Laryngoscope最新文献

Isolated superior orbital roof blow-in fractures are rare and may result in functional or aesthetic impairment requiring surgical intervention. This case report demonstrates the successful endoscopic repair of such a fracture, emphasizing the advantages of endoscopic techniques in achieving adequate visualization when direct access to the fracture site is limited.

Objective: To describe the prevalence and morphology of vocal fold contralateral reactive lesions in patients with vocal fold polyps or cysts, and to report disease regression following office-based laryngeal surgery (OBLS).

Methods: Medical records and video recordings of patients with vocal fold polyps or cysts who underwent OBLS between November 2023 and September 2025 were reviewed. Demographic data included age, gender, history of smoking, history of reflux disease, type of vocal fold pathology, and type of office-based laryngeal procedure. Prevalence, morphology, and disease regression of CRLs were assessed by two otolaryngologists who independently reviewed the video recordings of patients included in this study.

Results: Twenty-six males and 19 females were included in the study. The mean age was 48.9 ± 14.9 years. The prevalence of CRLs was 60%. Most of these lesions were fibrous. Eighteen lesions were treated with ILSI, and 8 lesions were treated with the blue laser and steroid injection. Five patients were lost to follow-up. Analysis of 21 CRLs showed complete disease regression in 52.4% of cases, and partial disease regression in 47.6% of cases. There was no statistically significant difference in disease regression between the two treatment subgroups (p = 0.284). There was a statistically significant difference in total disease regression of the primary lesion between those who had partial vs. complete disease regression of their CRL (p < 0.001).

Conclusion: CRLs are common in patients with vocal fold polyps and cysts. All lesions regressed partially or completely following OBLS using the blue laser and/or steroid injection.

Level of evidence: 3:

Objectives: Previous studies have examined the relationship between dysphonia and mental health, but often in small samples and not across age groups. In this large national epidemiological study, we examine if dysphonia is related to anxiety and depression generally and across cohorts of different ages.

Methods: This is a cross-sectional analysis of adults ≥ 18 years old in the All of Us dataset. The exposure was dysphonia (ICD-10 code R49.0), and the outcomes were anxiety (ICD-10 F41) and depression (ICD-10 F32-33). We performed multivariable logistic regression analyses, controlling for age, gender, race, ethnicity, insurance, education, smoking history, alcohol use, and medical comorbidities. A sub-analysis compared depression and anxiety odds across two and five age groups.

Results: Of 283,137 adults in our sample, the mean age was 56 years (standard deviation 16 years). Sixty-one percent identified as female. Controlling for covariates, those with dysphonia had 1.34 times (95% CI 1.27-1.41) the odds of depression and 1.44 times (1.37-1.52) the odds of anxiety compared to their non-dysphonia counterparts. After stratifying by age, the odds of depression and anxiety were 2.36 times (1.67-3.35) and 1.62 (1.14-2.30) respectively for participants ≥ 18-30 years old, 1.61 (1.37-1.89) and 1.75 (1.49-2.07) for > 30-45 year olds, 1.38 (1.23-1.55) and 1.46 (1.33-1.67) for > 45-60 year olds, 1.33 (1.23-1.44) and 1.46 (1.35-1.58) for > 60-75 year olds, and 1.22 (1.09-1.35) and 1.36 (1.22-1.51) for > 75 year olds.

Conclusions: Those with dysphonia had higher odds of depression and anxiety. Following stratification by age, the odds for each were highest for the youngest age group.

Level of evidence: 3:

Objective: To evaluate whether preoperative sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is associated with postoperative complications in adults with type 2 diabetes mellitus (T2DM) undergoing open surgical tracheostomy (OST).

Methods: We performed a retrospective cohort study using a multi-institutional electronic health record network. Adults with T2DM who underwent OST between 2013 and 2024 were identified using CPT and ICD-10-PCS codes. Exposure was defined as an SGLT2i prescription within 180 days before surgery. One-to-one propensity score matching on demographics, comorbidities, preoperative ventilator dependence, medications, and laboratory values generated balanced SGLT2i and non-SGLT2i cohorts. Ninety- and 180-day postoperative complications were compared using odds ratios (ORs) with 95% confidence intervals, with Benjamini-Hochberg false discovery rate (FDR) correction.

Results: Of 36,840 eligible adults (1329 SGLT2i; 35,511 non-SGLT2i), 1327 patients remained in each cohort after matching. At 90 days, SGLT2i use was associated with higher odds of heart failure exacerbation (OR 1.70, 95% CI 1.36-2.14), which remained significant after FDR adjustment. At 180 days, SGLT2i use was associated with increased odds of hypoglycemia (OR 2.01, 95% CI 1.30-3.13) and heart failure exacerbation (OR 1.61, 95% CI 1.30-1.99), both significant after FDR correction. Signals for surgical site infection, tracheostomy stoma malfunction, and dizziness/vertigo did not remain significant after adjustment.

Conclusion: In adults with T2DM undergoing OST, preoperative SGLT2i use was associated with increased postoperative hypoglycemia and heart failure exacerbation. These findings support careful perioperative management of SGLT2is in high-risk airway surgery and justify prospective studies to define optimal discontinuation strategies.

Level of evidence: 3

Objective: With regulatory approval of HPV-specific immunotherapy for recurrent respiratory papillomatosis (RRP) and growing experience with systemic bevacizumab, a management algorithm incorporating these medical treatments is warranted.

Data sources and methods: RRP Foundation (RRPF) Key Opinion Leaders offer a proposed management algorithm for adults with RRP considering published literature and commercial drug availability.

Results: Preventative HPV vaccination should be considered for all patients. Determination of HPV type and pulmonary imaging are important for contemporary RRP patient care and assist in decision making. Risks and benefits of papilloma debulking as needed versus medical management of RRP must be deliberated on a patient case-by-case basis. HPV-specific immunotherapy that induces an HPV-specific T cell response to target the underlying HPV infection that is the cause of RRP is safe, offers the possibility of durable disease control following a short treatment course and is the recommended first-line medical treatment for patients who wish to avoid the risks of repeat procedural management. Papilloma disease control with systemic bevacizumab, which carries defined risks and must be continued for clinical benefit is the recommended second-line medical treatment for patients who do not achieve a complete response with immunotherapy and wish to continue medical management. For patients who elect to be treated with debulking procedures as needed, use of locally-administered adjuvant should be considered.

Conclusion: This proposed management algorithm from the RRPF serves as a contemporary resource and information guide for adult patients with RRP and their physicians considering treatment options.

Level of evidence: 5:

Objective: To describe the role of optical coherence tomography (OCT) in the evaluation and surgical planning of pediatric patients with complex airway pathology.

Methods: We conducted a retrospective case series of four pediatric patients who underwent OCT imaging of the trachea and mainstem bronchi between 2020 and 2024 at a tertiary children's hospital. Imaging was performed intraoperatively using a microcatheter-based OCT catheter under general anesthesia. OCT findings were reviewed in conjunction with bronchoscopy, preoperative imaging, and operative reports.

Results: In each case, OCT provided high-resolution structural detail that refined diagnosis and informed surgical planning. OCT was instrumental in delineating the extent of stenosis, evaluating mainstem bronchial involvement, and assessing stent patency and epithelialization. OCT imaging demonstrated value both in preoperative assessment and postoperative follow-up.

Conclusion: OCT offers a high-resolution, radiation-free imaging modality for pediatric airway evaluation. In this small, uncontrolled series, OCT served as a feasible adjunct that provided additional structural detail concordant with operative findings and, in selected cases, informed surgical approach. Prospective studies are needed to define workflow, performance, and impact on outcomes.

Level of evidence: 4: