OBJECTIVESTo evaluate the potential of tonsillotomy (TT) as an alternative to tonsillectomy (TE) for treating children with obstructive sleep-disordered breathing (oSDB).DATA SOURCESTwo independent reviewers searched PubMed, the Cochrane Library, Embase, and additional sources to identify controlled studies comparing TT versus TE in pediatric patients with oSDB.REVIEW METHODSWe evaluated post-surgery symptom relief, and short- and long-term postoperative benefits for children. Fixed-effect meta-analysis, sensitivity analysis, and subgroup analysis were conducted.RESULTSIn our analysis of 32 studies with 9,430 children, the analysis revealed TT group had a similar therapeutic effect on improvement of OSA-18 as TE group (MD = 5.20, 95% CI: -32.67 to 43.07, p = 0.96). In terms of short-term outcome, the days to return to normal diet for TT group were shorter than that for TE group (MD = -2.49, 95%CI: -3.57 to -1.28; p < 0.001), less analgesics use (MD = -3.19, 95% CI = -3.44 to -2.93, p < 0.001), and lower postoperative secondary bleeding (RR = 0.33; 95%CI: 0.23 to 0.47; p < 0.001). But the risk of reoperation (OR = 8.28; 95%CI: 2.66 to 12.64; p < 0.001), oSDB recurrence (OR = 2.16; 95%CI: 1.20-3.86; p = 0.01), and postoperative infection (OR = 1.82; 95%CI: 1.34 to 2.47; p < 0.001) in TT group was significantly higher than that in TE group.CONCLUSIONSTonsillotomy reduces postoperative pain and bleeding, speeding up recovery for children with oSDB, and improving their quality of life. Yet, the risk of recurrent infections from residual tonsil tissue, which may require reoperation, calls for a careful evaluation of the procedure's short-term gains against its long-term risks.LEVEL OF EVIDENCENA Laryngoscope, 2024.
{"title":"Tonsillectomy Versus Tonsillotomy in Pediatric Sleep-Disordered Breathing: A Systematic Review and Multi-subgroup Meta-analysis.","authors":"Jiahong Lao,Feitong Jian,Rongrong Ge,Shuo Wu","doi":"10.1002/lary.31776","DOIUrl":"https://doi.org/10.1002/lary.31776","url":null,"abstract":"OBJECTIVESTo evaluate the potential of tonsillotomy (TT) as an alternative to tonsillectomy (TE) for treating children with obstructive sleep-disordered breathing (oSDB).DATA SOURCESTwo independent reviewers searched PubMed, the Cochrane Library, Embase, and additional sources to identify controlled studies comparing TT versus TE in pediatric patients with oSDB.REVIEW METHODSWe evaluated post-surgery symptom relief, and short- and long-term postoperative benefits for children. Fixed-effect meta-analysis, sensitivity analysis, and subgroup analysis were conducted.RESULTSIn our analysis of 32 studies with 9,430 children, the analysis revealed TT group had a similar therapeutic effect on improvement of OSA-18 as TE group (MD = 5.20, 95% CI: -32.67 to 43.07, p = 0.96). In terms of short-term outcome, the days to return to normal diet for TT group were shorter than that for TE group (MD = -2.49, 95%CI: -3.57 to -1.28; p < 0.001), less analgesics use (MD = -3.19, 95% CI = -3.44 to -2.93, p < 0.001), and lower postoperative secondary bleeding (RR = 0.33; 95%CI: 0.23 to 0.47; p < 0.001). But the risk of reoperation (OR = 8.28; 95%CI: 2.66 to 12.64; p < 0.001), oSDB recurrence (OR = 2.16; 95%CI: 1.20-3.86; p = 0.01), and postoperative infection (OR = 1.82; 95%CI: 1.34 to 2.47; p < 0.001) in TT group was significantly higher than that in TE group.CONCLUSIONSTonsillotomy reduces postoperative pain and bleeding, speeding up recovery for children with oSDB, and improving their quality of life. Yet, the risk of recurrent infections from residual tonsil tissue, which may require reoperation, calls for a careful evaluation of the procedure's short-term gains against its long-term risks.LEVEL OF EVIDENCENA Laryngoscope, 2024.","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"209 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meryem Demir,Vasileios Kouranos,Kostadin Stoenchev,Stephen R Durham,Guy W Scadding,Nilesh Morar,Chadwan Al Yaghchi,Guri S Sandhu,Hesham Saleh
Sarcoidosis is an inflammatory, non-caseating granulomatous multisystem disease associated with JAK-STAT (Janus kinases-signal transducer and activator of transcription proteins) pathway activation. We present a patient with severe multi-systemic sarcoidosis who showed marked improvement with tofacitinib with regards to pulmonary, cutaneous, nasal and laryngeal disease. Tofacitinib prevented critical laryngeal stenosis from progressing to tracheostomy, induced regression of cutaneous lesions and improved pulmonary function in this steroid-resistant and immunosuppressive intolerant case. This case report supports further the role of JAK-inhibitors in the treatment of systemic sarcoidosis. Laryngoscope, 2024.
