Laryngoscope最新文献

Objectives: This study aimed to comparatively evaluate the therapeutic efficacy of balloon dilation eustachian tuboplasty (BDET) versus tympanostomy tube insertion (TTI) in adult patients with unilateral chronic otitis media with effusion (COME), and to assess potential synergistic effects when combining both procedures (BDET + TTI).

Methods: We conducted a retrospective cohort study of 46 adult COME patients from the Eye and ENT Hospital of Fudan University who had failed a standardized 3-month non-surgical interventions and underwent one of three interventions: (1) TTI alone, (2) BDET + TTI, or (3) BDET alone. Preoperative evaluations included otoscopy, pure-tone audiometry (PTA), tympanometry, nasopharyngeal endoscopy, eustachian Tube Dysfunction Questionnaire (ETDQ-7), and temporal bone CT scans. Postoperative evaluation incorporated PTA, tympanometry, and ETDQ-7 assessment. Statistical analysis incorporated both within-group (pre-post) and between-group comparisons of therapeutic outcomes.

Results: All interventions demonstrated therapeutic safety with no postoperative complications. While all groups showed hearing improvement, the BDET group failed to achieve statistically significant improvement in air conduction (AC) thresholds. The BDET + TTI combination yielded superior outcomes to TTI alone in AC thresholds, air-bone gap (ABG), and ETDQ-7 scores improvements. Tympanometric normalization was significant in both TTI-containing groups but not in the BDET-alone group.

Conclusions: While BDET monotherapy shows limited efficacy in adult COME management, its combination with TTI produces superior therapeutic outcomes compared to either procedure alone. These results position BDET as a potentially valuable adjunct to conventional TTI rather than an independent treatment modality for this patient population.

Level of evidence: 3:

Objective(s): Robotic-assisted electrode array (EA) insertion is a promising technique that may enhance preservation of residual acoustic hearing after cochlear implant (CI) surgery. The purpose of this study is to evaluate the impact of robotic-assisted EA insertion on rates of delayed-onset hearing loss (DOHL).

Methods: Sixty (Advanced Bionics [AB]: 30, MED-EL: 30) adult patients underwent CI surgery with manual EA insertion and 29 (AB: 13, MED-EL: 16) with robotic-assisted insertion using the iotaSOFT system. The primary outcome variable was longitudinal change in low frequency pure-tone average (LFPTA). DOHL was defined as a decrease in LFPTA of > 10 dB compared to previous best postoperative LFPTA.

Results: Twenty-two (37%) out of the 60 subjects in the manual cohort and two (7%) out of the 29 subjects in the robotic-assisted cohort had DOHL over the entire length of available follow-up (p = 0.002, Fisher's exact test, two-tailed). When evaluating DOHL results for subjects who had LFPTA data at 12 months (±4 weeks) post initial activation, 11 (29%) out of the 38 (AB: 15, MED-EL: 23) subjects in the manual cohort and zero (0%) out of the 18 (AB: 8, MED-EL: 10) subjects in the robotic-assisted cohort had DOHL (p = 0.011, Fisher's exact test, two-tailed). The number needed to treat was 4.

Conclusion: Robotic-assisted EA insertion is associated with a clinically meaningful reduction in rates of DOHL. Preservation of residual acoustic hearing is a critical goal in CI surgery, and robotic-assisted EA insertion contributes towards achieving this goal.

Level of evidence: 3:

Objectives: Airway collapsibility varies with the level of anesthetic depth during drug-induced sleep endoscopy (DISE). Bispectral index (BIS) monitoring uses EEG signals to quantify anesthetic depth. We conducted a prospective study to examine changes in VOTE scores and pharyngeal opening pressure (PhOP) during DISE with positive airway pressure (DISE-PAP), at light and deep sedation.

Methods: Anesthetic depth was monitored using BIS during DISE-PAP for 17 patients. We classified BIS ≥ 55 as light sedation and < 55 as deep sedation. The DISE exam was performed and subsequently PAP applied to assess PhOP at both light and deep sedation. We defined PhOP as the minimum pressure wherein all areas of the airway were opened. A blinded evaluation of the procedure video was performed by either one of two sleep surgery fellows or an attending sleep surgeon to create a VOTE score for the DISE exam and PhOP.

Results: All n = 17 patients enrolled had OSA with a mean AHI of 30.5 and standard deviation 17.8. PhOP significantly correlated with BIS readings (rho = -0.45, p = 0.0328) but VOTE classification did not significantly correlate with BIS level (rho = 0.18, p = 0.189). The velum and epiglottis had opening pressures that correlated to BIS level (rho = -0.398; p = 0.044) and (rho = -0.426; p = 0.038), respectively.

Conclusions: Anesthetic depth measured by BIS correlates with airway resistance as measured by PhOP. PAP appears to be a useful tool during DISE as it gives a highly titratable and immediate measurement of pharyngeal collapsibility.

Level of evidence: 3:

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: