM and DPM (ρ_c = 0.99).

Conclusion: The DPM revealed higher pressure readings when compared to the IOPI and MicroRPM. However, differences in pressure readings were relatively small, highly predictable, and yielded substantial overall agreement. These findings suggest the DPM may be a valid, lower-cost alternative for objective assessments of tongue, lip, cheek, and respiratory muscle strength. Future research should expand on the present findings in clinical patient populations.

Level of evidence: NA Laryngoscope, 2024.

This study aimed to report our experience about endoscopic neck dissection through a post-auricular hairline incision, followed by intraoral resection of oral cancer and free flap reconstruction. Laryngoscope, 2024.

Objective(s): To conduct a preliminary investigation into the relationship between specific SNP variants, type II inflammation, and the effectiveness of dupilumab therapy and surgery in patients with CRS.

Methods: In this prospective study, 48 subjects were enrolled, comprising 32 CRS patients and 16 healthy controls. The CRS patients were subjected to either dupilumab therapy or endoscopic surgery according to EPOS guidelines. SNP variants were identified using the TaqMan SNP genotyping technique. The identified SNP profiles were compared between the control group and CRS patients, and their potential influence on treatment outcomes was evaluated. Treatment responses were assessed based on symptom scores, such as SS-I, SNOT-22, disease progression using the NPS findings, and SNP profiles at a 6-month follow-up. The primary measures included the Nasal Polyp Score, Smell Identification Test (SIT) score, and SNOT-22 outcomes.

Results: Dupilumab therapy and surgery significantly decreased NPS, with the last showing superior results. However, dupilumab therapy resulted in a significantly improved SIT score. Significant differences were observed in SNP profiles, particularly with rs1800629 (TNFA), rs2856838 (IL1a), rs17561 (IL1a), and rs1805011 (IL4R). In particular, the expression of rs2856838 and rs1805011 variants in the dupilumab group was associated with significantly better SIT and SNOT-22 outcomes than non-expressors. Also, the surgery group patients expressing the rs2856838 variant reported significant improvements in SNOT-22 scores.

Conclusion: These preliminary findings suggest that SNP genotypes may guide personalized treatment strategies for CRS. Further larger prospective studies are required to confirm these initial observations.

Level of evidence: 2 Laryngoscope, 2024.

Objective: To evaluate the impact of age on disease recurrence in idiopathic subglottic stenosis (iSGS) patients.

Methods: This was a retrospective chart review of iSGS patients treated with laser wedge excision. Patients did not have prior surgery. Survival rates free of recurrence were estimated using the Kaplan-Meier methods, and associations were evaluated using Cox Proportional Hazards models.

Results: Eighty-five female patients were included in the study. Most patients (68%) were postmenopausal, had first period at or before 13 years of age, had at least one full-term pregnancy (82%), were not undergoing hormone replacement therapy (93%), were not using hormonal birth control (88%), and were either partially or completely compliant with triple therapy regime (80%). There was a statistically significant average reduction in risk of recurrence of 5% for every additional year of age (p < 0.0001). When compared to patients older than 65 years of age, patients less than 35 were nearly 10 times more likely to recur (p = 0.002), and patients 55-65 and 45-55 years of age were 8 and 5 times more likely to recur, respectively (p = 0.003 and 0.009). Additionally, females on birth control showed decreased risk of recurrence of 74% compared with their counterparts (p = 0.04).

Conclusion: This is the first study to demonstrate an inverse relationship between age and disease recurrence in patients with iSGS following surgery. Using age as a surrogate for menopausal status, these results suggest that increased age and/or birth control provide a protective effect through decreased recurrence rates, possibly mediated by decreased estrogen levels.

Level of evidence: 4 Laryngoscope, 2024.

Objective: Oxymetazoline hydrochloride has been shown to be effective in some studies for acquired blepharoptosis and for aesthetic upper eyelid elevation. This study aims to systematically review the literature on the use of topical oxymetazoline for treating acquired blepharoptosis.

Databases reviewed: PubMed (U.S. National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane.

Methods: A systematic review of studies published between 2013 and 2024 following PRISMA guidelines was performed using the PubMed, Scopus, and Cochrane databases. Primary outcomes included pre- to posttreatment change in marginal reflex distance (MRD1) after treatment with topical oxymetazoline, and mean difference (pre-to-posttreatment) in MRD1 versus control.

