Annals of Otology Rhinology and Laryngology最新文献

Objectives: Drug-induced sleep endoscopy (DISE) is increasingly being used in children with obstructive sleep apnea (OSA) to identify specific sites of upper airway obstruction and plan surgical interventions. This study aims to test the reliability and validity of a new grading system for pediatric DISE procedures (PedDISE-8).

Methods: We conducted a retrospective chart review of children 0 to 18 years old with OSA who underwent DISE. Four independent raters reviewed and graded each video recording twice using the PedDISE-8. Eight upper airway sites were evaluated: inferior turbinates, adenoid, velum, tonsils/lateral pharyngeal walls, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. Intraclass correlation coefficients were calculated to determine inter-rater and intra-rater rating reliability for each site. External validity was assessed by analyzing the correlation between the number of sites with severe obstruction and polysomnographic data.

Results: DISE recordings were reviewed for 86 pediatric patients, 59.5% of whom were male and 26.7% were obese. The median age was 3.5 (IQR 2.4-5.3) years, and the median obstructive apnea-hypopnea index (oAHI) was 5.5 (IQR 3.1-10.4). Moderate to good inter-rater and intra-rater reliability were found for all eight sites (intraclass correlation coefficient 0.67 to 0.88 and 0.71 to 0.87, respectively). The number of sites with severe obstruction correlated positively with the oAHI (τ = 0.119, P = .004).

Conclusions: The PedDISE-8 grading system demonstrated good inter-rater and intra-rater reliability and external validity. It can be used in children undergoing DISE for OSA.

Objective: To determine if a short 10-minute video of either CT images (Video1: V1) or CT and endoscopic surgical videos (Video 2: V2) could be used to improve sinonasal anatomy knowledge in medical students (Med) and otolaryngology residents (OtoR).

Background: YouTube is a widely used platform for surgical training, yet many educational videos are of poor quality. We developed and validated two 10-minute narrated videos of sinus anatomy, the first (V1) incorporated CT images of critical structures while the second (V2) combined CT images and surgical endoscopic video. In tandem, we developed a sinonasal assessment used to test sinonasal anatomy, surgical landmarks, and situational awareness.

Methods: We performed a multicenter, randomized IRB-approved educational study evaluating the efficacy of the V1 and V2 videos by comparing pre-test (PrT) and post-test (PoT) scores in Med and OtoR subject groups. Subjects then watched the alternate video and preferences were assessed.

Results: A total of 30 Med and 37 OtoR successfully completed the study at 6 different institutions. There were significant differences in pre-test knowledge with OtoR scoring higher than Med in all 3 pre-test subdomains [(S1: 4.3 v s2.9, P < .0001, S2: 4.4 vs 3.1, P < .0001, and S3: 4.6 vs 3.2, P < .0001)]. In the Med group, both V1 and V2 educational videos significantly improved post-test scores compared to pre-test scores (V1: 10.06 vs 12.59, P = .0005; V2: 8.23 vs 11.08, P = .0008). In the OtoR group, only the V2 educational video showed significant improvement (13.24 vs 14.76, P < .0001). Both groups thought the videos were helpful and improved their spatial awareness of sinus anatomy.

Conclusions: Short, validated videos significantly improve sinonasal education and should be incorporated in modern training programs.

Background: The 22-item Sinonasal Outcome Test (SNOT-22) is a widely used patient-reported outcome measure (PROM) for assessing chronic rhinosinusitis (CRS). However, incomplete surveys may impact its predictive utility.

Aims: This study explores SNOT-22 completion rates, response trends, and potential factors influencing survey omissions aiming to optimize its predictive utility and practical application.

Methods: SNOT-22 surveys were retrospectively collected from patients at various time points throughout their CRS treatment. Surveys with at least one question unanswered were included in the study. Completely unanswered surveys were excluded. Survey response dynamics and trends were analyzed and reported.

Results: 1,034 SNOT-22 surveys were collected, 18% of the surveys were incomplete. Questions on "Ear fullness" and "Embarrassed" were most unanswered, while "Need to blow nose" and "Nasal blockage" were least unanswered. Questions later in the survey showed a moderate positive correlation with missing responses. Mean scores per question were higher in incomplete than in complete surveys, though differences in SNOT-22 scores between partially and fully completed surveys weren't significant.

Conclusion: Our study found that a large number of SNOT-22 surveys were incomplete, higher than rates reported in similar PROMs. Mean scores did not differ significantly between partial and complete surveys, suggesting interpretation should prioritize individual responses over total scores. Potential barriers to survey completion include question wording, symptom relevance, and survey length. Future research should further investigate survey completion through qualitative methods and randomized question ordering to refine survey design.