肉样瘤病是一种炎症性、非酪氨酸肉芽肿性多系统疾病，与JAK-STAT（Janus激酶-信号转导和激活转录蛋白）通路激活有关。我们介绍了一名患有严重多系统肉样瘤病的患者，该患者使用托法替尼后，肺部、皮肤、鼻腔和喉部疾病均有明显改善。托法替尼避免了严重的喉部狭窄发展到气管切开，促使皮肤病变消退，并改善了这位类固醇耐药和免疫抑制剂不耐受病例的肺功能。本病例报告进一步证实了 JAK 抑制剂在治疗系统性肉样瘤病中的作用。喉镜》，2024 年。
{"title":"JAK-inhibitor Tofacitinib in Severe Laryngeal Sarcoidosis: A Case Report.","authors":"Meryem Demir,Vasileios Kouranos,Kostadin Stoenchev,Stephen R Durham,Guy W Scadding,Nilesh Morar,Chadwan Al Yaghchi,Guri S Sandhu,Hesham Saleh","doi":"10.1002/lary.31778","DOIUrl":"https://doi.org/10.1002/lary.31778","url":null,"abstract":"Sarcoidosis is an inflammatory, non-caseating granulomatous multisystem disease associated with JAK-STAT (Janus kinases-signal transducer and activator of transcription proteins) pathway activation. We present a patient with severe multi-systemic sarcoidosis who showed marked improvement with tofacitinib with regards to pulmonary, cutaneous, nasal and laryngeal disease. Tofacitinib prevented critical laryngeal stenosis from progressing to tracheostomy, induced regression of cutaneous lesions and improved pulmonary function in this steroid-resistant and immunosuppressive intolerant case. This case report supports further the role of JAK-inhibitors in the treatment of systemic sarcoidosis. Laryngoscope, 2024.","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite tracheotomy being a routine procedure, it is not rare to encounter anatomic irregularities that can compromise its success. In this report, we describe a case in which a high riding innominate artery was identified within the surgical trajectory moments before incision, which ultimately necessitated airway securement using an alternative laryngological procedure. Laryngoscope, 2024
{"title":"High‐Riding Innominate Artery: Booby Trap for ICU Tracheotomy","authors":"Vijay R. Ramakrishnan, Samuel L. Kaefer","doi":"10.1002/lary.31769","DOIUrl":"https://doi.org/10.1002/lary.31769","url":null,"abstract":"<jats:label/>Despite tracheotomy being a routine procedure, it is not rare to encounter anatomic irregularities that can compromise its success. In this report, we describe a case in which a high riding innominate artery was identified within the surgical trajectory moments before incision, which ultimately necessitated airway securement using an alternative laryngological procedure. <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ObjectivesTo evaluate the effectiveness of employing the water sac dilation (WSD) method during endoscopy‐assisted transoral resection of parapharyngeal space benign tumor (PSBT).MethodsBetween February 2017 and January 2022, a total of 32 patients diagnosed with PSBT were included in this prospective study and were randomly allocated into two groups: the WSD group and the control group. Tumors of the WSD group patients were all dissected using the WSD method.ResultsThe final numbers of studied patients in WSD group and control group were 17 and 15, respectively. The basic information was comparable between these two groups of patients. All these patients successfully underwent tumor resection via transoral approach. The operation time, intraoperative blood loss, drainage volume on the first postoperative day, drainage duration, and the total drainage volume in the WSD group patients were significantly lower than those in the control group patients (all p < 0.05). No surgical complications occurred, and no residual tumor or recurrence could be identified at 6 months after surgery in both groups of patients.ConclusionThe application of the WSD method in endoscopy‐assisted transoral resection of PSBT effectively attenuated intraoperative injury, improved surgical efficiency, and accelerated postoperative recovery.Level of Evidence3 Laryngoscope, 2024
