Annals of Otology Rhinology and Laryngology最新文献

Objective: Despite vaccination and early antibiotic treatment, pneumococcal meningitis remains a disease with significant mortality and morbidity. The resulting inflammatory response can lead to cochlear fibrosis, ossification where cochlear implant surgeries are far challenging. Our study aimed to investigate the preventive effect of controlled-release dexamethasone implant in such cases in terms of structural integrity.

Methods: Twenty-four rats were induced with pneumococcal meningitis and randomized into study (n = 16) and control (n = 8) groups. Controlled-release dexamethasone implants were placed transbullarly into the right round window of the study group. Bilateral cochleas underwent histological examination 3 months post-infection.

Results: In the study, cochlear effects of pneumococcal meningitis were evaluated. The basal turn was significantly more affected by fibrosis and ossification (P = .013 and .010, respectively). Compared with control ears, the dexamethasone implant group showed less fibrosis in all turns and less ossification in the basal turn (P = .014, .003, .044, and .035, respectively).

Conclusion: In pneumococcal meningitis, fibrosis and ossification occur more intensively in the basal turn of the cochlea. Controlled-release dexamethasone implants are effective in preventing cochlear ossification and fibrosis. The prevention from the structural damage indicates the potential role of these dexamethasone implants in post-meningitic hearing loss and easing cochlear implant surgeries.

Objectives: Chronic otitis media can cause ossicular chain discontinuity (OCD), especially erosion of long process of incus. This study introduces a novel "Hot Dog" technique for OCD reconstruction that combines glass ionomer cement (GIC) with autogenous cartilage dust and platelet-rich fibrin (PRF) to address these limitations. The aim is to evaluate the auditory and anatomical outcomes of the "Hot Dog" technique compared to GIC alone, and to describe the "Hot Dog" reconstruction method in detail.

Methods: This prospective, randomized controlled trial compared the "Hot Dog" technique to GIC alone for incudostapedial rebridging. Thirty-eight adult patients were included and randomized (18 patients in both study and control groups). Preoperative and postoperative pure-tone audiometry were performed. Air-bone gap (ABG) and ABG gain were measured at least 12 months postoperatively. Postoperative complications were assessed.

Results: Both groups achieved significant postoperative ABG closure (mean gain: 22.8 dB in "Hot Dog" vs 19 dB in GIC), with no statistically significant difference. A success rate of 100% (postoperative ABG ≤ 20 dB) was observed in both groups at a minimum 12-month follow-up. No complications were observed in the "Hot Dog" group, while 1 patient in the GIC group developed a postoperative tympanic membrane perforation.

Conclusion: The "Hot Dog" technique demonstrated promise for incudostapedial rebridging, achieving significant hearing improvement and a favorable complication profile compared to GIC alone. While a trend toward better hearing was observed, larger studies with longer follow-up are needed to confirm these findings and definitively compare its efficacy to established techniques.

Level of evidence: Level 1b.

Objectives: Though a common procedure, tonsillectomy is often associated with significant risks such as bleeding, odynophagia, and dehydration. There has been some research investigating racial/ethnic and socioeconomic disparities in other pediatric otolaryngic issues such as otitis media and sleep disordered breathing. However, there is a paucity of research regarding disparities in children undergoing tonsillectomy.

Methods: A retrospective case control study was performed on all pediatric patients who underwent tonsillectomy with or without adenoidectomy from January 1, 2019 to December 31, 2020 at a tertiary care center. Patient records were documented including demographics, race, ethnicity, type of insurance, surgical technique, and post-operative complications. A major post-operative complication was defined as post-surgical hemorrhage, uncontrolled pain, or dehydration requiring medical attention.

Results: There were 1751 patients included in the study with an average age of 6.7 years old with 55.3% patients white, 41.6% black and 3% identified as another race and 8% patients Hispanic or Latino. A complication occurred in 7% of patients including 2.3% who experienced a post-operative hemorrhage and 4.6% with dehydration or poor pain control. Among the entire cohort, 64.2% were publicly insured while 35.8% had private insurance and 1.2% were self-pay.There was no statistically significant difference in terms of probability of complication among patients with different races (P = .85), ethnicities (P = .18) or insurance type (P = .48). Those with bleeding complications were found to be significantly older (P = .011). There was a statistically significant lower likelihood of complication in patients who underwent intracapsular tonsillectomy compared to total electrocautery tonsillectomy (P < .001).

Discussion: We found no racial/ethnic or socioeconomic disparities in the risk of post-operative complications in children who underwent tonsillectomy. Despite the frequency of tonsillectomy in children, there are few studies addressing inequalities. Further investigation of disparities in other regions of the United States should be performed.

Background: Surgical registries have been widely adopted in high-income countries to improve patient outcomes. However, similar data-driven initiatives are still scarce in low- and middle-income countries (LMICs).

Aims: This study aimed to address the challenges of implementing a perioperative registry for otolaryngology-head and neck surgery (OHNS) in Mekelle, Ethiopia, and to assess strategies for ensuring its long-term sustainability.

