Annals of Otology Rhinology and Laryngology最新文献

Objective: Soluble fibrinogen-like protein 2 (sFGL2) may be involved in the pathology and progression of allergic rhinitis (AR) through regulating T-helper (Th)2 cell response. This study aimed to explore the ability of sFGL2 to estimate outcomes in AR patients.

Methods: sFGL2 was detected in the serum sample of 119 AR patients at baseline and 20 healthy controls (HCs) after enrollment by enzyme-linked immunosorbent assay. In AR patients, disease severity was assessed at baseline as well as 4 weeks (W4) and 8 weeks (W8) after enrollment by the total nasal symptom score (TNSS).

Results: sFGL2 was higher in AR patients than HCs [median (interquartile range): 100.0 (70.0-154.0) vs 47.0 (31.5-78.5) ng/mL] (P < .001). In AR patients, sFGL2 was positively correlated with TNSS score (P = .002), itching score (P = .037), sneezing score (P = .012), and interleukin (IL)-4 (P = .006) at baseline. TNSS score declined from baseline to W8 in AR patients (P < .001). To further explore the association between sFGL2 levels and treatment outcomes, we compared the sFGL2 levels between patients with TNSS scores at W4 or W8 >4 and those with TNSS scores at W4 or W8 ≤4. It was found that sFGL2 was only increased in AR patients with a TNSS score at W4 >4 versus those with a TNSS score at W4 ≤4 (P = .012).

Conclusion: Serum sFGL2 is increased in AR patients, and its high level estimates an increased Th2 cytokine and disease severity as well as poor outcomes.

Parathyroid gland (PG) auto-transplantation is performed to preserve the function of de-vascularized or unintentionally removed PGs, however, little has been published about the technique and outcomes in children. In our study, we aimed to present the results of PG auto-transplantation in children undergoing thyroidectomy or parathyroidectomy at a tertiary single institution. A retrospective review identified 14 patients (<18 years of age) who underwent PG auto-transplantation from January 2000 to December 2022. 57.1% (8/14) had transient postoperative hypocalcemia and 14.3% (2/14) had permanent postoperative hypocalcemia. Eight patients had transient hypoparathyroidism, correlating with the rate of transient hypocalcemia. The most common reimplantation site was the sternocleidomastoid (11/14) and it was significantly associated with normalized calcium levels 6 months after auto-transplantation (p=0.033). Bilateral central neck dissection and surgical indication of cancer had a statistically significant association with transient hypocalcemia (p=0.03 and p=0.005, respectively). Our study provides valuable insights into the outcomes of PG auto-transplantation in pediatric patients, highlighting the potential for successful engraftment and factors associated with hypocalcemia.

Objectives: Transoral robotic surgery (TORS) for benign glottic conditions is scarcely represented in the literature. We aimed in this study to report on the technical feasibility of an explicitly transoral robotic approach for a patient with posterior glottic stenosis, and to highlight extant limitations in exposure and robotic instrumentation of the glottis.

Methods: Retrospective chart review of a single patient undergoing a TORS approach to maximize the posterior glottic aperture.

Results: A 42-year-old female patient with posterior glottic stenosis and a tracheotomy was consented for a robotic posterior glottic scar lysis, KTP-laser assisted partial arytenoidectomy, balloon dilation, and steroid injection. The da Vinci Intuitive Surgical single-port robotic platform was used with 2 robotic arms (needle driver and scissors), and an FK-WO transoral retractor with a straight tongue blade was deployed to facilitate endolaryngeal exposure. KTP laser fiber was passed through a robotic, semi-flexible drop-in guide, and manipulated with the needle driver. Case duration was 40 minutes. There were no perioperative or immediate post-operative complications noted on short-term follow-up.

Conclusion: We demonstrate technical feasibility and equipoise between an explicitly robotic approach and a standard endoscopic approach to posterior glottic stenosis, a common glottic condition. Further technological development and adaptation of surgical technique are necessary to advance benign robotic laryngeal surgery.

Objectives: Silent sinus syndrome (SSS) is a rare condition involving idiopathic maxillary sinus underdevelopment, orbital floor resorption, enophthalmos, and hypoglobus. SSS is more commonly described in adults, with only very limited literature in the pediatric population. Given the rarity of the condition, there is a lack of consensus regarding proper diagnostic criteria and treatment strategies. We present a case of pediatric SSS and a review of other cases in the literature.

Methods: Case report and systematic review.

Results: A 12-year-old female patient was referred for incidental MRI findings suggestive of SSS. Examination revealed minimal enophthalmos with some hypoglobus. A CT scan of the sinuses confirmed the diagnosis of SSS, and the patient underwent a right sided endoscopic modified medial maxillectomy/mega-antrostomy with image guidance given the significant maxillary hypoplasia. A literature review of CINAHL, PubMed, and Scopus identified 15 studies that referenced pediatric SSS cases.

Conclusions: This article reports a case of pediatric SSS and compares the presenting symptoms, diagnostic criteria, and surgical intervention to other cases of pediatric SSS. As pediatric SSS is a very rare disease, this case offers a possible treatment strategy for a severely atelectatic maxillary sinus.

Objective: The reach and impact of social media as it pertains to medical information among the parents and guardians of pediatric otolaryngology patients is unknown. This survey-based study investigates the use of social media as a source of medical knowledge in this population.

Methods: Parents and guardians visiting a pediatric Otolaryngology clinic located at a tertiary care children's hospital in southern California from September 2022 to May 2023 were approached for study inclusion. Decision tree and logistic regression analysis was conducted to identify patterns of social media usage in association with factors of interest.

Results: Of the 400 parents included in the study, most were female (80.0%); 49.5% were 30 to 40 years of age, and 18.8% were <30 years old. Most (90.0%) used social media, and 44.5% actively used it to obtain health information related to care for their children. A large proportion of parents (73.0%) were interested in social media content to better understand their child's condition, particularly the opportunity to view videos and images of a surgery planned for their child (75.0%). About half (50.5%) would permit their child's doctor to post about their child on social media, and 53.8% stated they would be more inclined to choose a surgeon who uses social media to educate families about their child's condition.

Conclusion: Most parents/guardians were interested in and had obtained critical medical information on social media, especially content pertaining to their child's medical condition(s). Analysis of survey responses identified the social media content most valued by parents/guardians of children undergoing otolaryngological surgery. These findings can be used by pediatric otolaryngologists to better understand their patients' preferences and improve access to health information for their patients on social media, as well as to grow their practices.

Background: Superselective lateral neck dissection (SSND), defined as dissection of 2 or less contiguous lateral cervical nodal levels, has emerged as a treatment option for metastatic papillary thyroid carcinoma (PTC), in place of a selective neck dissection (SND). There are few studies exploring outcomes of SSND compared to SND in this context.

Materials and methods: This was a single institution retrospective study. All patients who were diagnosed with PTC and had a lateral neck dissection from 2019 to 2022 were reviewed. Patient demographics and outcomes were compared.

Results: A total of 136 patients met inclusion criteria. About 106 (78%) had a SND and 30 (22%) had a SSND. There was no significant difference between patients who underwent SND versus SSND regarding frequency of post-operative complications, length of stay (2.49 vs 2.31 days), post-operative thyroglobulin >10 ng/mL (21 vs 3 patients), regional recurrence (14% vs 17%), reoperation rates (16.7% vs 17.4%), or adjuvant radioactive iodine therapy (75% vs 63%; P > .05).

Conclusions: SSND for PTC had similar short-term clinical outcomes when compared to SND.

Objective: To investigate the association between subglottic stenosis (SGS) and obstructive sleep apnea (OSA).

Methods: This is a cross-sectional pilot cohort study conducted at a single tertiary academic center from 2022 to 2023. Subjects with non-traumatic SGS were recruited for enrollment. All subjects completed a peak expiratory flow (PEF) measurement, validated sleep questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and a 1-night home sleep test (HST). Demographic data were summarized. Prevalence was calculated and descriptively compared to a matched population. Partial correlation analysis evaluated the relationship of PEF% and Meyer-Cotton grading, in addition to PEF% and apnea-hypopnea index (AHI). Sleep quality was compared in subjects with and without OSA via a Mann-Whitney U test.

Results: Twenty subjects participated; all were Caucasian females with a mean age of 48.4 (10.4) years and a body mass index (BMI) of 24.1 (3.8). The majority (80%) had idiopathic SGS, and a mean PEF 288 (71) L/min. OSA was present in 40% of subjects, of which 15% had moderate OSA. PEF% did not correlate to AHI (P > .05). Poor sleep quality (PSQI ≥ 5) was present in 70% of subjects and 20% had excessive daytime sleepiness (ESS > 9). PSQI and ESS did not differ between subjects with and without OSA (P > .05).

Conclusion: OSA prevalence is elevated in a cohort of subjects with SGS. Further study of airway dilation's impact on OSA is necessary. Screening and surveillance for OSA in patients with subglottic stenosis may need to be considered based on this study's findings.Level of Evidence: Level 3.

Objectives: Vocal fold injection augmentation with hyaluronic acid (HA) fillers is a common treatment for glottic insufficiency. While generally well-tolerated, rare inflammatory reactions can occur in 3% to 5% of patients. All reported reactions resolved after corticosteroid treatment, and no cases of recurrent inflammatory reaction with airway obstruction following steroid treatment have been reported. This case report describes a unique case of recurrent inflammatory reactions following laryngeal HA injection and management with hyaluronidase injection to prevent further reactions.

Methods: A retrospective review was conducted of this patient's medical record.

Results: We present the case of a 42-year-old female with left vocal fold immobility who experienced recurrent inflammatory reactions and airway symptoms following laryngeal HA injection despite corticosteroid treatment. Recurrent inflammatory reaction following corticosteroid treatment of an initial inflammatory reaction has not been reported. This patient was managed with hyaluronidase injection to dissolve residual HA, which successfully prevented further reactions.

Conclusion: This case highlights the potential for recurrent inflammatory reactions following HA injection despite corticosteroid treatment and describes the novel role of hyaluronidase in managing such complications.

Background: Branchial cleft cysts are pediatric congenital anomalies that can present as sinus tracts to the neck. Intraoperative methylene blue dye with fibrin glue has been suggested as an effective tool for tracking the tract's depth to help definitively excise. In this large retrospective study of 118 patients spanning a decade, we aim to elucidate outcomes of branchial cleft anomaly excision without methylene blue dye.

Methods: A retrospective review was conducted with patients who received branchial cleft anomaly (BCA) with sinus tract excision at Monroe Carrell Jr. Children's Hospital from June 2012 to June 2022. We collected demographic variables, BCA characteristics, perioperative care variables (ie, prior drainage, imaging, and concurrent procedure), and perioperative outcomes (ie, intra- and post-operative complications). Median and interquartile range (IQR) were calculated for continuous demographic variables, and average and standard deviation (SD) were calculated for sinus tract length. Two-tailed Chi-square or Fisher's exact tests were performed to compare categorical samples where applicable with a statistical significance threshold set a priori at P < .05, and multivariable logistic regression assessed significant associations.

Results: The sample included 118 patients with an average tract length of 3.3 cm (SD = 1.7 cm). Incision/drainage was performed before definitive excision in 16 (13.6%) patients and was associated with age above the median (aOR = 5.29, 95% CI = 1.39-20.09, P = .015) and female sex (aOR = 3.81, 95% CI = 1.12-13.01, P = .032). Most patients (N = 85, 72.0%) did not receive imaging. Among 118 cases, 2 (1.7%) required return to the operating room for surgical site complications. No patients experienced intra-operative complications or tract recurrence necessitating revision surgery.

Conclusion: Patients with branchial cleft sinus tracts that were surgically excised without intraoperative dye achieved definitive resection with no recurrence and limited post-operative complications. While not a direct comparison, these results suggest that using intraoperative dye may be associated with unnecessary costs without benefit in outcomes.

Objective: Surgical management of head and neck cancer (HNC) can result in significant functional deficits. Large tumors of the oral cavity may require extensive resection and the need for microvascular free-flap reconstruction involving the use of adynamic tissue. This may result in oral incompetence, drooling, and unsatisfactory esthetic outcomes. Maintenance of the orbicularis oris and function of the oral sphincter are important objectives in the reconstruction of large defects. When this cannot be accomplished, secondary local flaps can be employed to restore the orbicularis oris.

Methods: We present 2 cases of oral incompetence following microvascular free- flap reconstruction for large resections of HNC.

Results: All cases were managed with debulking of flap, modified Karapandzic flaps, and advancement of composite skin, muscle, and buccal mucosa to restore the function of the oral sphincter and improve oral competence. The surgical techniques demonstrated in our cases resulted in improvement in both functional and esthetic outcomes.

Conclusion: Restoring continuity of the orbicularis oris muscle is a critical functional and esthetic consideration in microvascular free flap reconstruction where the lip is involved or disrupted. However, when this cannot be achieved, restoration of the oral sphincter and oral commissure can be achieved with a secondary reconstructive procedure.