{"title":"The Use of Water Sac Dilation in Resecting Parapharyngeal Space Benign Tumor via Transoral Approach","authors":"Yuke Dong, Junbo Zhang, Yujie Li, Wei Huang, Yanwei Dang, Tao Li, Lianfang Xu, Xiao Shen, Hongyan Li, Lijie Huang, Beiying Li","doi":"10.1002/lary.31772","DOIUrl":"https://doi.org/10.1002/lary.31772","url":null,"abstract":"ObjectivesTo evaluate the effectiveness of employing the water sac dilation (WSD) method during endoscopy‐assisted transoral resection of parapharyngeal space benign tumor (PSBT).MethodsBetween February 2017 and January 2022, a total of 32 patients diagnosed with PSBT were included in this prospective study and were randomly allocated into two groups: the WSD group and the control group. Tumors of the WSD group patients were all dissected using the WSD method.ResultsThe final numbers of studied patients in WSD group and control group were 17 and 15, respectively. The basic information was comparable between these two groups of patients. All these patients successfully underwent tumor resection via transoral approach. The operation time, intraoperative blood loss, drainage volume on the first postoperative day, drainage duration, and the total drainage volume in the WSD group patients were significantly lower than those in the control group patients (all <jats:italic>p</jats:italic> < 0.05). No surgical complications occurred, and no residual tumor or recurrence could be identified at 6 months after surgery in both groups of patients.ConclusionThe application of the WSD method in endoscopy‐assisted transoral resection of PSBT effectively attenuated intraoperative injury, improved surgical efficiency, and accelerated postoperative recovery.Level of Evidence3 <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mihai A. Bentan, Graham Pingree, Lawrance Lee, Thomas Fitzpatrick, Theodore Schuman
ObjectiveTo compare the efficacy of th2‐targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS).MethodsThe TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non‐mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.ResultsAll mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%–13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%–19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%–15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%–10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%–7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%–4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%–11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%–22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%–19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%–12.17%, p = 0.005).ConclusionAlthough all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.Level of EvidenceNA Laryngoscope, 2024
目的比较th2靶向生物药物（dupilumab、omalizumab和mepolizumab）在降低慢性鼻息肉性鼻炎（CRSwNP）和过敏性真菌性鼻炎（AFRS）患者接受功能性内窥镜鼻窦手术（FESS）的绝对风险（ARR）方面的疗效。方法在TriNetX研究网络数据库中查询每种mAb在2024年3月之前的市场寿命。根据年龄、性别、种族和哮喘诊断结果，将患有 CRSwNP 的成人与非 mAb 对照组进行倾向评分匹配。主要结果是FESS率，次要结果包括住院率、急诊科就诊率和急性鼻窦炎发病率。结果所有 mAbs 都降低了 CRSwNP 患者的 FESS 风险（dupilumab，ARR 11.48%，95% CI 9.82%-13.15%，p = 0.001；omalizumab，ARR 12.02%，95% CI 4.36%-19.68%，p = 0.002；mepolizumab，ARR 10.32%，95% CI 5.24%-15.40%，p = 0.001）。只有杜比单抗还降低了住院风险（ARR 8.59%，95% CI 7.04%-10.15%，p <0.001）、急诊室就诊风险（ARR 5.94%，95% CI 4.28%-7.61%，p <0.001）和急性鼻窦炎风险（ARR 2.60%，95% CI 1.09%-4.12%，p = 0.001）。在 AFRS 患者中，只有 dupilumab 能降低所有结果的风险：FESS（ARR 6.97%，95 CI 2.86%-11.09%，P = 0.001）、住院（ARR 16.93%，95 CI 11.30%-22.57%，P <0.001）、ED 就诊（ARR 13.15%，95 CI 7.15%-19.14%，P <0.结论虽然所有 mAbs 都能降低 CRSwNP 的 FESS 风险，但只有 dupilumab 还能降低次要结局。同样，只有 dupilumab 能改善 AFRS 患者的所有预后。这些数据证明了 mAbs 在减轻 CRSwNP 和 AFRS 患者的疾病负担和改善患者预后方面的潜力。
