Laryngoscope最新文献

Hemorrhagic transformation of vestibular schwannoma following stereotactic radiation is a rare but serious complication. We report a case presenting with acute facial paralysis due to intratumoral hemorrhage 12 years after stereotactic radiosurgery. This case highlights hemorrhagic transformation as a potential cause of sudden neurological deterioration in previously irradiated vestibular schwannomas and underscores the importance of long-term MRI surveillance for early detection and timely intervention.

Objective: Surgical repair and 3D-printed customized septal prosthesis (3D-PCSP) are options for septal perforation treatment. We performed a study to compare the clinical outcomes of surgery and 3D-PCSP using the NOSE-Perf Scale (NPfS).

Methods: A chart review was performed on patients undergoing surgical repair or 3D-PCSP placement between January 2018 and July 2024. The change in NPfS was used as primary endpoint. Demographics, ASA score, perforation size, etiology, and follow-up duration were reported.

Results: Thirty-five patients, 23 for surgical repairs and 12 for 3D-PCSP, were included in this review [median (IQR)]. In the surgical repair group, perforation length and height measured 12 (10-18) mm and 10 (8-15) mm, respectively. Baseline NPfS was 24 (16-32), and this decreased to 8 (6-13) following surgical repair (p < 0.001). Follow-up time was 12 (5-21) months. In the 3D-PCSP group, septal perforation length and height measured 25 (15-30) mm and 17 (15-20) mm, respectively. The baseline NPfS was 17 (3-24.5), and this decreased to 9.5 (7-13) following 3D-PCSP placement (p = 0.001). The follow-up was 18.4 (16-23) months. NPfS reduction was greater for surgical repair (p = 0.018).

Conclusions: Surgery and 3D-PCSP offer meaningful symptom relief for NSP patients. Treatment decisions should be individualized through shared decision-making that considers patient comorbidities, preferences, surgeon experience, and risk tolerance. In this cohort, surgical repair was associated with greater NPfS reduction compared with 3D-PCSP placement.

Level of evidence: 3:

Objective: Hearing loss (HL) negatively impacts all aspects of health, yet poor access to hearing healthcare (HHC) among adults is a pervasive public health problem. The inaccessibility of HHC is amplified in rural adults. Rural health clinics (RHC) are a critical healthcare system tasked with improving health in rural communities and the objective of this study is to assess the prevalence of HL and the utilization of HHC within RHCs.

Methods: Using cross-sectional study design, adults were recruited from 10 RHC throughout rural Kentucky, mostly within Appalachia. The primary outcomes were (1) presence of HL on screening and (2) history of a hearing test within the last year and within the last 5 years. Additional outcomes included sociodemographic and overall health status. Descriptive, univariate, and multivariate analyses were conducted.

Results: A total of 403 participants (mean age 51.1) were recruited. A total of 388 participants completed a hearing screening and 271 (70%) screened positive for HL, yet only 3.4% and 13.4% of participants had undergone a hearing test in the past 1 and 5 years, respectively. Adults with higher education levels were less likely to have HL (OR 0.47; 95% CI 0.26-0.86; p = 0.02). HL in this sample was associated with noise exposure (OR 1.97; CI 1.08 to 3.61; p = 0.03) and poorer mental health (OR 3.48; 95% CI 1.74-7.18; p = 0.001).

Conclusion: Rural adults in RHC have a high prevalence of HL and low utilization of HHC. Promoting and expanding access to HHC within RHCs may improve hearing health among rural adults.

Level of evidence: 3:

The use of piezoelectric instrumentation has been investigated to perform an endoscopic-assisted transpterygoid maxillectomy for a maxillary ameloblastoma. This technology allowed safe disinsertion of the pterygoid root from the cranial base through a precise and clean osteotomy, while minimizing the risk of inadvertent soft-tissue injury. Piezoelectric saws can represent an alternative to high-speed endoscopic drills in selected cases. For posterior maxillary neoplasms, we recommend the employment of endoscopic-assisted maxillectomy, as it offers improved anatomical exposure and a more accurate control of tumor margins.

This study offers insight into the nuances of leadership development and emergence for female chairs in the evolving landscape of leadership in Otolaryngology-Head and Neck Surgery. Elucidating the various pathways to leadership will assist in advancing careers and will assist in fostering diversity in surgical leadership roles.

This study evaluated whether smartphone-based video head impulse testing (s-vHIT) can enhance bedside HIT in acute vestibular syndrome. Using a slow-motion smartphone recording setup, s-vHIT enabled visualization of overt and covert saccades, including vertical canal responses, with qualitative agreement with conventional vHIT. These findings indicate that s-vHIT may offer a practical and ergonomic approach for video documentation and may add diagnostic value in acute vestibular assessment.

Objective: Distant metastases in the head and neck region are rare, often posing challenges for ENT specialists and being of crucial importance in the management of infraclavicular primary tumors.

Methods: The case series presented here aims to outline the relevant aetiologies and clinical presentation in the head and neck region. Aspects of diagnostics, differential diagnostics, therapy, and prognosis are discussed. A total of 136 cases (7.8%) from 1735 patients recorded in our tumor database between 2000 and 2023 were included. All cases represent patients consecutively operated on during this period.

Results: The metastases of the patients (58 women, 78 men, median 64 years) were predominantly located in the cervical lymph nodes (86.8%). Organ metastases mainly affected the parotid gland (38.9%). Histologically, adenocarcinomas were most frequently diagnosed (40.4%). The primary tumors were mainly lung carcinomas (33.1%), followed by mammary and renal cell carcinomas. The clinical manifestation was indolent swelling in most cases. In 91 cases (66.9%), head and neck metastases were the first manifestation of the primary tumor. Only 7 of the cases presented with an isolated cervical metastasis.

Conclusions: Localizing a metastasis in the supraclavicular neck region and/or a histological finding other than squamous cell carcinoma indicates a remote primary tumor. The considerable relevance of cervical metastases in the (initial) primary tumor diagnosis is due to their early clinical manifestation and easy biopsy accessibility. In most cases, distant cervical metastasis is an indication of advanced tumor disease.

Level of evidence: 4: