Annals of Otology Rhinology and Laryngology最新文献

Objective: To determine if disparities exist in patient follow-up post-bilateral myringotomy with tympanostomy tube placement.

Introduction: Bilateral myringotomy with tympanostomy tube placement (BMT) is the most common surgery performed in children in the U.S. The current literature suggests there are no demographic differences in treatment of otitis media, however these studies have limited data on postoperative follow-up. This study aims to assess socioeconomic and other factors that affect follow-up after BMT.

Methods: A retrospective chart review of pediatric patients seen at a tertiary medical center who underwent BMT was conducted. Demographic, medical, and socioeconomic information was collected. Fisher's exact test was used to estimate association between follow-up with all nominal responses. Logistic regression was used to estimate association between follow-up with quantitative responses.

Results: A total of 750 patients (62.1% male) were included with 37.7% of patients identifying as non-Caucasian and 30.6% as Hispanic. The mean (SD) age at time of surgery was 5.1 (4.4) years. Patients undergoing a concurrent tonsillectomy and adenoidectomy (T&A) were less likely to follow-up than those with BMT alone. This was true even after adjusting for age and distance from medical center (OR = 0.46, 95% CI = 0.27-0.79; P = .01). Race, type of insurance, medical-comorbidities, indication for surgery, and distance from clinic did not affect rate of follow-up (P > .05). Those who underwent multiple BMTs and those with developmental delay may also be less likely to follow-up, although this finding did not meet statistical significance (P < .1).

Discussion: Our study demonstrates socioeconomic variables, indication for surgery, and co-morbidities were not statistically significant factors in determining rates of follow-up after BMT. Interestingly, concurrent T&A was associated with lower rates of follow-up. Findings in this study suggest large medical centers with diverse patient populations see similar rates of follow-up post-BMT across a variety of variables.

Level of evidence: 3.

Objective: To assess the impact of extent of parotidectomy on surgical and oncologic outcomes in low grade mucoepidermoid carcinoma (LGMEC).

Methods: A retrospective chart review of all patients undergoing primary surgical treatment for LGMEC from 2000 to 2022 was conducted. Clinical features collected included demographics, facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence.

Results: 58 patients were included; 10 patients underwent partial parotidectomy (PP), 38 underwent superficial parotidectomy (SP), and 10 underwent near-total/total parotidectomy. PP and SP patients had smaller tumors and more superficial tumors compared to near-total/total parotidectomy group (P = .03). PP and SP were more likely to have negative margins and less locoregional disease compared to near-total/total parotidectomy patients (P < .01). Near-total/total parotidectomy were more likely to undergo facial nerve resection (20% vs 0% for PP & SP respectively) (P = .05). Immediate postoperative facial nerve function was significantly better among PP patients (73% HB I) compared to SP (44% HB I) and near-total/total parotidectomy patients (0% HB I) (P < .01). Most patients regained their facial nerve function although only 40% of the near-total/total parotidectomy patients had a HB I at the time of last follow up (P < .01). Patients were followed for a median of 6.2 years, during which only 1 patient (total parotidectomy) had a recurrence.

Conclusions: PP offers a safe and effective approach for small LGMEC tumors, ensuring better facial nerve function postoperatively with minimal complications compared to more extensive surgery.

Objective: To develop a reliable prognostic grading scale for pneumolabyrinth detected on CT.

Design: Retrospective case series.

Setting: Tertiary care institution.

Participants: A total of 39 patients with pneumolabyrinth identified through CT imaging from 2010 to 2019 were included. The main outcome measures involved reviewing clinical outcomes and radiographic features. The extent of pneumolabyrinth was assessed and graded as low, intermediate, or high risk for permanent hearing loss, by expert radiologists.

Main outcomes and measures: The primary outcome of the study was the association between the extent of pneumolabyrinth, as graded by a novel prognostic scale (low, intermediate, or high risk), and the likelihood of permanent hearing loss. Hearing outcomes and vestibular symptoms were assessed through retrospective chart review, while the grading of pneumolabyrinth extent was based on expert radiologic evaluations of CT imaging. The hypothesis regarding the predictive utility of the grading scale was formulated after data collection. Reliability of the grading scale was measured using Cohen's kappa and Fleiss' kappa.