Objective(s): To quantify and compare pre-procedure worry versus the experience of pain, gagging, and dyspnea during in-office laryngoscopy procedures in patients who did or did not receive pre-procedure anxiolytics, and to explore patient perception of intra-procedure interventions.

Methods: Patients undergoing awake laryngology procedures at a quaternary care center were enrolled. The State-Trait Anxiety Inventory (STAI) Y1 and Y2 questionnaires were administered to establish baseline levels of state anxiety and trait anxiety, respectively. Pre-procedure and post-procedure surveys assessed patient perception of select interventions.

Results: 34 patients were enrolled (35.3% female, 91.2% white, mean age 60 years). Pre-procedure, 51.5% of patients reported some degree of worry about pain, 61.8% about gagging, 52.9% about dyspnea, and 55.9% about having something in their nose/throat. Post-procedure, 54.5% reported experiencing pain to some degree, 63.6% had gagging, 39.4% had dyspnea, and 78.7% were bothered by having something in their nose/throat. Patients who received a pre-procedure anxiolytic were significantly more likely to report more pain compared to those who did not. The highest rated interventions were pre-procedural education (97.0% "Very helpful"), verbal reassurance (96.9%), provider communicating steps of the procedure (96.9%), and reminders to breathe (87.5%).

Conclusion: For patients undergoing awake laryngology procedures, the anticipation of gagging, pain, trouble breathing, and scope-related discomfort are worrisome factors. Of these, scope-related discomfort and gagging are the most often-reported sources of intraprocedural discomfort. The interventions patients found most helpful were based on preprocedural education and clear intraprocedural communication, which suggests that purposeful communication has a role in relieving anxiety.

Level of evidence: Level 4.

Purpose: The ability to hear is germane in fostering communiation skills in children and plays a crucial role in their overall wellbeing. Unfortunately, hearing impairment is one of the most common developmental discrepancies in children.

Objective: To describe and evaluate the current legislation surrounding pediatric hearing aid reimbursement and the implications of these policies.

Evidence review: A review of the scientific literature in addition to several state legislature sites was used to write this article.

Major findings: Private insurance reimbursement for pediatric hearing aids is variable between vendors and states. Only half of United States have passed legislation requiring insurers to cover hearing aids for their subscribers. Due to the lack of reimbursement for these expensive yet medically necessary devices, families across the country experience financial distress associated with the lack of coverage for hearing aids. In many cases, this leaves children without the ability to hear to their fullest potential.

Conclusion: It is time we as otolaryngologists advocate for a national solution to this issue and promote a national policy to require private insurers to cover the costs of hearing aids for their subscribers.

Introduction: External ear malformations represent a spectrum of congenital anomalies that may involve the external auditory canal (EAC), tympanic membrane (TM), or associated structures. A rare anomaly, the EAC skin wedge, results from incomplete canalization during embryologic development. This report presents the clinical presentation, diagnostic evaluation, and surgical management of this condition.

Objective: To detail the successful surgical management of an isolated EAC skin wedge and demonstrate the applicability of argon laser in treating these congenital anomalies.

Methods: A 13-month-old female presented with recurrent otitis media and mild bilateral conductive hearing loss. Physical examination revealed a fan-like skin wedge spanning the EAC to the TM. Imaging with temporal bone computed tomography confirmed the extent of the anomaly. Under general anesthesia, the skin wedge was ablated using an argon laser, followed by antibiotic-soaked packing to prevent scarring and recurrence. Follow-up audiometry and endoscopic evaluations assessed outcomes.

Results: The procedure was well-tolerated, with no intraoperative complications. At 3 weeks and 3 months postoperatively, no recurrence of the skin wedge was observed, and audiometry normalized. The patient demonstrated improved middle ear ventilation and resolution of conductive hearing loss.

Conclusions: This case demonstrates the successful use of argon laser in the management of a rare congenital EAC anomaly. Argon lasers offer precise ablation and excellent hemostasis, making them a valuable option for similar cases. This report emphasizes the importance of tailored surgical approaches for rare pediatric ear malformations.

Objectives: The primary objective of this case series is to assess the effectiveness of the off-label use of the PROPEL drug-eluting stent, traditionally FDA-approved for sinus surgery, in preventing restenosis following canalplasty in patients with chronic otologic conditions or congenital anomalies. The stent provides both mechanical support to maintain canal patency and localized steroid delivery to reduce inflammation and scarring.

Methods: Four patients with various otologic conditions underwent canalplasty, followed by the placement of drug-eluting stents into the external auditory canal. The stents were inserted to address postoperative stenosis. Clinical outcomes, including ear canal patency, hearing improvement, and the rate of restenosis, were evaluated through regular follow-ups.