{"title":"Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis","authors":"Mihai A. Bentan, Graham Pingree, Lawrance Lee, Thomas Fitzpatrick, Theodore Schuman","doi":"10.1002/lary.31774","DOIUrl":"https://doi.org/10.1002/lary.31774","url":null,"abstract":"ObjectiveTo compare the efficacy of th2‐targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS).MethodsThe TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non‐mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.ResultsAll mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%–13.15%, <jats:italic>p</jats:italic> < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%–19.68%, <jats:italic>p</jats:italic> = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%–15.40%, <jats:italic>p</jats:italic> < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%–10.15%, <jats:italic>p</jats:italic> < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%–7.61%, <jats:italic>p</jats:italic> < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%–4.12%, <jats:italic>p</jats:italic> = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%–11.09%, <jats:italic>p</jats:italic> = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%–22.57%, <jats:italic>p</jats:italic> < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%–19.14%, <jats:italic>p</jats:italic> < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%–12.17%, <jats:italic>p</jats:italic> = 0.005).ConclusionAlthough all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.Level of EvidenceNA <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Costantino, Jeffery Scott Magnuson, Uthman Alamoudi, Bruce Haughey
ObjectivesThe prognostic significance of human papillomavirus (HPV) genotypes in oropharyngeal squamous cell carcinoma (OPSCC) has garnered considerable attention due to the increasing reliance on HPV status for clinical decision‐making. This study aimed to compare the survival outcomes associated with different HPV genotypes in patients with OPSCC relative to HPV‐negative tumors, providing insights into the potential implications for treatment de‐intensification strategies.MethodsPatients diagnosed with invasive OPSCC were included from the National Cancer Database (NCDB). Patients were stratified based on HPV status and genotype, with HPV‐negative tumors serving as the reference group. Multivariable Cox regression analysis was performed to assess the independent prognostic value of different HPV genotypes.ResultsTh majority of patient were classified as HPV‐positive (N = 17,358, 70.0%), with HPV 16 being the most common genotype (N = 15410/17358, 88.8%) compared with other high‐risk (N = 1217/17,358, 7.0%) and low‐risk (N = 731/17,358, 4.2%) HPV genotypes. A significantly lower risk of death was measured for all HPV‐positive compared with HPV‐negative tumors (HPV 16: adjusted HR 0.51; 95% CI: 0.49–0.54; other high‐risk HPV: adjusted HR 0.56; 95% CI: 0.49–0.63; low‐risk HPV: adjusted HR 0.59; 95% CI: 0.50–0.68; p < 0.001).ConclusionThis study highlights the significant prognostic value of HPV genotypes in OPSCC, underscoring the superior survival outcomes of HPV‐positive tumors across all genotypes compared with HPV‐negative tumors. Detailed HPV subtype analysis can inform better treatment decisions and support de‐intensification strategies for patients with low‐risk genotypes.Level of Evidence3 Laryngoscope, 2024
{"title":"Prognostic Significance of Human Papillomavirus Genotypes in Oropharyngeal Squamous Cell Carcinoma","authors":"Andrea Costantino, Jeffery Scott Magnuson, Uthman Alamoudi, Bruce Haughey","doi":"10.1002/lary.31775","DOIUrl":"https://doi.org/10.1002/lary.31775","url":null,"abstract":"ObjectivesThe prognostic significance of human papillomavirus (HPV) genotypes in oropharyngeal squamous cell carcinoma (OPSCC) has garnered considerable attention due to the increasing reliance on HPV status for clinical decision‐making. This study aimed to compare the survival outcomes associated with different HPV genotypes in patients with OPSCC relative to HPV‐negative tumors, providing insights into the potential implications for treatment de‐intensification strategies.MethodsPatients diagnosed with invasive OPSCC were included from the National Cancer Database (NCDB). Patients were stratified based on HPV status and genotype, with HPV‐negative tumors serving as the reference