Results: The patient cohort had a median age of 30 years (range = 8-84 years), 33% of whom were female. Trauma, predominantly temporal bone fractures (87.5%), was the most common cause. The grading scale demonstrated excellent intra-rater reliability (Cohen's kappa = .95) and substantial inter-rater reliability (Fleiss' kappa = .729). High risk pneumolabyrinth cases had a higher rate of profound hearing loss (90.9%) compared low or intermediate risk cases (46.2%, P = .0136). Dizziness was not associated with pneumolabyrinth grade, but correlated with involvement of semicircular canals (72.7%) compared to patients with pneumolabyrinth limited to vestibule and/or cochlea (31.3%, P = .008). Presence of pneumolabyrinth isolated to the vestibular labyrinth was significantly associated with dizziness symptoms (P = .047).

Conclusion: Our novel grading scale reliably predicted clinical outcomes, providing prognostic utility in hearing status and potential guidance in surgical approach.

Background: Malignant mesenchymal tumors involving the parotid gland are uncommon, characteristically aggressive, and little is known with few reports documented.

Study design: Retrospective case series.

Setting: Single institution tertiary care center, 2010 to 2022.

Method: Patients were identified from an institutional parotid tumor database. Patient history, demographics, pathologic diagnosis, treatment, and follow up were documented.

Results: Eight patients were identified, 3 were males. The average age was 61 years old, and the most common tumors identified were pleomorphic sarcomas (3 patients). Presenting symptoms included: preauricular/cheek mass in 7 patients, facial pain (4), otalgia (4), aural fullness (3), and numbness (1). All patients received a parotidectomy, and 4 patients received adjuvant therapy of either radiation or chemoradiation. Post-operatively, there were 3 cases of distant recurrence, 2 cases of regional recurrence, and 1 case of local recurrence. There were 2 reports of death.

Conclusion: Malignant mesenchymal tumors of the parotid are rare, represent varied histologies. Due to their aggressive nature, surgical resection with radiation and close follow-up may be an appropriate treatment regimen in controlling the disease.

Objective: To evaluate device survival and identify risk factors for failure in pediatric cochlear implant (CI) surgery to guide strategies for minimizing failure rates and improving survival outcomes.

Methods: A retrospective analysis was conducted on pediatric patients who underwent CI surgery at the Children's Hospital, Zhejiang University School of Medicine, from September 2008 to September 2023. Device survival was assessed using the Kaplan-Meier method while independent factors influencing device survival were analyzed using the log-rank test and Cox regression model.

Results: Among 602 children, the mean age at first CI surgery was 50.3 months (range = 8-155 months). The cohort included 353 males (58.6%) and 249 females (41.4%). Revision surgery was required in 28 cases (4.7%), primarily due to device failure (17/28, 60.7%), including 14 hard and 3 soft failures. Kaplan-Meier analysis showed CI survival rates of 99.1%, 98.1%, 96.7%, 96.4%, and 96.4% at 1, 2, 3, 5, and 10 years post-surgery, respectively. The log-rank test identified sex, age, and history of head trauma as significant factors affecting device survival (P < .05). Multivariate Cox regression confirmed that male sex, first implantation ≤3 years of years, and postoperative head trauma were independent risk factors for device failure.

Conclusions: Pediatric cochlear implantation is generally safe and effective, though device failure remains a concern, necessitating revision surgery remains. Male children who undergo cochlear implantation at ≤3 years of age or have a history of postoperative head trauma require enhanced postoperative care. This includes avoiding vigorous head impacts and increasing follow-up visits to monitor device function and speech recovery. Manufacturers should prioritize developing more durable, impact-resistant cochlear implants to reduce failure rates and improve long-term device survival.