Results: All patients showed improved ear canal patency, with minimal restenosis observed during follow-up. Hearing improvement was reported in 3 out of 4 patients. The pediatric case exhibited mild medial canal stenosis despite stent placement, but overall improvement was noted. No adverse effects were associated with the stent usage.

Conclusions: The off-label use of a drug-eluting stent in canalplasty appears to reduce restenosis rates and maintain canal patency in adults effectively. Further research is warranted to standardize protocols and expand its indications for otologic surgery, particularly in pediatric cases where outcomes may vary.

Background: Laryngeal carcinoma is not uncommon worldwide. We conducted this study to comprehensively compare the outcome of stapler versus conventional suturing in total laryngectomy primary or salvage.

Patients and methods: This is a retrospective study conducted in our tertiary institute from 2015 to 2022 involving patients diagnosed with laryngeal carcinoma who underwent total laryngectomy either primary or salvage. We divided patients into 4 groups: primary or salvage laryngectomy, closed with stapler or manual suturing. The reported outcomes included : operative time, length of hospital stay, start of oral feeding, incidence of pharyngocutaneous fistula, positivity of surgical margins, and surgical site infection. Patients with multiple comorbidities and those requiring a flap for pharyngeal closure were excluded .

Results: A total of 91 patients were included in our study. Pharyngocutaneous fistula rate was 19% in conventional patient group in comparison to 6.7% in stapler group for primary total laryngectomy while it was 12.5% for salvage with stapler and 25% for salvage with conventional. Hospital stay was 6 ± 1.5 days for stapler and 11.4 ± 2.9 days for conventional suturing in primary laryngectomy. It was 8.8 ± 1.3 days for stapler and 13.1 ± 1.8 for conventional suturing in salvage laryngectomy. There was highly significant difference found as regard mean operative time, start of oral feeding and hospital stay in favor of stapler use.

Conclusion: Stapler use in total laryngectomy is is a simple, fast, and effective technique with tension free watertight closure, better hemostasis, less contamination of surgical field than manual suturing.

Purpose: Functional septorhinoplasty is an effective treatment for nasal airway obstruction. Little distinction exists between bilaterally and unilaterally obstructed patients in literature. Our study evaluates outcomes in patients with unilateral nasal airway obstruction compared to those with bilateral nasal airway obstruction as measured by nasal obstruction symptom evaluation scores following functional septorhinoplasty.

Materials and methods: A total of 227 patients underwent functional septorhinoplasty for nasal airway obstruction. Patients were grouped into unilateral (n = 64) and bilateral (n = 163) nasal obstruction cohorts based on patient report and physician assessment. Nasal obstruction symptom evaluation (NOSE) scores were obtained pre-operatively and post-operatively at least 3 months following surgery.

Results: Patients with unilateral nasal obstruction had slightly less severe symptoms preoperatively than patients with bilateral obstruction. Average preoperative NOSE scores for patients with unilateral obstruction was 64 (SD = 19) and 72 (SD = 18) for patients with bilateral obstruction (P = .004). Postoperative NOSE scores following septorhinoplasty were significantly reduced for patients with both unilateral and bilateral nasal obstruction (postoperative NOSE scores unilateral: 17, SD = 16 ; bilateral: 23, SD = 21). There was no statistical significance in outcomes between patients with unilateral or bilateral nasal obstruction groups.

Conclusions: Symptoms in patients with unilateral obstruction are similar but slightly less severe than patients with bilateral obstruction. Patients with unilateral and bilateral nasal obstruction experienced a similar degree of improvement in symptom following functional septorhinoplasty.

Objectives: Characterize the presentation of chronic airway obstruction for patients presenting with massive thyroid goiters.

Methods: Demographic data acquisition was undertaken on 5 patients who presented with a compressive goiter and had pre-operative severe airway obstruction secondary to supraglottic and laryngeal edema. Each patient had a resolution of severe airway obstruction post-thyroidectomy.

Results: In all, 5 patients were diagnosed with severe airway obstruction due to chronic obstruction by a thyroid goiter. Several airway management interventions were pursued during definitive surgery (conventional or videolaryngoscopic intubation and a hybrid endoscopic approach incorporating the Seldinger technique). Successful thyroidectomy led to rapid resolution of laryngeal edema.

Conclusion: Venolaryngeal obstruction syndrome is proposed as a term to describe the laryngeal findings in compressive goiters. The pathophysiological sequence resulting in chronic airway obstruction may have similar mechanisms to expanding neck hematomas after thyroid surgery.