group. Multivariable Cox regression analysis was performed to assess the independent prognostic value of different HPV genotypes.ResultsTh majority of patient were classified as HPV‐positive (<jats:italic>N</jats:italic> = 17,358, 70.0%), with HPV 16 being the most common genotype (<jats:italic>N</jats:italic> = 15410/17358, 88.8%) compared with other high‐risk (<jats:italic>N</jats:italic> = 1217/17,358, 7.0%) and low‐risk (<jats:italic>N</jats:italic> = 731/17,358, 4.2%) HPV genotypes. A significantly lower risk of death was measured for all HPV‐positive compared with HPV‐negative tumors (HPV 16: adjusted HR 0.51; 95% CI: 0.49–0.54; other high‐risk HPV: adjusted HR 0.56; 95% CI: 0.49–0.63; low‐risk HPV: adjusted HR 0.59; 95% CI: 0.50–0.68; <jats:italic>p</jats:italic> < 0.001).ConclusionThis study highlights the significant prognostic value of HPV genotypes in OPSCC, underscoring the superior survival outcomes of HPV‐positive tumors across all genotypes compared with HPV‐negative tumors. Detailed HPV subtype analysis can inform better treatment decisions and support de‐intensification strategies for patients with low‐risk genotypes.Level of Evidence3 <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica M.L. Pagel, Rachel H. Jonas, James J. Daniero, Patrick O. McGarey
The report describes the novel use of an endoscopic CO2 LASER assisted posterior glottic rotation flap in a professional voice user with non‐intubation related posterior glottic insufficiency. The 78‐year‐old patient presented with progressive dysphonia and dyspnea with speaking with stroboscopy findings of posterior glottic insufficiency.After several empiric voice treatments without improvement, the described surgery was performed to correct posterior glottic insufficiency. After surgery, VHI‐10 improved from 25 to 9, overall CAPE‐V from 69 to 6.5. The patient resumed public speaking and lecturing with maintained improvement in vocal quality and function at last follow‐up six months postoperatively. Laryngoscope, 2024
{"title":"Endoscopic Mucosal Rotational Flap for Posterior Glottic Insufficiency: A Case Report","authors":"Jessica M.L. Pagel, Rachel H. Jonas, James J. Daniero, Patrick O. McGarey","doi":"10.1002/lary.31760","DOIUrl":"https://doi.org/10.1002/lary.31760","url":null,"abstract":"The report describes the novel use of an endoscopic CO2 LASER assisted posterior glottic rotation flap in a professional voice user with non‐intubation related posterior glottic insufficiency. The 78‐year‐old patient presented with progressive dysphonia and dyspnea with speaking with stroboscopy findings of posterior glottic insufficiency.After several empiric voice treatments without improvement, the described surgery was performed to correct posterior glottic insufficiency. After surgery, VHI‐10 improved from 25 to 9, overall CAPE‐V from 69 to 6.5. The patient resumed public speaking and lecturing with maintained improvement in vocal quality and function at last follow‐up six months postoperatively. <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gary Gartling, Lea Sayce, Zachary Zimmerman, Alysha Slater, Lizzie Hary, Wenqing Yang, Michele Santacatterina, Bernard Rousseau, Ryan C. Branski
IntroductionGlucocorticoids (GCs) are commonly prescribed for laryngeal indications due to their potent anti‐inflammatory properties. However, GCs effect on vocal fold (VF) epithelial morphology and barrier function following injury is overlooked and may be key to efficacy. In this study, the effects of GCs on epithelial morphology and barrier function were quantified in injured VFs. We seek to increase our understanding of biochemical processes underlying GC mechanisms to refine therapeutic strategies.MethodsMicroflap injury was induced in 65 rabbits. Seven days after injury, animals received bilateral 20 μL intracordal injections of saline, dexamethasone, methylprednisolone, or triamcinolone (n = 15 per condition). Five rabbits in each condition were euthanized 1, 7, or 60 days following treatment. An additional five animals served as non‐injured/untreated controls. To quantify transepithelial electrical resistance (TEER), 1 mm epithelial biopsies were placed in an Ussing chamber. The contralateral VF was processed for transmission electron microscopy and epithelial depth analysis.ResultsAt 60 days, GC treatment maintained TEER levels similar to non‐injured/untreated controls. However, triamcinolone reduced TEER compared with saline‐treated conditions. Acutely, epithelial hyperplasia typically persisted in all injured VFs. At 60 days, only dexamethasone and triamcinolone increased epithelial depth in injured VFs; all GCs increased epithelial depth compared with non‐injured/untreated controls.ConclusionAcutely, GCs did not alter TEER. Additionally, GCs did not alter epithelial depth compared with saline treatment, indicating alignment with natural healing responses. At 60 days, GCs exhibited varying degrees of TEER restoration and epithelial hyperplasia, possibly due to distinct pharmacodynamic profiles.Level of EvidenceNA Laryngoscope, 2024
{"title":"Acute Effects of Steroids on Vocal Fold Epithelium Post‐injury in a Preclinical Model","authors":"Gary Gartling, Lea Sayce, Zachary Zimmerman, Alysha Slater, Lizzie Hary, Wenqing Yang, Michele Santacatterina, Bernard Rousseau, Ryan C. Branski","doi":"10.1002/lary.31729","DOIUrl":"https://doi.org/10.1002/lary.31729","url":null,"abstract":"IntroductionGlucocorticoids (GCs) are commonly prescribed for laryngeal indications due to their potent anti‐inflammatory properties. However, GCs effect on vocal fold (VF) epithelial morphology and barrier function following injury is overlooked and may be key to efficacy. In this study, the effects of GCs on epithelial morphology and barrier function were quantified in injured VFs. We seek to increase our understanding of biochemical processes underlying GC mechanisms to refine therapeutic strategies.MethodsMicroflap injury was induced in 65 rabbits. Seven days after injury, animals received bilateral 20 μL intracordal injections of saline, dexamethasone, methylprednisolone, or triamcinolone (<jats:italic>n</jats:italic> = 15 per condition). Five rabbits in each condition were euthanized 1, 7, or 60 days following treatment. An additional five animals served as non‐injured/untreated controls. To quantify transepithelial electrical resistance (TEER), 1 mm epithelial biopsies were placed in an Ussing chamber. The contralateral VF was processed for transmission electron microscopy and epithelial depth analysis.ResultsAt 60 days, GC treatment maintained TEER levels similar to non‐injured/untreated controls. However, triamcinolone reduced TEER compared with saline‐treated conditions. Acutely, epithelial hyperplasia typically persisted in all injured VFs. At 60 days, only dexamethasone and triamcinolone increased epithelial depth in injured VFs; all GCs increased epithelial depth compared with non‐injured/untreated controls.ConclusionAcutely, GCs did not alter TEER. Additionally, GCs did not alter epithelial depth compared with saline treatment, indicating alignment with natural healing responses. At 60 days, GCs exhibited varying degrees of TEER restoration and epithelial hyperplasia, possibly due to distinct pharmacodynamic profiles.Level of EvidenceNA <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel D. Ghaderi, Matthew R. Aronson, Amrita Mehta, Ryan M. Friedman, Kendra S. McDaid, Terri Giordano, Ian N. Jacobs, Riccardo Gottardi
