Laryngoscope最新文献

Objectives: Sinonasal inverted papilloma (SNIP) is a benign sinonasal tumor with a tendency to recur and potential for malignant transformation. Dysplasia may be present, ranging from mild to severe. We aim to evaluate the effect of dysplasia on tumor behavior and patient outcomes.

Methods: Retrospective chart review of SNIP cases from 2002 to 2023 treated by fellowship-trained Rhinologists at seven institutions. Clinical data were extracted, and tumors were histologically confirmed.

Results: Four hundred and forty-eight patients were eligible for analysis. The mean age was 58 years with an average postoperative surveillance of 27 months. Most patients had tumors without dysplasia (74.3%), followed by severe (10.5%), mild (10.0%), and moderate (5.1%) dysplasia. The overall recurrence rate was 11.6%. Unifocal attachment was most prevalent in tumors without dysplasia. Among patients with multifocal attachment, recurrence was highest in those with severe dysplasia (38.1%) compared to no dysplasia (17.2%). Unifocal attachment was associated with improved recurrence-free survival in all three histology types (without, mild, and moderate dysplasia).

Conclusion: In the largest study to date examining the effect of dysplasia on patient outcomes, we found that SNIP that has severe dysplasia to be high risk for recurrence while the other three types of dysplasia to be of lower risk. We therefore propose a two-tiered grading system to improve consensus among pathologists and to guide patient counseling. In the treatment of SNIP, high-risk dysplasia is more often associated with multifocal attachment pattern and remains the most challenging to treat.

Level of evidence: 3:

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.

Objective: To review the literature regarding malleostapedotomy as primary or revision surgery in patients with stapes fixation, to point out the state of the art regarding indications, techniques and outcomes of this procedure.

Data sources: PubMed, CINAHL and Cochrane databases were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Review methods: Clinical studies describing malleostapedotomy in patients with stapes fixation were included in this Systematic Review. Data about indications, intraoperative findings, features of the prostheses and audiological results were recorded.

Results: A total of 25 articles and 632 ears that underwent malleostapedotomy were included in the analysis. This technique has been employed for both primary and revision surgeries, evolving over time alongside advancements in the prostheses used. Revision otosclerosis surgery was identified as the most common surgery necessitating malleostapedotomy. Among the cases, 44.8% achieved ABG closure within 10 dB, while 84.9% achieved ABG closure within 20 dB.

Conclusions: Malleostapedotomy is a safe and valid surgical technique that can be performed when incus anchoring stapedoplasty is not feasible.

Objectives: To determine whether children < 3 years of age who do not require oxygen beyond 3 h and pass an asleep room air challenge (AsRAC), defined as maintaining a SpO₂ of ≥ 90% for 20 min during sleep, would be safe for discharge after tonsillectomy with or without adenoidectomy (T+/-A).

Methods: All children aged 24-36 months undergoing T+/-A from 2019 to 2021 were included. Demographic, clinical, and polysomnography (PSG) results were stratified based on the presence of a prolonged oxygen requirement (POR) and compared using the Kruskal-Wallis test for continuous variables and Chi-squared test or Fisher's Exact tests for categorical variables. Univariate and multiple logistic models were performed.

Results: A total of 645 children were included. Overall, 524 (81.2%) successfully weaned from oxygen within 3 h of surgery, and 517 (98.7%) of patients who were off oxygen within 3 h never went back on oxygen during the monitoring period. Patient sex (OR = 1.88 [95% CI, 1.19-2.96]; p = 0.006) and diagnosis of chronic lung disease (CLD) (OR = 13.41 [95% CI, 3.69-48.81]; p < 0.0001) were the only statistically significant risk factors associated with a POR. No association was found between any of the preoperative PSG variables and a POR.

Conclusions: Children between the ages of 24- and 36-months undergoing T+/-A who have weaned off oxygen within 3 h after surgery and passed an AsRAC would be candidates for same-day surgery. CLD was the only clinically relevant risk factor for a POR, and no preoperative PSG variables predicted POR.

Level of evidence: 4:

Objective: Eustachian tube dysfunction (ETD) is traditionally classified as either patulous or obstructive. Recent evidence suggests that obstructive ETD may comprise a broad array of clinical presentations. This study aimed to define subtypes of obstructive ETD according to common clinical features.

Methods: This cross-sectional study included adults diagnosed with ETD at a single academic medical center between October 2014 and June 2022. Clinical data was recorded, including patient-reported ETDQ-7 score, nasal endoscopy findings, tympanometry findings, medical comorbidities, timing of symptoms, symptom laterality and duration of ear fullness. Principle component analysis (PCA) was used to distinguish the most important clinical features and hierarchical cluster analysis was used to delineate symptom cluster groups.

Results: Among 490 obstructive ETD patients, seven clinical characteristics were found to be the most important: duration, severity, laterality, constancy, sinusitis symptoms, history of pressure equalization tube, and comorbid reflux disease. Five phenotypic clusters were described by the clinical data, which were predictive of relative risk of comorbidity of sinusitis and GERD, as well as abnormality on endoscopy and tympanometry. Patients with bilateral symptoms had longer mean symptom duration than patients with unilateral symptoms (8.5 vs. 6.1 months; p < 0.001) and patients with sinusitis symptoms were more likely to have bilateral symptoms compared to those without (76.6% vs. 59.1%; OR = 0.442 [95% CI: 0.330, 0.651]; p < 0.001).

Conclusion: Our group has identified five data-driven symptom cluster groups that may be translated into clinical practice.

Level of evidence: 3:

Objective: To determine the prevalence and clinical relevance of labyrinthine abnormalities detected by delayed 3D FLAIR MRI in untreated otosclerosis with labyrinthine symptoms, and to evaluate correlations with clinical and audiometric data.

Design: Retrospective observational study, single tertiary referral center.

Methods: Thirty-four patients (58 ears) with confirmed otosclerosis by high-resolution CT presenting with labyrinthine symptoms and no prior surgery underwent 3T labyrinthine MRI with a post-contrast delayed 3D FLAIR sequence. Two blinded neuroradiologists independently reviewed CT to confirm otosclerotic and MRI to assess endolymphatic space anomalies and blood-labyrinth barrier (BLB) disruption. Findings were correlated with clinical symptoms and bone-conduction thresholds.

Results: Otosclerotic foci most frequently involved the pre-stapedial region (57/58, 98%). Morphological anomalies of the endolymph were rare, with one case of endolymphatic hydrops (1/58, 2%). In contrast, BLB disruption was identified in 34/58 ears (59%), predominantly in the basal cochlear turn (34/58, 59%) and peri-saccular region (32/58, 55%). BLB disruption was strongly associated with endosteal involvement (76%) and round window involvement (89%), and was universally present in obliterative round window involvement (100%). Its prevalence increased with hearing loss type (55% in conductive, 66% in mixed, and 100% in pure sensorineural hearing loss). However, no significant correlation was found between BLB intensity and bone-conduction thresholds.

Conclusion: Endolymphatic hydrops was rare in untreated otosclerosis with labyrinthine symptoms. Conversely, BLB disruption was frequent in this symptom-select population, spatially correlated with otosclerotic foci, reflecting underlying microvascular remodeling. While not directly predictive of hearing thresholds, BLB disruption may represent an imaging biomarker of disease activity.

Level of evidence: 4:

Objectives: To evaluate the diagnostic value of preoperative hematologic inflammatory indices in distinguishing benign from malignant parotid gland tumors and to assess their potential as adjunctive diagnostic tools.

Methods: This retrospective observational study included 259 patients who underwent parotidectomy at the Department of Otorhinolaryngology, Necmettin Erbakan University Faculty of Medicine, from January 2020 to January 2025. Demographic data, histopathologic diagnoses, and preoperative parameters were reviewed. Inflammatory indices (NLR, PLR, SII, SIRI, WMR, and NP/LHb) were calculated. Comparative analyses among pleomorphic adenoma, Warthin's tumor, and malignant tumors were performed using one-way ANOVA, Kruskal-Wallis, and post hoc tests. Receiver operating characteristic (ROC) analysis was used to determine discriminative performance.

Results: Of the 259 patients, 101 had pleomorphic adenoma, 107 had Warthin tumor, and 51 had malignant tumors. Warthin tumors demonstrated significantly higher white blood cell, neutrophil, lymphocyte, monocyte, and hemoglobin levels than both pleomorphic adenoma and malignant tumors (p < 0.001). Malignant tumors were associated with older age, larger tumor size and volume, higher NLR and PLR values, and lower lymphocyte, monocyte, and hemoglobin levels (all p < 0.05). ROC analysis identified age (cut-off: 60.5 years; AUC = 0.642) and tumor volume (cut-off: 24.75 cm³; AUC = 0.664) as the strongest predictors of malignancy. An NLR cut-off value of 1.62 yielded 86% sensitivity and 31% specificity for differentiating malignant from benign lesions.

Conclusions: Preoperative hematologic indices-NLR and PLR-may serve as inexpensive, accessible adjunctive tools in evaluating parotid masses. Integration of inflammatory indices into radiomics-based or nomogram-driven diagnostic models has the potential to improve diagnostic accuracy.

