Laryngoscope最新文献

Objective: To determine the effect of the surgical bouffant cap on hearing, sound localization, and speech intelligibility in the operating room (OR).

Background: Covering of the ear during surgical procedures has been promoted to prevent surgical site infection (SSI) from ear pathogens. However, the potential impact of ear covering on hearing in the OR has not been studied.

Methods: Twenty participants with normal hearing underwent auditory testing with and without surgical attire (bouffant cap and surgical mask). Auditory threshold testing was performed with warble tones in a sound-treated booth. In the speech intelligibility test, participants were instructed to identify the last word of Speech Perception in Noise (SPIN) sentences (high and low predictability) in OR background noise. In the sound source localization test, participants were asked to localize a speech source amidst OR background noise.

Results: Threshold measures showed no significant effect of wearing surgical attire on detection thresholds. Wearing surgical attire significantly impaired speech intelligibility (p < 0.05). Sound localization was not statistically significant.

Conclusions: The use of the surgical bouffant cap and mask makes it more difficult to understand speech in the presence of OR noise. This could lead to miscommunication and impact surgical outcome; thus, ear covering should be avoided.

Level of evidence: N/A Laryngoscope, 2024.

Introduction: This study queries the US laryngology workforce geographic distribution and density and models laryngology workforce trends through 2050.

Methods: A national database of fellowship-trained laryngologists (FTLs) and nonfellowship-trained laryngologists (nFTLs) practicing primarily laryngology was formed by identifying laryngologists via internet search, with validation by regional laryngologists and senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, institutional affiliation, and practice zip code. US Census Bureau population data and projections were grouped by hospital referral region (HRR), as defined by the Dartmouth Healthcare Atlas. The National Resident Matching Program (NRMP) provided annual fellowship match data from 2012 to 2022.

Results: As of May 2023, there were 349 active laryngologists in the United States, including 303 FTLs. The median practice length for all laryngologists was 11 years. HRRs with the largest number of laryngologists were Manhattan, Boston, and Los Angeles, with 23, 16, and 14 respectively. One hundred and ninety-four of 306 (63%) HRRs did not have an active, primary laryngologist. The national median density of people per laryngologist including HRRs with at least one laryngologist was 645,160. Assuming a 35-year practice horizon prior to workforce exit and holding the 2018-2022 NRMP average of 18 fellows constant, the number of forecasted laryngologists by 2040 would be 568-an increase of 66%.

Conclusions: To date, no comprehensive database of practicing US laryngologists nor laryngology workforce forecast exists. Based on current benchmarks, the laryngology workforce would increase by 66% by 2040, ideally addressing the current dearth of laryngologists in low-density areas.

Level of evidence: NA Laryngoscope, 2024.

Objective: We examined the epidemiology of parotid gland lymphomas (PGL), the incidence, survival rates, clinical features, and association with primary Sjögren's syndrome (pSS).

Methods: This retrospective nationwide cohort study analyzed data from Danish patients diagnosed with PGL between 2000 and 2020. Data were collected from medical records, the National Pathology Register, and the Danish lymphoma database. Statistical analyses included Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models.

Results: A total of 433 patients were included. The incidence rate was 0.39 per 100,000 person-years, with PGL constituting 1.9% of all non-Hodgkins lymphoma in Denmark. The average annual incidence was 2.7% (incidence rate ratio = 1.027, p < 0.01). Follicular lymphoma (FL) was the most common subtype with 154 cases (35.6%), followed by large B-cell lymphoma (LBCL) with 119 cases (27.5%), and extranodal marginal zone lymphoma (EMZL) with 84 cases (19.4%). The median overall survival (OS) for FL was 9.5 years (95% CI 6.9-10.2), with 5-year and 10-year OS rates of 70% and 44%, respectively. For LBCL, the median OS was 7.8 years (95% CI 5.0-8.8), with 5-year and 10-year OS rates of 59% and 33%. EMZL had a median OS of 12.8 years (95% CI 9.0-16.3), with 5-year and 10-year OS rate of 83% and 55%. EMZL was significantly associated with pSS, relative risk 21.97 (95% CI 2.81-171.53). Advanced age, B symptoms, and elevated LDH levels were significantly linked to poorer overall survival.

Conclusion: This study offers new epidemiological, clinical, and prognostic insights, with a focus on their association with pSS.

Level of evidence: 3 Laryngoscope, 2024.

Background: Empty nose syndrome (ENS) is a poorly understood condition that affects a minority of patients who undergo inferior turbinate (IT) surgery. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) was validated to diagnose ENS following IT reduction, with an ENS6Q ≥ 11 being suggestive of ENS. Medial flap turbinoplasty (MFT) involves IT bone removal ± submucosal reduction (SMR) and is highly effective at surgically treating IT hypertrophy. This study's purpose was to determine the incidence of ENS following MFT by comparing ENS6Q scores preoperatively and postoperatively.