ObjectivePediatric subglottic stenosis (SGS) is characterized by subglottic narrowing which occurs when pathological fibroblasts deposit extracellular matrix that reduces airway patency. Recent clinical observations have suggested that azithromycin may have favorable impacts on SGS reduction while treating airway infections; furthermore, our recent work in mice demonstrated that the airway microbiome influences SGS. In this work, we characterize the protective effect of azithromycin as an immunomodulatory and antibacterial therapeutic against subglottic stenosis.MethodsImmunomodulatory and antifibrotic effects of azithromycin were assessed on TGF‐β1‐stimulated airway fibroblasts at 10 μg/mL for 5 days. Changes in gene expression were quantified by RT‐qPCR and myofibroblast differentiation by α‐SMA immunostaining. Murine airways were pretreated (2‐weeks) with intranasal azithromycin before SGS injury by a twisted wire brush. Disease severity and immune response were characterized by histology and immunostaining for immune cells.ResultsIn vitro, azithromycin treatment of TGF‐β1‐stimulated fibroblasts exhibited strong reductions in extracellular matrix (COL1A1, LOX) and myofibroblast‐related gene expression (ACTA2). Notably, there was a significant reduction in pro‐fibrotic expression, which was observed with 10 μg/mL azithromycin. Immunostaining of fibroblasts for α‐SMA revealed strong reductions in the number of positive‐staining cells and the intensity of each positive cell. In vivo, azithromycin exhibited a significant decrease in lamina propria thickness indicative of reduced stenosis with associated changes in T‐cell infiltration.ConclusionsOverall, we show azithromycin prevents pro‐fibrotic gene expression and myofibroblast differentiation and can help protect mice from developing SGS. This introduces azithromycin as a potential treatment for SGS.Level of EvidenceNA Laryngoscope, 2024
{"title":"Azithromycin Prevents Subglottic Stenosis in Mice","authors":"Daniel D. Ghaderi, Matthew R. Aronson, Amrita Mehta, Ryan M. Friedman, Kendra S. McDaid, Terri Giordano, Ian N. Jacobs, Riccardo Gottardi","doi":"10.1002/lary.31754","DOIUrl":"https://doi.org/10.1002/lary.31754","url":null,"abstract":"ObjectivePediatric subglottic stenosis (SGS) is characterized by subglottic narrowing which occurs when pathological fibroblasts deposit extracellular matrix that reduces airway patency. Recent clinical observations have suggested that azithromycin may have favorable impacts on SGS reduction while treating airway infections; furthermore, our recent work in mice demonstrated that the airway microbiome influences SGS. In this work, we characterize the protective effect of azithromycin as an immunomodulatory and antibacterial therapeutic against subglottic stenosis.MethodsImmunomodulatory and antifibrotic effects of azithromycin were assessed on TGF‐β1‐stimulated airway fibroblasts at 10 μg/mL for 5 days. Changes in gene expression were quantified by RT‐qPCR and myofibroblast differentiation by α‐SMA immunostaining. Murine airways were pretreated (2‐weeks) with intranasal azithromycin before SGS injury by a twisted wire brush. Disease severity and immune response were characterized by histology and immunostaining for immune cells.Results<jats:italic>In vitro</jats:italic>, azithromycin treatment of TGF‐β1‐stimulated fibroblasts exhibited strong reductions in extracellular matrix (<jats:italic>COL1A1, LOX</jats:italic>) and myofibroblast‐related gene expression (<jats:italic>ACTA2</jats:italic>). Notably, there was a significant reduction in pro‐fibrotic expression, which was observed with 10 μg/mL azithromycin. Immunostaining of fibroblasts for α‐SMA revealed strong reductions in the number of positive‐staining cells and the intensity of each positive cell. <jats:italic>In vivo</jats:italic>, azithromycin exhibited a significant decrease in lamina propria thickness indicative of reduced stenosis with associated changes in T‐cell infiltration.ConclusionsOverall, we show azithromycin prevents pro‐fibrotic gene expression and myofibroblast differentiation and can help protect mice from developing SGS. This introduces azithromycin as a potential treatment for SGS.Level of EvidenceNA <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priya Arya, Yansy Salmerón, Alexandra E. Quimby, Kevin Wong, Jason A. Brant, Tiffany P. Hwa
ObjectiveTo ascertain trends in ototoxicity observed with monoclonal antibodies (mABs) and understand the impact they may have on hearing function.Data SourcesPubMed, Embase, Scopus.Review MethodsA systematic review was performed following PRISMA guidelines. Data were reviewed for demographics, utilized mABs with respective indication and dosing, audiometric outcomes, and treatment for otologic effects.ResultsOf 757 studies reviewed, a total of 44 were included, encompassing 18,046 patients treated with mABs. Mean age of the sample was 57.8 years old. The search yielded 18 agents of ototoxicity, with reported symptoms of ototoxicity such as hearing loss, tinnitus, and/or aural fullness occurring in 1079 of total patients. Main agents causing ototoxicity were teprotumumab (n = 17/44 studies), nivolumab (n = 10/44), ipilimumab (n = 9/44), pembrolizumab (n = 5/44), and rituximab (n = 4/44). Thirty‐one of 44 studies encompassing eight agents reported audiometric data for ototoxic agents, showing sensorineural hearing loss primarily in the high‐frequency range. Only two articles performed ultrahigh‐frequency audiograms.ConclusionMonoclonal antibody usage is expanding, but the vast majority of studies lack substantial audiometric data. Where reported, study design and inclusion criteria vary greatly. Future studies would benefit from rigid inclusion of audiometric data, prospective study design, and consideration of formal ototoxicity screening. Otolaryngologists should be aware of the cochlear immune response and potential impact of this expanding medication class on hearing function. Laryngoscope, 2024
{"title":"The Impact of Monoclonal Antibody Usage on Hearing Outcomes: A Systematic Review","authors":"Priya Arya, Yansy Salmerón, Alexandra E. Quimby, Kevin Wong, Jason A. Brant, Tiffany P. Hwa","doi":"10.1002/lary.31763","DOIUrl":"https://doi.org/10.1002/lary.31763","url":null,"abstract":"ObjectiveTo ascertain trends in ototoxicity observed with monoclonal antibodies (mABs) and understand the impact they may have on hearing function.Data SourcesPubMed, Embase, Scopus.Review MethodsA systematic review was performed following PRISMA guidelines. Data were reviewed for demographics, utilized mABs with respective indication and dosing, audiometric outcomes, and treatment for otologic effects.ResultsOf 757 studies reviewed, a total of 44 were included, encompassing 18,046 patients treated with mABs. Mean age of the sample was 57.8 years old. The search yielded 18 agents of ototoxicity, with reported symptoms of ototoxicity such as hearing loss, tinnitus, and/or aural fullness occurring in 1079 of total patients. Main agents causing ototoxicity were teprotumumab (<jats:italic>n</jats:italic> = 17/44 studies), nivolumab (<jats:italic>n</jats:italic> = 10/44), ipilimumab (<jats:italic>n</jats:italic> = 9/44), pembrolizumab (<jats:italic>n</jats:italic> = 5/44), and rituximab (<jats:italic>n</jats:italic> = 4/44). Thirty‐one of 44 studies encompassing eight agents reported audiometric data for ototoxic agents, showing sensorineural hearing loss primarily in the high‐frequency range. Only two articles performed ultrahigh‐frequency audiograms.ConclusionMonoclonal antibody usage is expanding, but the vast majority of studies lack substantial audiometric data. Where reported, study design and inclusion criteria vary greatly. Future studies would benefit from rigid inclusion of audiometric data, prospective study design, and consideration of formal ototoxicity screening. Otolaryngologists should be aware of the cochlear immune response and potential impact of this expanding medication class on hearing function. <jats:italic>Laryngoscope</jats:italic>, 2024","PeriodicalId":501696,"journal":{"name":"The Laryngoscope","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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