Level of evidence: N/A.

Objective: The study's objective is to assess the safety profile and complication rates of hyaluronic acid-based vocal fold injection augmentation (VFIA), specifically evaluating inflammatory reactions, injection volume, and COVID-19 vaccination status.

Methods: A retrospective cohort study was conducted of 299 VFIA procedures performed using Restylane-L at a single academic institution. Medical charts were reviewed to collect patient demographics, injection details (approach, location, and volume), videolaryngostroboscopy exams, and post-injection outcomes, including complication rates and nature of inflammatory reactions.

Results: The overall complication rate was 4.0% (12/299), with inflammatory complications comprising 2.34% (7/299) of cases. Inflammatory symptoms developed a mean of 4.3 days after injection (median: 3 days; range: 12 h-10 days) and resolved in all cases with corticosteroid therapy. A statistically significant difference in injection volume was noted among groups (p = 0.037), although post hoc comparisons did not demonstrate significance. COVID-19 vaccination status was not associated with complication rates (p = 0.84).

Conclusions: VFIA using HA-based material demonstrates a low rate of complications, and all inflammatory reactions resolved with medical management. Injection volume may play a role in complication risk, but further multi-site studies are needed. No association between COVID-19 vaccination and adverse outcomes was identified.

Level of evidence: 3:

Objective: This study examined the relationship between socioeconomic deprivation and quality of life as measured by the Voice Handicap Index (VHI) in adults with voice disorders.

Methods: A cross sectional design was utilized. One-thousand one-hundred and twenty adults with voice disorders were included in this study (mean age = 53.6, SD = 16.5; males = 429 females = 788). Patients were divided into the following diagnostic groups: muscle tension dysphonia (32%), benign vocal fold lesions (29.4%), laryngospasm (12.3%), vocal fold paralysis (11.1%), neurological voice disorders (6.2%), laryngeal cancer (5.9%), and presbyphonia (3%). VHI scores, Grade Roughness Breathiness Asthenia and Strain (GRBAS) ratings, age, sex, employment status, and smoking history were extracted from initial voice evaluations. Socioeconomic deprivation was measured using the Area Deprivation Index (ADI).

Results: Patients living in areas with the highest socioeconomic deprivation presented with greater total (p < 0.001), functional (p < 0.001), physical (p < 0.001), and emotional VHI scores (p < 0.001) when compared to those living in more affluent areas-even when controlling for dysphonia severity, age, sex, voice-related diagnosis, employment status, and smoking history. The association between VHI and ADI was strongest for total score and emotional subscore, as VHI total scores increased by 0.32 (95% CI = 0.26-1.26, p < 0.001) and VHI Emotional scores increased by 0.18 (95% CI = 0.16-0.21, p < 0.001) for every 1-point increase in ADI.

Conclusions: Patients living with socioeconomic deprivation experienced greater voice-related handicap from voice disorders than those from more affluent backgrounds. Future work is needed to better characterize the relationship between quality of life and socioeconomic deprivation in those with voice disorders.

Level of evidence: 3:

Objective: The modified sleep apnea severity index (mSASI) combines patient anatomy, weight, sleep study metrics, and symptoms into a composite OSA index ranging from 1 (least severe) to 3 (most severe). Our study aims to assess the association between the mSASI and cardiovascular (CV) risk factors in patients undergoing sleep surgery.

Study design: Retrospective cohort review.

Setting: Single-institution tertiary care center.

Methods: CPAP-intolerant OSA patients who underwent hypoglossal nerve stimulation, maxillomandibular advancement, or expansion sphincter pharyngoplasty at our institution from 2014 to 2021 were included. Cardiovascular comorbidities and 5-year Framingham Risk Score (FRS) were assessed at the preoperative visit. Chi-squared and Wilcoxon rank sum test analyses were performed using R Studio.

Results: Of the 209 patients included, 118 had an mSASI = 1, 71 had an mSASI = 2, and 20 had an mSASI = 3. Patients with an mSASI of 2 or 3 were more likely to have HTN (33% vs 51%, p = 0.011). Baseline mSASI (β = 4.4, 95% CI 0.04-8.7) and age (β = 1.3, 95% CI 1.0-1.6) were independently associated with increased FRS on multivariable linear regression (p < 0.05). However, this association did not persist in secondary models excluding constituent components of mSASI and FRS.

Conclusions: The mSASI may offer additional benefits in assessing OSA risk severity based on CV risk factors compared to the AHI alone. However, given that this association was not replicated in the secondary analysis, further research is needed to evaluate the utility beyond its individual factors and traditional metrics alone.

Level of evidence: 4: