Expansion laryngoplasty is a new, combined procedure which can treat both glottic and subglottic stenosis simulataneously. This is a small case series showing how to perform this surgery as well as outcomes from a 15-year period. Laryngoscope, 2024.
Expansion laryngoplasty is a new, combined procedure which can treat both glottic and subglottic stenosis simulataneously. This is a small case series showing how to perform this surgery as well as outcomes from a 15-year period. Laryngoscope, 2024.
Objective: To investigate the association between sleep deprivation and vestibular dysfunction by Video Head Impulse Test (vHIT).
Methods: This prospective clinical trial explores the impact of acute sleep deprivation on the vestibular-ocular reflex (VOR) in medical residents. The study involved healthy physicians from diverse medical disciplines. Participants underwent vHIT assessments before and after a 26-h shift. The examinations focused solely on the right lateral semicircular canal. Participants further completed a demographics and fatigue questionnaire, including the Fatigue Severity Scale (FSS) questionnaire and a Visual Analog Fatigue Score (VAFS).
Results: The study involved 30 medical residents. Participants experienced a statistically significant decrease in VOR gain in the right horizontal semicircular canal during a 26-h shift (p < 0.01). While the FSS and VAFS questionnaires showed no significant difference before and after the shift, the analysis of ∆VOR gain indicated a statistically significant increase associated with decreased sleep time during the shift (p = 0.018, 95% Confidence Interval [0.08, 0.68]). The most substantial increase in ∆VOR occurred between 22-26 h of sleep deprivation. No significant differences were observed in ∆VOR between genders, ages, disciplines, department shifts versus emergency room shifts, or years of residency.
Conclusion: vHIT can be used as an objective, reliable screening tool for severe sleep deprivation among physicians. The decrease in the VOR gain may indicate that vestibular function is influenced by sleep deprivation. The clinical significance of these findings is still questioned, more studies may help to assess this effect.
Level of evidence: 3 Laryngoscope, 2024.
Objectives: Surgeons experience a risk for physical strain and injury secondary to physical demands in the workplace. To minimize injury and maximize career longevity, physicians should be aware of ergonomics pitfalls and postural correction methods. This study investigates ergonomic trends in Facial Plastic and Reconstructive Surgery (FPRS) clinic by quantifying surgeons' and trainees' cervicothoracic spine posture.
Methods: Participants completed a 22-item questionnaire to evaluate current ergonomic practices. A lightweight device was calibrated and attached to the mid-scapular region of participants, providing real-time posture feedback. The percentage of time in upright posture was recorded during clinical and operative workdays. Upright posture was defined as neutral spine positioning with acceptable mild to moderate deviations.
Results: Two FPRS attending surgeons, 1 FPRS fellow, and 11 otolaryngology residents participated over 12 months. Discomfort was most commonly reported in the neck, shoulders, and upper back during clinic. Symptoms were self-treated by changing body position, wearing specialized footwear, adjusting height of the chair or examination table, or ignoring discomfort. Eighty-two percent were unaware of ergonomic guidelines or appropriate considerations. Time spent in upright posture was significantly higher in clinic (84.9%) than in the OR (53.5%) (p < 0.001). Upright posture declined after reaching 6 work hours (p = 0.029); no such patterns were observed in the OR (p = 0.946).
Conclusion: Although time spent in upright posture was objectively poorer in the OR, these data suggest ergonomics are an important consideration in the outpatient setting, with surgeons experiencing discomfort during and after clinic. Further investigation is warranted to identify actionable changes and promote healthy ergonomics.
Level of evidence: N/A Laryngoscope, 2024.
Objective: Klotho is a protein with various biological functions, including anti-aging effects. Although research suggests Klotho plays a key role in auditory function, the relationship between serum Klotho levels and high-frequency hearing loss (HFHL) in older adults remains unclear.
Methods: We analyzed data from individuals aged 70-79 years participating in the 2009-2010 cycle of the National Health and Nutrition Examination Survey. Multivariate logistic regression models were employed to assess the relationship between serum Klotho levels and HFHL. Restricted cubic splines were utilized to evaluate linearity and examine the dose-response relationship. Additionally, we performed subgroup analyses to evaluate the consistency of this relationship across various subgroups.
Results: In this study of 422 elderly individuals aged 70-79 years (mean age 73.8 years, with 47.4% male participants), the median serum Klotho concentration was 754.6 pg/mL. Multivariable logistic regression analysis consistently demonstrated that higher serum Klotho levels were associated with a reduced risk of HFHL across various models (ORs: 0.24-0.32, p = 0.020-0.028). Additionally, restricted cubic spline analysis confirmed a linear negative association between serum Klotho levels and HFHL risk, with a p-value for nonlinearity of 0.474. Subgroup analyses did not reveal any statistically significant interactions modifying this relationship.
Conclusion: Serum Klotho levels are inversely associated with the risk of HFHL.
Level of evidence: 3 Laryngoscope, 2024 Laryngoscope, 2024.
Objectives: Adult naso-orbital-ethmoid (NOE) fractures are estimated to account for 5% of all adult facial fractures without published consensus on management. The purpose of this investigation was to assess the available literature regarding the treatment and outcomes of adult naso-orbital-ethmoid fractures.
Data sources: Cochrane Library, PubMed, Scopus, and CINAHL.
Methods: Following PRISMA guidelines, databases were searched from inception through July 25, 2024 for studies pertaining to the treatment of NOE fractures. Measures of interest included patient demographics, associated fractures, type of intervention, and complications.