Results: Five articles included data from 458 patients for analysis. Meta-analysis demonstrated significant improvement in MRD1 measurements posttreatment with oxymetazoline (1.40 mm; 95% confidence interval, CI [0.41 mm, 2.40 mm]). In addition, when compared to controls, patients treated with oxymetazoline demonstrated greater increase in MRD1 values (0.83 mm; 95% CI [0.10 mm, 1.55 mmm]). Heterogeneity, measured by I² statistic, was high in all studies (85%-95%).

Conclusion: The use of oxymetazoline 0.1% ophthalmic solution significantly improves MRD1 in patients with acquired blepharoptosis. Further studies comparing this treatment in other etiologies of acquired blepharoptosis should be conducted. Laryngoscope, 2024.

Objective: Tympanostomy tube placement has been shown to decrease systemic antibiotics usage in patients with recurrent acute otitis media. Systemic antibiotics in children are associated with an increase in antibiotic-associated conditions (asthma, allergic rhinitis, food allergy, atopic dermatitis, celiac disease, overweight/obesity, attention-deficit hyperactivity disorder [ADHD], autism, learning disability, and Clostridium difficile colonization) later in life. The objective of this study is to estimate whether tympanostomy tube placement is associated with a reduction in antibiotic-associated conditions in children with recurrent acute otitis media (RAOM).

Methods: A retrospective cohort review of electronic medical records from 1991 to 2011 at a large pediatric hospital system was performed identifying 27,584 patients under 18 years old with RAOM, defined by 3 or more episodes of AOM. Antibiotic-associated conditions were defined using ICD-9 and ICD-10 codes.

Results: The enrollment population was largely composed of White patients (28.9%), Black patients (30.1%), and Hispanic/Latino patients (16.4%). The number of systemic antibiotics prescribed per encounter was significantly lower in children who pursued tympanostomy tubes (0.14 antibiotics per encounter) versus those who did not (0.23 antibiotics per encounter) (p < 0.001). Patients with RAOM who received tympanostomy tubes were less likely to have diagnoses of overweight/obesity (OR. 0.62 [0.55, 0.68]; p < 0.001), asthma (OR 0.8 [0.74, 0.87]; p < 0.001), allergic rhinitis (OR 0.72 [0.65, 0.81]; p < 0.001), and atopic dermatitis (0.78 [0.71, 0.86]; p < 0.001).

Conclusions and relevance: Tympanostomy tube placement is associated with less systemic antibiotic administration and a decreased incidence of overweight/obesity, asthma, allergic rhinitis, and atopic dermatitis in children diagnosed with RAOM.

Level of evidence: 4 Laryngoscope, 2024.

Objectives: To establish a combined classification based on intrapapillary capillary loops (IPCLs) and morphological characteristics to improve the accuracy of pathological prediction of vocal fold leukoplakia (VFL).

Material and methods: A prospective research was conducted of VFL patients diagnosed by IPCLs and morphology. The VFL cases were classified as Type I-III based on IPCLs and morphological characteristics. Type I referred to VFL with dendritic vessels but not IPCLs. Type II defined VFL without any IPCLs or vessels and classified by morphology into two subtypes as non-rough Type IIa and rough Type IIb. Type III referred to VFL with IPCLs and classified into two subtypes as Type IIIa with small IPCLs and Type IIIb with large IPCLs or vascular distortion in or around lesions. Predicting pathology accuracy was analyzed.

Results: 182 eligible patients were recruited. The prediction accuracy rates of VFL pathology were 81.5% according to the 2019 Ni classification. The combined classification includes 4 cases of Type I, 28 Type IIa, 35 Type IIb, 56 Type IIIa, and 59 Type IIIb VFLs. The prediction accuracy rate of combined classification ranged from 95.1% to 97.3% in three observers. The average sensitivity, specificity, positive predictive value, negative predictive value was 97.8%, 86.2%, 97.4%, 88.2%, respectively. The inter-observer agreement varied from 84.1% to 94.0%, and mean area under curve of receiver-operating curve analysis was 0.954.

Conclusions and significance: The new combined classification based on IPCLs and morphological characteristics could predict pathology of VFL accurately.

Level of evidence: 4 Laryngoscope, 2024.