Methods: A retrospective cohort study was conducted on consecutive patients who underwent bilateral MFT with or without septoplasty to address nasal obstruction. Preoperative and postoperative nasal obstruction and septoplasty effectiveness (NOSE, 0-20) and ENS6Q (0-30) scores were compared at a minimum 12 months postoperatively.

Results: Of 100 patients, mean age was 48.9 years and 53% were male. Mean follow-up was 25.0 months (range: 12-66 months). Patients underwent MFT with SMR in 70% of cases, whereas 30% had bone removal only, and 79% had septoplasty. NOSE scores decreased significantly postoperatively (mean 9-point reduction, p < 0.0001). Mean preoperative and postoperative ENS6Qs were 8.5 and 3.0, respectively, with a mean 5.6-point decrease postoperatively (p < 0.0001). While some patients developed elevated ENS6Q scores mainly in the first 3 months postoperatively, no patients had ENS6Q scores ≥11 at final follow-up.

Conclusions: MFT ± septoplasty led to significant long-term reduction in nasal obstruction, with no patients ultimately developing ENS6Q ≥ 11 postoperatively. Therefore, MFT was unlikely to cause ENS.

Level of evidence: Level 4 Laryngoscope, 2024.

Laryngeal anatomical variations in Cri du Chat syndrome remain incompletely characterized in the medical literature, with few published photographic documentations. We present a case of a 20-month-old male with confirmed 5p15 deletion who presented with congenital inspiratory stridor and dysphagia. Videofluoroscopic evaluation at 13 months demonstrated aspiration of thin liquids. Microlaryngobronchoscopy revealed a Cormack-Lehane grade 3 view with a retroflexed epiglottis secondary to tight aryepiglottic folds, and laterally positioned false vocal cords resulting in broad, flat ventricles. Bilateral aryepiglottic fold division improved direct laryngoscopic visualization to Cormack-Lehane grade 1. This report provides detailed laryngeal characterization with photographic documentation, contributing to the understanding of airway variations in this syndrome. Recognition of these anatomical features is crucial for optimizing airway management strategies in this patient population. Laryngoscope, 2024.

Introduction: Anticoagulants (AC) are associated with epistaxis in atrial fibrillation (AF) patients. Left atrial appendage occlusion (LAAO) is a treatment that allows AF patients to stop AC. The aim of this study is to evaluate the risk of developing epistaxis following LAAO versus direct oral anticoagulants (DOAC) and warfarin.

Methods: This study uses the TriNetX database as well as institutional records. The TriNetX database was searched for AF patients on a DOAC, warfarin, or treated with LAAO. Epistaxis odds ratios were compared 1 day-6 months and 6 months-3 years following initiation of DOAC, warfarin, or LAAO. Records of LAAO patients at our institution were also reviewed.

Results: The TriNetX query returned 1,185,862 patients. On TriNetX, LAAO patients had significantly higher odds of epistaxis likely due to antiplatelet therapy from 1 day-6 months compared to warfarin patients with DOAC patients (p < 0.0001). From 6 months-3 years after treatment initiation, LAAO patients experience reduced odds of epistaxis and epistaxis requiring nasal packing compared to warfarin patients (OR: 0.69 p = 0.0003; OR: 0.58 p = 0.0043). Institutionally, epistaxis resolved in 66% (8/12) LAAO patients with a history of epistaxis with an average follow-up of 1.5 years.

Discussion: LAAO decreased the frequency of epistaxis and epistaxis requiring nasal packing in AF patients on warfarin after 6 months. Our institutional experience demonstrates long-term improvement in epistaxis after LAAO for DOAC and warfarin patients. Additional studies need to be performed to account for dual antiplatelet following LAAO on epistaxis risk.

Level of evidence: Level 3 Laryngoscope, 2024.

Objective: This pilot study was designed to test the tolerability of a lower scope position and feasibility of custom-designed MATLAB graphical user interface (GUI) used to analyze playback review of laryngeal high-speed videoendoscopy (laryngeal HSV) during healthy volitional dry swallows. We hypothesized this method would conceptually provide time resolution for glottic closure events compared with standard (30 frames per second, fps), and enable a means to measure timing, sequence, and duration of laryngeal movements during swallowing not otherwise visualized.

Methods: A total of 14 healthy adults (4 male, 22-80 years) participated. We performed laryngeal HSV at 500fps. Measurements included: (i) feasibility and tolerability of the procedure; (ii) identification of a swallowing segment of interest (SOI) for the peak of the swallow; and (iii) description of laryngeal swallowing movements using a GUI.

Results: Fourteen subjects tolerated the procedure without discomfort and swallow images were able to be analyzed in 12. Using our GUI, mean SOI was 260 ms, yielding 130 frames for analysis (compared with seven in standard laryngoscopy). Vocal fold adduction, vocal fold medialization, and anterior-posterior arytenoid compression to the epiglottis prior to whiteout could be identified and sequenced.

Conclusion: Participants tolerated a low position of the endoscope during dry volitional swallows. The output of our GUI demonstrated a novel technique for identifying, describing, and sequencing a swallowing SOI. Future studies should investigate laryngeal closure and arytenoid positioning with a bolus and in a range of ages, genders, and etiologies in both healthy and abnormal populations to better understand swallowing physiology.