Results: A total of 16 studies were included for meta-analysis, consisting of 459 patients. The patients included in the analysis had a mean age of 30.6 years (95% CI: 26.9-34.3 years) with a male-to-female gender ratio of 2.7:1. Operative intervention, specifically open reduction and internal fixation (ORIF) (90.1%; 95: CI: 76.6-98.1%), was the most commonly performed management. Closed reduction has been reported for all three types. The most frequently reported complications included nasolacrimal duct obstruction (38.6%; 95% CI: 10.6-71.7%), postoperative epiphora (24.9%; 95% CI: 6.4-50.4%), and telecanthus (20.9%; 95% CI: 1.7-53.5%).
Conclusions: Surgical intervention can be considered for all NOE types. Despite surgical intervention, NOE fractures remain difficult to treat, and inadequate repair may result in complications. Laryngoscope, 2024.
Recurrent laryngeal nerve injuries can occur during thyroid and neck procedures or similar interventions. Immediate nerve repair when possible is preferred to both faciliate the repair and allow timely recovery of the muscle. Here, we report a case of transected left recurrent laryngeal nerve repaired by allograft nerve interposition with excellent return of speaking and singing voice with vocal cord function. Laryngoscope, 2024.
Objective: To analyze national trends in the prevalence of office-based laryngeal ablative procedures and compare those with traditional operative excisional procedures utilizing direct laryngoscopy.
Methodology: For years 2013-2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 31572 (flexible laryngoscopy with laser ablation of lesion), 31540 (operative direct laryngoscopy with excision of lesion), 31541 (operative direct microlaryngoscopy with excision of lesion), and 31545 (operative direct microlaryngoscopy with excision of lesion and local tissue flap reconstruction). For each CPT code, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed. Biopsy procedures were not included.
Results: The annual number of office-based laser procedures (CPT 31572) remained relatively constant since the CPT code was introduced in 2017 (range: 18887-25241 procedures annually, trendline slope = +16, R2:0.02). Office-based laser procedures comprised a small portion of total laryngeal excisional procedures (range: 8.4%-12.1%). The total number of operative laryngeal excisions, billed by CPT 31540 and 31541, declined over the studied time frame (Trendline slope = -132, R2:0.93; Trendline slope = -950, R2: 0.93 respectively).
Conclusions: Office-based laser procedures comprise a small fraction of procedures to remove laryngeal lesions. The number of office-based laser procedures has been relatively stable over the last 5 years. This finding contrasts with the prevailing health care trend toward office-based procedures. Further research is needed to understand the decrease in operative laryngeal lesion excision procedures observed over the last 10 years.
Level of evidence: 4 Laryngoscope, 2024.
Objectives: To assess vestibular function, video head impulse test (vHIT) is taken as the gold standard by evaluating the vestibulo-ocular reflex (VOR). However, vHIT requires the patient to wear a specialized head-mounted goggle equipment that needs to be calibrated before each use. For this, we proposed an intelligent head impulse test (iHIT) setting with a monocular infrared camera instead of the head-mounted goggle and contributed correspondingly a video classification approach with deep learning to vestibular function determination.
Methods: Within the iHIT framework, a monocular infrared camera was set in front of the patient to capture test videos, based on which a dataset DiHIT of HIT video clips was set up. We then proposed a two-stage multi-modal video classification network, trained on the dataset DiHIT, that took as input the eye motion and head motion data extracted from the facial keypoints via HIT clips and outputted the identification of the semicircular canal (SCC) being tested (SCC identification) and determination of VOR abnormality (SCC qualitation).
Results: Experiments on this dataset DiHIT showed that it achieved the accuracy of 100% in prediction of SCC identification. Furthermore, it attained predictive accuracies of 84.1% in horizontal and 79.0% in vertical SCC qualitation.
Conclusions: Compared with existing video-based HIT, iHIT eliminates goggles, does not require equipment calibration, and achieves complete automation. Furthermore, iHIT will bring more benefits to users due to its low cost and ease of operation. Codes and use case pipeline are available at: https://github.com/dec1st2023/iHIT.
Level of evidence: 3 Laryngoscope, 2024.
Objectives: Providing insight for pediatric ear surgery via investigations on the development patterns of ossicles, mastoid, and external auditory canal (EAC).
Methods: This retrospective study analyzed high-resolution computed tomography (HRCT) scans of 191 healthy temporal bones ranging from infants to adults. Subjects were grouped by 1-year intervals for developmental regression models and 3-year intervals for stage comparisons using t-tests or Mann-Whitney U tests.
Results: The size of auditory ossicles and tympanic cavity (TC) remained stable during development, while the minimum diameter of the tympanic sinus (TS) entrance was reduced. Regarding mastoid pneumatization, the air cells can be observed at birth, became pronounced at 2 years old, and were fully developed around the age of 5, with subsequent growth primarily involving radial expansion. Furthermore, the EAC demonstrated significant growth with age: the width of EAC increased linearly ( = 0.12x + 4.01, R2 = 0.85), while the length of EAC followed a polynomial growth pattern ( = -0.03x2 + 1.15x + 6.25, R2 = 0.96).
Conclusions: Ossicles and TC remain stable during development. Furthermore, mastoid air cells may have developed in the early stages of life, while their diameter increases synchronously with EAC. All in all, ossicular chain reconstruction surgery and endoscopic ear surgery can be performed in babies.
Level of evidence: NA Laryngoscope, 2024.
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