Methods: The registry was developed using REDCap, through a collaborative effort between otolaryngologists in the United States and Ethiopia, ensuring its relevance to the local context. On-site training sessions were conducted for 13 OHNS residents and four senior surgeons to facilitate their use of the registry. A Wi-Fi router was installed in the operating room to enable real-time data entry. Continuous support was provided through remote communication between the local team and the U.S. research team. Sustainability strategies focused on fostering local ownership, integrating the registry into existing workflows, and maintaining continuous data monitoring.

Results: Despite facing challenges like intermittent internet connectivity and issues with workflow integration, the local team successfully integrated the registry into routine clinical and surgical practices. Key strategies included providing dedicated Wi-Fi routers, modifying registry fields for improved efficiency, and emphasizing the registry's value to the institution. Ongoing collaboration between the local team and the U.S. team enabled continuous optimization and data collection.

Conclusion: The successful implementation of this perioperative registry underscores the importance of engaging local stakeholders and integrating sustainable workflows. This initiative serves as a model for other LMICs seeking to establish surgical registries that enhance data-driven decision-making at both the patient and institutional levels.

Objectives: To assess the prevalence and clinical characterization of variants in the TECTA gene among individuals with bilateral sensorineural hearing loss of unknown etiology in northern Spain.

Methods: A 6-year (2018-2024) observational, prospective, and descriptive study was conducted on patients with bilateral sensorineural hearing loss at a tertiary hospital. Next generation sequencing using a gene panel for sensorineural hearing loss was performed to detect pathogenic, likely pathogenic, or variants of unknown significance in the TECTA gene.

Results: Among 326 patients, pathogenic or likely pathogenic TECTA variants were found in 7 patients (2.14%), including c.3107G>A (n = 6) and c.5383+6T>A (n = 1). Variants of unknown significance were found in 8 patients (2.45%). About 14 of 15 probands had a family history of hearing loss with autosomal dominant inheritance. Eight relatives with confirmed pathogenic variants were also included, totalling 23 cases. Six patients with pathogenic variants and 3 with variants of unknown significance had moderate mid-frequency hearing loss, while others had severe high-frequency loss. Hearing loss was typically progressive, ranging from congenital onset to the fifth decade. Most were treated with hearing aids; none required cochlear implants.

Conclusions: TECTA gene variants are relatively common in this population, with c.3107G>A being the most frequent. The typical phenotype is slowly progressive, mid-to-high frequency sensorineural hearing loss, often starting in childhood and usually requiring hearing aids fitting with good results in improving speech intelligibility.

Objectives: Cancers of the maxillary region are often treated surgically with a maxillectomy followed by rehabilitation involving surgical reconstruction or obturator insertion to improve functional outcomes. However, there is a lack of consensus regarding the specific indications for either rehabilitation method. The objective of this study was to identify unique functional domains for maxillectomy patients who underwent surgical reconstruction or obturator insertion post-op to provide standardized data that can inform selection of either method.

Methods: This mixed-methods qualitative research was conducted from January 2020 to June 2022 at London Health Sciences Centre, a tertiary care center in London, Ontario, Canada. Phase I included open-ended patient interviews through grounded theory, while phase II incorporated focus groups through the Delphi technique. Phase I identified functional domains of interest, which were further refined based on importance to patients in phase II. Inclusion criteria consisted of adults, 18 years or older who underwent maxillectomy surgery for head and neck cancer.

Results: A total of 22 patients were included in phase I and 8 patients were included in phase II. The top 4 functional domains that affected patients regardless of rehabilitation method were eating difficulties, speaking difficulties, social discomfort with public eating, and numbness. The top 4 unique functional domains identified for the surgical group were dry mouth, trismus, chewing difficulties, and eye-related symptoms. The top 4 unique functional domains for the obturator group were obturator discomfort, nasal regurgitation, weight loss, and voice changes.

Conclusions: This study identified functional domains affecting maxillectomy patients, which can be used to inform decisions regarding selection of rehabilitation method in clinical practice. This data can also in the future to create the first patient-reported outcomes instrument for this patient population.

Objectives: To test the hypothesis that surgical otologic intervention for any type of adult hearing loss decreases the odds for incident adverse life events (ALEs) and medical comorbidities (MCBs).

Study design: Retrospective cohort database study.

Methods: Electronic medical record data from the TriNetX Research Network were queried for adults (age ≥18 years) with congenital, sensorineural, conductive, and mixed hearing loss (HL). Patients were further stratified into 3 groups by presence or absence (HL-surgery) of surgical intervention at any point following diagnosis, including (1) stapes surgery (HL + stapes); (2) cochlear implantation and bone-anchored hearing aid (HL + CI); and (3) mastoidectomy alone and tympanoplasty with or without mastoidectomy (HL + TM). Primary outcomes were defined as odds for new ALEs or MCBs at any point given HL treatment status [Odds ratio with 95% confidence interval, (OR; 95% CI, P-value)]. Cohorts were balanced using propensity-score matching (PSM) based on US census-defined demographics and congenital comorbidities.

