Laryngoscope最新文献

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:

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