Objective: The apnea-hypopnea index (AHI) defines obstructive sleep apnea (OSA) severity but fails to describe nuances in disease burden. The modified sleep apnea severity index (mSASI) combines patient anatomy, weight, sleep study metrics, and symptoms to provide a composite OSA index ranging from 1 to 3. While prior studies have associated mSASI with quality of life and hypertension, its utility in continuous positive pressure intolerant (CPAPi) surgical patients remains unexplored.

Methods: A retrospective cohort study of surgically treated CPAPi patients who underwent upper airway stimulation (UAS), maxillomandibular advancement (MMA), or expansion sphincter pharyngoplasty (ESP) at our Tertiary Care Academic Center from 2014 to 2021. Five hundred twenty-eight patients were identified and 260 had available data to calculate mSASI pre- and postoperatively using the published method. Wilcoxon rank-sum tests were used during the analysis.

Results: Out of 260 patients, 167 underwent UAS (64%), 73 ESP (28%), and 20 MMA (8%). Fifty-five percent had a preoperative mSASI = 1 (average = 1.56, standard deviation = 0.68). The average overall change in mSASI postoperatively was -0.32 (p < .01). mSASI change in UAS, ESP, and MMA groups was -0.21, -0.51, and -0.50, respectively. Of note, 64% of UAS patients had a preoperative mSASI = 1, compared to 40% and 37% for MMA and ESP, respectively. The change in mSASI score was not significantly associated with treatment efficacy per Sher's Criteria (p = .6)Conclusion:The mSASI is a valuable alternative index to measure preoperative OSA severity and characterize surgical outcomes. Further prospective studies are needed to confirm these findings and to determine its ability to detect risk reduction post-treatment.

Level of evidence: 4.

Objective: To describe outcomes of patients with a history of cutaneous squamous cell carcinoma (cSCC) of the head and neck previously treated with definitive surgery and radiation therapy (RT), who undergo salvage surgery for disease recurrence. There is minimal data available on this cohort of patients.

Methods: This was a retrospective case series. Patients evaluated for advanced cSCC of the head and neck between 2003 and 2022 were reviewed. Those with a history of surgery and adjuvant RT undergoing salvage surgery for recurrence were included in the main cohort. Comparisons were made to patients undergoing primary/initial treatment, and to those undergoing salvage surgery for recurrence but without a history of adjuvant RT.

Results: Of the 579 patients reviewed, 49 met inclusion criteria for the main cohort. Average length of follow up was 22 months. A total of 19 patients (38.8%) experienced recurrence, all within 14 months of salvage surgery. Among patents staged BWH T2b or T3, there was a 50% recurrence rate. Average overall survival following surgery was 35.6 months (95% CI = 24.7-46.4).

Conclusion: Patients in this cohort have a high rate of recurrence and an overall survival of approximately 3 years.

Background: Sentinel lymph node biopsy (SLNB) is integral to management of head and neck melanomas (HNM). Here, we evaluate how radiotracer selection (Tc-99m tilmanocept or Tc-99m sulfur colloid) and imaging modality (planar imaging or single positron emission computed tomography (SPECT)) may influence SLNB and its outcomes.

Methods: We performed a retrospective chart review of patients who received SLNB for HNM at our institution between January 2000 and July 2022.

Results: A total of 211 patients received Tc-99m tilmanocept (Tc-tilmanocept) and 113 received Tc-99m sulfur colloid (Tc-SC). There was no difference between Tc-tilmanocept and Tc-SC in terms of number of nodal levels to which the radiotracers localized (1.48 ± 0.93 SD vs 1.38 ± 0.93, respectively). Tc-tilmanocept had a lower rate of failed sentinel node identification as reported on radiology reports compared to Tc-SC (1.9% vs 11.5%, P < .001). There was a lower 5-year recurrence rate with Tc-tilmanocept versus Tc-SC (20.9% vs 28.3%, respectively P = .07), but this difference was not significant. When analyzing only cases in which SPECT was obtained, this there was no observed difference in 5-year recurrence rate. With SPECT, fewer patients had non-specific description of their node localization as "cervical" without further detailing of nodal basin (0% SPECT vs 9.7% non-SPECT, P < .001). Multivariable linear regression analysis for predictors of HNM 5-year recurrence found the odds ratio for SPECT imaging was 0.43, but not statistically significant (P = .06).

Conclusions: Tc-tilmanocept may be associated with greater rate of successful radiotracer migration along lymphatics compared to Tc-SC. SPECT imaging may confer more precision of the nodal basin to which radiotracer localizes as fewer patients receiving SPECT had radiology findings showing nonspecific localization of nodes to "cervical" basins without further specification. More patients are necessary to determine if Tc-tilmanocept and SPECT imaging are associated with lower melanoma recurrence rate.

Objectives: This study compared a simplified in situ self-administered hearing screening test, conducted with a neckband-type self-fitting device, with conventional pure-tone audiometry. It evaluated the maximum speech-shaped noise level for screening (MSNLS), crucial for evaluating the feasibility of this in situ screening test in quiet environments.

Methods: This study included 30 adults with normal hearing and 30 adults with mild to moderately severe hearing impairment. A binaural neckband-type self-fitting device was developed. The results of an in situ hearing screening test conducted using the self-fitting device were compared with those obtained using traditional pure-tone audiometry conducted using TDH-50 earphones. Subsequently, MSNLS was determined by assessing noise-masking effects on screening outcomes. All tests were conducted in an audiometric booth, with the hearing screening test conducted in the booth with the door open.

Results: Strong positive correlations were observed between the results of pure-tone audiometry and those of hearing screening tests across all test frequencies, with the strongest correlation observed at 2000 Hz (r_s = 0.793, P < .001) and the weakest correlation observed at 500 Hz (r_s = 0.625, P < .001). Comparisons of screening tests results with pure-tone thresholds across all test frequencies revealed differences of approximately 10 dB HL for 80% of all ears. The sensitivity and specificity of the hearing screening test in detecting candidates with hearing loss (>30 dB HL) who are suitable for this device were 93% and 90%, respectively. The hearing-impaired group exhibited MSNLSs, such as 57 dB SPL at 500 Hz, exceeding ambient noise levels in an empty classroom.

Conclusion: The in situ hearing screening test, conducted using a self-fitting device, exhibited reasonable accuracy for self-fitting scenarios in general quiet environments. This test can be used for monitoring mild to moderate hearing loss or fluctuating hearing loss, such as that associated with Ménière's disease.

Objective: To assess the efficacy and safety of simultaneous labyrinthectomy and cochlear implantation (CI) in patients with refractory Ménière's disease (MD).

Methods: A retrospective review of patients with definite refractory MD per American Academy of Otolaryngology-Head and Neck Surgery treated via simultaneous transmastoid labyrinthectomy and CI was performed at a tertiary referral center. Patients' clinical and audiometric outcomes were assessed and analyzed.

Results: Twenty-four patients underwent simultaneous transmastoid labyrinthectomy and CI between 7/2015 and 9/2023 (median age = 58 years [interquartile range (IQR) = 43.5-64.5], 54% female). Complete resolution of vertigo occurred in 23 patients (96%). Evaluating available data at ≥6 months postoperatively, both CNC (n = 9; 36% vs 40%, P = .76) and AzBio scores (n = 13; 40% vs 62%, P = .15) improved after surgery. When performing a sound localization task with the CI on, the median score in identifying the noise was 32% (IQR = 22%-56%) with a median degree error of 27.9 (IQR = 15.8-38.0) versus a median score with the CI off of 20% (IQR = 14%-42%) with a median degree error of 43.8 (IQR = 21.9-73.5) at a median of 9.8 months (IQR = 6.7-14.6) from surgery.

Conclusions: The present study represents one of the largest cohorts of refractory MD patients undergoing simultaneous labyrinthectomy and CI. Combining these procedures appears safe, enables excellent control of vertigo, and expedites aural rehabilitation in appropriately selected candidates, but future study is warranted to continue to evaluate this treatment paradigm.