Results: There were 2 577 153 patients included in this study. Matched analysis demonstrated that HL + stapes adults (n = 7985) had 0.37-lower odds (95% CI = 0.30-0.47, P < .0001) of experiencing any incident ALE versus HL-surgery adults (n = 2 518 409). Adults in the HL + CI cohort (n = 17 129) had 0.58-lower odds (0.52-0.66, P < .0001) of experiencing any incident MCB versus HL-surgery adults.

Conclusions: This study highlights the benefit of surgical intervention for adult hearing loss on social and medical phenomes. These findings represent the largest cohort study to date demonstrating this association and further support that hearing restoration improves patient socioeconomic and medical outcomes.

Objective: Assess timing and prevalence of thyroid-stimulating hormone (TSH) testing after total laryngectomy (TL). Identify prevalence of postoperative hypothyroidism and determine associations between thyroidectomy, postoperative hypothyroidism, and wound complications, including pharyngocutaneous fistula (PCF).

Methods: Retrospective chart review performed at 2 tertiary care centers of adult patients undergoing TL between 2013 and 2021. Demographic data, perioperative labs and post-operative outcomes were collected. Analysis was performed.

Results: Of 237 patients identified, thyroid removal was performed in 156 (65.8%), including 23 (9.7%) total thyroidectomies and 133 (56.1%) hemi-thyroidectomies. Of the 191 (80.6%) receiving postoperative TSH testing, 98 (41.4%) had TSH testing within 90 days, and 112 (58.6%) developed hypothyroidism. Mean postoperative TSH testing interval was 222.0 days (SSD 400.2), with variations associated with age (P = .026), gender (P = .009), PCF formation (P < .001), history of radiation therapy (RT, P = .011), and preoperative levothyroxine use (P = .031). Partial or total thyroid removal significantly increased the likelihood of high postoperative TSH (OR = 2.631, P = .002, 95% CI [1.410, 4.911]). PCF occurred in 62 (26.2%) patients, and there were no significant associations between pre/postoperative TSH or thyroid removal and PCF development or wound complications.

Conclusion: Thyroidectomy was associated with elevated postoperative TSH levels, adding support to prior literature for consideration of avoiding thyroid removal during TL when appropriate. The wide range of TSH testing intervals and prevalence of postoperative hypothyroidism in our cohort highlights the importance of monitoring thyroid function in TL patients during the perioperative period.

Objective: To assess outcomes of CI in adolescent patients with ANSD, a population which has not yet been comprehensively reviewed through a scoping review.

Methods: A scoping review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of MEDLINE, EMBASE, Cochrane DSR, Cochrane CENTRAL, CINAHL, and Web of Science was performed. Cohort and case studies evaluating outcomes of CI in adolescents with ANSD were selected. A case report of an adolescent ANSD patient who underwent CI from our tertiary care academic hospital setting is also reported.

Results: Our search identified a total of 17 articles after screening 488 articles. Among the 24 patients isolated from the selected articles, the vast majority showed some level of improvement in their hearing ability (n = 21, 87.5%). Additionally, of the 20 individuals whose hearing outcomes had a comparison cohort of subjects under 10 years old, nearly half showed better or similar levels of hearing improvement (n = 9, 45%).

Conclusions: Adolescents with ANSD receiving CI have notable improvements in hearing outcomes, but to a lesser degree than younger cohorts with ANSD. As such, CI should be considered as a valid treatment option for adolescents with ANSD. However, the benefit of such intervention has a wide variability, presumably based on the different pathologies that can cause their hearing loss and not necessarily the age at implantation.

Objective(s): Coins are the most frequently ingested foreign bodies by children. While rigid esophagoscopy with concomitant intubation is frequently used for removal, it has the potential for serious complications. We aimed to assess and compare the safety, efficacy, and efficiency of two different techniques for pediatric cervical esophageal coin removal.

Methods: Retrospective chart review identified patients who underwent esophageal coin removal from January 2017-August 2023 at one of two tertiary academic centers: Ann & Robert H. Lurie Children's Hospital and Yale-New Haven Hospital. Patients with foreign bodies other than coins were excluded. Patients underwent one of two approaches for cervical esophageal coin removal depending on surgeon preference: (1) induction of general anesthesia, intubation, rigid esophagoscopy, and coin extraction with optical forceps (esophagoscope group) or (2) mask ventilation, insertion of a straight laryngoscope blade into the esophagus orifice, and coin extraction with alligator forceps (straight laryngoscope group). Primary outcomes were successful removal of the esophageal coin, regarded a marker of efficacy, as well as operative and anesthesia times, which were regarded as measures of efficiency. Secondary outcomes were postoperative complications, regarded as markers of safety.

Results: Of the 108 patients meeting inclusion criteria, 23 (21.3%) were in the straight laryngoscope group and 85 (78.7%) in the esophagoscope group. Mean operative time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (2.8 ± 1.5 minutes vs 13.8 ± 17.2 minutes, respectively, p < .0001). Mean anesthesia time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (24.2 ± 6.4 minutes vs 44.7 ±1 6.2 minutes, respectively, p < .0001). There were no intra- or post-operative complications in the straight laryngoscope group and two minor complications in the esophagoscope group.

Conclusions: Esophagoscopy using a straight laryngoscope blade under mask anesthesia can represent a safe and efficient alternative for impacted esophageal coin removal.