Level of evidence: NA Laryngoscope, 2024.

Objective: Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a challenging condition often managed with biologic therapies. This study compares the clinical effects and response times of dupilumab, omalizumab, and mepolizumab in Italian patients with severe uncontrolled CRSwNP.

Methods: This bicentric, retrospective study included 33 patients treated at two Italian hospitals between April and December 2023. Inclusion criteria followed EPOS 2020 guidelines, focusing on adults with bilateral polyposis, history of endoscopic sinus surgery, and evidence of type 2 inflammation. Patients self-administered biologics according to AIFA protocols. Outcomes were assessed using SNOT-22 for quality of life, Nasal Polyp Score (NPS) for polyp size, and Sniffin' Sticks-12 for olfactory function at baseline, 4 weeks, 3, 6, and 9 months.

Results: All three treatment groups (dupilumab, omalizumab, mepolizumab) showed significant improvements in SNOT-22 scores from baseline to 9 months, with no significant differences between groups. Dupilumab showed the most rapid and sustained improvement in NPS, with significant reductions observed from 4 weeks onward. Both omalizumab and mepolizumab showed significant NPS reductions by 6 months. Olfactory function improved significantly in the dupilumab group, with a notable decrease in anosmic patients from 64.3% to 28.6% at 9 months. Asthma control, measured by Asthma Control Test (ACT) scores, improved across all groups.

Conclusion: Dupilumab, omalizumab, and mepolizumab significantly improve quality of life and reduce nasal polyp size in CRSwNP patients, with dupilumab showing the fastest response. These findings support the effectiveness of biologics in real-world settings for managing severe CRSwNP.

Level of evidence: 3 Laryngoscope, 2024.

Objective: Pretreatment evaluation of bone invasion in head and neck cancer is critical for treatment strategies. We investigated the usefulness of subtraction CT (SCT) in evaluating mandibular bone invasion in oral squamous cell carcinoma (OSCC).

Methods: This retrospective investigation included patients with OSCC who underwent surgery at the Shizuoka Cancer Center Hospital between 2018 and 2022. We evaluated tumor invasion of the mandibular bone by interpreting conventional computed tomography (CT), SCT, and magnetic resonance imaging (MRI) and comparing the findings with the pathological examination. Sensitivity and specificity were compared using the McNemar test, whereas Spearman's correlation and Bland-Altman methods were utilized to assess mandibular bone invasion depth.

Results: A total of 71 patients were enrolled. SCT showed significantly higher sensitivity than conventional CT for evaluating mandibular marrow invasion (97.2% vs. 80.6%, p = 0.031). In the evaluation of mandibular canal involvement, SCT showed significantly higher specificity than MRI (95.9% vs. 81.6%, p = 0.016). Furthermore, SCT demonstrated the highest correlation with pathological bone invasion depth (correlation coefficients: CT = 0.933, SCT = 0.950, MRI = 0.908; all p < 0.05).

Conclusion: These results suggest that SCT is more effective than conventional imaging for diagnosing mandibular bone invasion and may be a useful modality for the pretreatment diagnosis of head and neck cancer.

Level of evidence: 3 Laryngoscope, 2024.

Background: Age-related vocal atrophy (ARVA) causes vocal fold bowing, impacting communication and quality of life. The assessment of vocal fold bowing is largely subjective. Glottal Image Capture (GlottIC) is a new mobile application that helps quantify vocal fold bowing. We aim through this study to assess its reliability, compare it to manual calculation method, and compare differences between visual-perceptual bowing severity ratings.

Methods: Ten raters independently quantified Bowing Index (BI) using GlottIC from 10 videostroboscopic images among individuals with ARVA. There was 100% duplication of images to facilitate intra-rater reliability analyses using Pearson's correlation. Inter-rater reliability was quantified using Intraclass Correlation Coefficient (ICC) for experienced and novice raters. The correlation between manual calculations using ImageJ and GlottIC was analyzed.

Results: The intra-rater reliability for total BI was strong (r = 0.822, p < 0.001). The inter-rater reliability for BI, calculated using ICC, was (ICC = 0.720; 95% CI: 0.579-0.852), indicating good consistency among the raters. Experts had higher ICC (ICC = 0.808; 95% CI: 0.678-0.906) compared to novice raters (ICC = 0.651; 95% CI: 0.468-0.816). There was a positive correlation between GlottIC and manual BI (r = 0.811, p < 0.001). As the BI increased, the bowing severity, based on visual-perceptual ratings, also increased (p < 0.001).

Conclusion: GlottIC is a reliable mobile application that can quantify vocal fold bowing in patients with ARVA with high intra- and inter-rater reliability. GlottIC BI measurments are highly correlated with manual BI and visual-perceptual ratings of bowing severity. Further improvements in reliability may be achieved with more robust rater training and automated technologies.

Level of evidence: Level 3 Laryngoscope, 2024.