Laryngoscope最新文献

Objective: Post-irradiation sinonasal mucosa disease (SMD) is observed in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT), leading to a detrimental impact on quality of life. This study aimed to assess the incidence, severity, and regression of the post-irradiation SMD among patients with NPC treated with proton therapy.

Methods: NPC patients treated with proton therapy were retrospectively enrolled. The incidence of SMD was detected using scheduled follow-up magnetic resonance images. The severity of SMD was evaluated using the Lund-Mackay (L-M) staging system. Localized inflammation of the nasopharynx was measured with the endoscopy score.

Results: A total of 161 NPC patients were recruited. The incidence of SMD significantly increased from the third month to the first year after RT. The severity of SMD gradually decreased over time. Regression analyses showed that patients with pre-treatment SMD (OR = 1.75; p = 0.005) and lower serum total protein (OR = 0.16; p = 0.01) were associated with persistence of SMD at 2 years post-RT. Correlations were observed between post-RT L-M and endoscopy scores (r_s = 0.239, p < 0.001). A high endoscopy score (cut-off value, 1.5 [sensitivity, 87.5%; specificity, 49.2%]) predicted the persistence of SMD.

Conclusions: Proton therapy in patients with NPC induces SMD, which peaked at 3 months post-RT, decreased gradually with time, and became insignificant at 2 years post-RT. Pre-existence of SMD and lower serum total protein levels were factors associated with the persistence of post-irradiation SMDs.

Level of evidence: 4 Laryngoscope, 2024.

Objective: To determine which ear environment risk factors impact ossiculoplasty hearing outcomes and to generate a statistically-valid grading system for ossiculoplasty outcome reporting.

Study type: Retrospective case series.

Methods: A multi-institutional database was generated from cases performed between 2011 and 2019. Preoperative and postoperative hearing thresholds were recorded alongside potential ear environment risk factors. Multiple variable linear regression statistical analyses of risk factors were applied to determine independent association with postoperative pure tone average air-bone gap (PTA-ABG). Significant factors were used to generate a statistically-weighted grading scale of Ear Environment Risk (EER).

Results: 1679 cases had a mean follow-up time of 33.6 months (SD 36.3) and a mean postoperative PTA-ABG of 21.2 (SD 12.8). Multiple revision status (p < 0.001), presence of canal wall down mastoidectomy cavity (p = 0.020), absent malleus (p < 0.001), absent stapes superstructure (p = 0.016), frequent otorrhea (p = 0.008), pediatric age (p < 0.001), and blunted/lateralized tympanic membrane (p = 0.003) were independently correlated with PTA-ABG. These factors were incorporated into an EER Scoring System with four distinct risk groups wherein each risk group was significantly correlated with PTA-ABG, and this grading system was better correlated with PTA-ABG (Kendall's τ = 0.193) than other existing published grading scales.

Conclusion: Grading environment risk according to a novel EER scoring system generates meaningful risk groupings that correlate with ossiculoplasty postoperative PTA-ABG, and this holds potential to frame reporting of hearing outcomes for future ossiculoplasty research.

Level of evidence: 3 Laryngoscope, 2024.

Objectives: To investigate the relationship between social determinants of health and timeliness of management, adherence to follow-up, and outcomes of treatment with interarytenoid injection augmentation (IAIA).

Methods: Retrospective cohort study of all pediatric patients treated with IAIA at a large pediatric institution's multidisciplinary aerodigestive clinic between August 2022 and February 2024. Retrieved demographic factors, dates of referral, consultation, treatment, and follow-up, as well as objective measures of dysphagia and aspiration via videofluoroscopic swallow study (VFSS) reports, using dysphagia outcome and severity scale (DOSS) scores and the greatest unsafe thickness, or 'aspiration score'. These factors were analyzed for correlation with social determinants of health determined through the Area of Deprivation Index (ADI).

Results: A total of 120 patients, median age 15 months were included. All underwent IAIA for the indication of persistent pharyngeal dysphagia. The median national ADI score was 45. Patients experienced average improvement in laryngeal penetration and aspiration from an aspiration score of slightly thick preoperatively to thin postoperatively, and improvement in dysphagia from mild-moderate to mild. No correlation was identified between ADI, race and ethnicity, or sex and measures of timeliness of treatment, loss to follow-up, receipt of feeding therapy, or outcome of treatment.

Conclusion: Addressing persistent dysphagia in pediatric patients with IAIA seems to be equivalently efficacious across a wide population, and outcome did not vary significantly depending on patients' race or socioeconomic contexts. This finding may be due in part to the utilization of a well-organized multidisciplinary center to treat these complex patients.

Level of evidence: 4 Laryngoscope, 2024.

Objective: To conduct a systematic review and network meta-analysis to evaluate the safety and efficacy of intrapolyp steroid injection compared with oral steroids, nasal steroid wash, nasal steroid spray, and a control group in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

Data sources: PubMed, Scopus, Web of Science, Embase, and CENTRAL.

Review methods: Both randomized and non-randomized clinical trials were included. For risk of bias assessment, we used the RoB-2 and ROBINS-I tools. Our outcomes focused on safety and efficacy, including rates of visual disturbance and bleeding, as well as improvements in nasal polyps evaluated through three domains: endoscopic, radiologic, and patient-reported assessments. Safety data were pooled as events (%), while efficacy data were pooled as mean difference (MD) or standardized mean difference (SMD).

Results: Eight clinical trials involving 579 patients were analyzed. The pooled analyses showed low event rates for visual disturbances (event rate = 0.64%, 95% CI [0.00%, 2.23%]) and bleeding (event rate = 0.61%, 95% CI [0.00%, 2.25%]). Additionally, intrapolyp steroid injections were found to be comparable with oral steroids, with no statistically significant differences. Moreover, intrapolyp steroid injections demonstrated some superiority over nasal sprays, nasal washes, and the control group.

Conclusion: This network meta-analysis confirms that intrapolyp steroid injections have a favorable safety and efficacy profile as a viable management option for CRSwNP. The injections showed comparable efficacy with oral steroids and demonstrated certain advantages over other treatments, such as nasal sprays and washes. Further research with larger sample sizes and standardized protocols are needed. Laryngoscope, 2024.

Objective(s): Head and neck rhabdomyosarcoma (HNRMS) is a rare malignant tumor in adults. No standard treatment for adults with HNRMS currently exists.

Methods: A retrospective study of 72 newly diagnosed consecutive adult patients with HNRMS was conducted at one institution between November 2010 and April 2023. The log-rank tests were used to compare the differences in survival between treatment groups, and overall survival (OS), local recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. We used restricted cubic spline models fitted for Cox proportional hazards models to determine the association between chemotherapy cycles/radiotherapy dose and mortality.

Results: The 2-year OS, PFS, LRFS, and DMFS rates for the entire cohort were 51.0%, 39.2%, 44.3%, and 47.3%, respectively. Radiotherapy significantly improved the OS (p < 0.01), PFS (p < 0.01), LRFS (p < 0.01), and DMFS (p < 0.01). Surgery had no effect on OS (49.3% vs. 53.0%, p = 0.62), PFS (36.9% vs. 41.8%, p = 0.31), LRFS (41.6% vs. 47.4%, p = 0.27), or DMFS (44.4% vs. 50.2%, p = 0.43). The restricted cubic spline showed that eight (HR = 1.002, 95% CI: 0.996-1.007) cycles of chemotherapy and 62.5Gy radiation therapy resulted in the lowest mortality.

Conclusion: For HNRMS, eight cycles of chemotherapy and 62.5Gy of radiation might be sufficient. Poor response to chemotherapy predicted an extreme worse outcome. Surgery played a limited role in the treatment.

Level of evidence: III Laryngoscope, 2024.

Objective: To evaluate characteristics associated with increased cost and length of hospitalization of mandible fracture management.

Study design: Retrospective chart review.

Methods: Demographics, injury mechanism, associated injuries, treatment information, and associated costs were collected for all patients treated for mandible fracture treated at a single institution over a 14-year period. Univariable and multivariable analyses were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization.

Results: We identified 552 patients with 834 mandible fractures from 2008 to 2022. Patients' mean age was 40 years, 67% were male, and 38% Caucasian. The median cost of treatment, adjusted for inflation, was $8,869.49, and median length of stay (LOS) was 3.0 days. Associated cranial/intracranial injury, transfer presentation, increased facial fractures, and traffic-related injuries resulted in a significant increase in both cost and LOS. LOS had a significant impact on cost, while age also significantly increased LOS for patients with mandible fractures.

Conclusions: This study represents one of the largest comprehensive databases of mandible fractures and one of the first to provide a descriptive cost and inpatient burden analysis of mandible fracture management. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to identify and mitigate factors that we identified as contributing to increased cost and length of hospitalization.

Lay summary: This study represents one of the largest reviews of cost and inpatient burden of mandible fractures. We found that presentation via transfer, traffic-related injuries, and more facial fractures were associated with significantly higher cost and longer length of hospitalization.

Level of evidence: 4 Laryngoscope, 2024.

Objective: To examine how rural residence interacts with SES and race/ethnicity relative to Head and neck squamous cell carcinoma (HNSCC) treatment delay and outcomes.

Methods: The SEER database was queried for patients aged ≥18 with HNSCC. Out of 164,337 cases, 126,052 remained after exclusions for missing data. Statistical tests performed included Chi-squared tests, log-binomial regression models, and parametric accelerated failure time (AFT) models, with a significance level of α < 0.05.

Results: About 38% of patients residing in lowest SES census tracts were rural, whereas over 98% of patients from highest SES tracts were urban. Delayed treatment was associated with shorter median survival [aTR = 0.968, 95% confidence interval (CI): 0.939, 0.999]. Risk for treatment delay increased with decreasing SES and was greater for those with minoritized race/ethnicity status. Rurality was associated with a lower risk [aRR: 0.917, 95% CI: 0.892, 0.946] of treatment delays but was not predictive for patient survival (aTR: 1.019 [0.978, 1.061]). Cancer-specific mortality increased with decreasing SES and was higher in patients with minoritized race/ethnicity status.

Conclusion: Rurality was associated with decreased risk for treatment delay but not with worse survival relative to urban residence, whereas low SES and minority status remained predictive for poor outcome regardless of geographic context (level of evidence: 4). Although these findings argue against HNSCC survival deficits specific to rural populations, there remains concern regarding potential care shortfalls in rural populations not detected in this sample. Confirmatory patient-level analysis should be prioritized to optimize support along the rural/urban divide.

Level of evidence: IV Laryngoscope, 2024.

Purpose: This study aims to investigate whether artificial intelligence can improve the diagnostic accuracy of vertigo related diseases.

Experimental design: Based on the clinical guidelines, clinical symptoms and laboratory test results were extracted from electronic medical records as variables. These variables were then input into a machine learning diagnostic model for classification and diagnosis. This study encompasses two primary objectives: Task 1 to distinguish between patients with Benign Paroxysmal Positional Vertigo (BPPV) and non-BPPV. In Task 2, further classifying non-BPPV patients into Ménière's Disease (MD), Vestibular Migraine (VM), and Sudden Sensorineural Hearing Loss accompanied by Vertigo (SSNHLV). The sensitivity, precision, and area under the curve (AUC) metric is primarily used to assess the performance of the machine learning model development phase in a prospective validation cohort.

Results: In our study, 1789 patients were recruited as the training cohort and 1148 patients as the prospective validation cohort. The comprehensive diagnostic performance of the XGBoost model surpasses that of traditional models. The sensitivity, accuracy, and AUC in task 1 were 98.32%, 87.03%, and 0.947, respectively. In task 2, the sensitivity values for MD, SSNHLV, and VM were 89.00%, 100.0%, and 79.40%, respectively. The precision values were 88.80%, 100.0%, and 80.00%, respectively. The AUC values were 0.933, 1.000, and 0.931, respectively. The model can significantly improve the accuracy of diagnosing vertigo diseases.

Conclusions: This system may enhance the accuracy of classification and diagnosis of vertigo diseases. It offers initial therapy or referrals to clinical doctors, particularly in resource-limited settings.

Level of evidence: N/A Laryngoscope, 2024.