Annals of Otology Rhinology and Laryngology最新文献

Objectives: Rosuvastatin is an antihyperlipidemic statin group pharmacological agent with antioxidant, neuroprotective, and anti-inflammatory effects. In this study, we aimed to examine the functional, electrophysiological, and histopathological effects of rosuvastatin or in combination with corticosteroids on facial nerve regeneration in rats with traumatic peripheral facial paralysis (PFP).

Methods: PFP was induced in 28 female Sprague Dawley rats that we divided into 4 groups: group 1, control group; group 2, methylprednisolone group; group 3, rosuvastatin group; group 4, rosuvastatin and methylprednisolone group. Electrophysiological, functional, and histopathological examinations were performed before and after the medications.

Results: Electrophysiological threshold values of group 3 and group 4 were found to be significantly lower than the control group on day 21 after treatment (P = .002, P = .001; P < .01).In the histopathological evaluation, axonal degeneration, macrovacuolization, and vascular congestion levels were compared between the groups, and a statistically significant difference was observed in group 4 compared to the control group. The recovery time of the eye corneal reflex was found to be significantly higher in the control group than in groups 3 and 4 when comparing postoperative day 1 to day 7 and postoperative day 1 to day 14.

Conclusion: Rosuvastatin, especially when combined with methylprednisolone was found to significantly increase the facial nerve electrophysiological, functional, and histopathological recovery in injury-induced traumatic PFP.

Objectives: Hypoglossal nerve stimulation (HNS) is a treatment option for patients with moderate-to-severe obstructive sleep apnea. In the post-implant period, awake endoscopy with advanced programming (AEAP) can be employed to improve apnea hypopnea index (AHI) reduction and/or patient comfort. This study describes response patterns to HNS after AEAP as well as patient-specific patterns in our patient population.

Methods: Retrospective evaluation of 17 consecutive patients who underwent AEAP between June 2019 and December 2022. Post-AEAP AHIs were used to create 2 response groups, which facilitated analysis of patient-based characteristics. AHI reporting, deemed non-titration AHI (NT-AHI), is the whole-night AHI resulting from non-titration studies. Chi-squared, Pearson correlation coefficient, and independent samples t-test were used to determine significance deemed as P < .05.

Results: Fifteen of 17 patients (88.2%) presented for failed NT-AHI reduction, and 2/17 (11.8%) presented for comfort measures. Eleven patients (65%) showed an improvement in post-AEAP NT-AHI; 6 (35%) patients failed to improve. Four patients with either lateral wall collapse or concentric wall collapse at the tongue base failed to improve NT-AHI compared to a single patient who showed an improved NT-AHI (P = .017). Of the 2 patients who presented with discomfort, patient 1/2 demonstrated improvement in device usage, and patient 2/2 reported improved comfort while maintaining average device usage.

Conclusion: AEAP is a powerful tool that offers the ability to identify settings conducive to increased therapy efficacy and improved treatment tolerability. Airway phenotypes are closely correlated with treatment efficacy, and as such, careful anatomical consideration of the upper airway must be performed when titrating therapy.

Lay summary: Amongst the different treatment options for obstructive sleep apnea, hypoglossal nerve stimulation has been shown to be effective in positive-airway-pressure intolerant patients. This article explores response patterns to AEAP and highlights the importance of careful anatomical considerations of the upper airway.

Level of evidence: Level 3.

Objective: This article seeks to systematically review existing literature on the use of acupuncture in treating olfactory dysfunction in order to better understand the methodology and efficacy of this alternative treatment modality.

Methods: A comprehensive search of PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar was conducted. The review was conducted by 2 independent reviewers that authored this article. Inclusion criteria included all studies analyzing the efficacy of acupuncture for treatment of olfactory dysfunction. Articles were excluded if they were duplicates, opinion or review papers, incomplete or unavailable papers, or if they were in a language other than English.

Results: The review found 10 articles matching the inclusion criteria that overall showed a positive improvement in olfactory dysfunction after acupuncture intervention in multiple settings. Challenges highlighted in this review include variability in acupuncture protocols, such as differences in point selection, session frequency, and overall treatment duration, as well as the lack of standardized outcome measures for assessing olfactory function.

Conclusion: This systematic review suggests acupuncture may have therapeutic effect on improvement of olfactory function across various types of olfactory disorders, most notably seen in post-viral anosmia. Given the variability in acupuncture protocols and lack of standardized outcome measures, there is a need for further research with standardized methods and larger sample sizes. Olfactory dysfunction is fundamentally a quality-of-life issue; advancing research could solidify acupuncture as a valuable and cost-effective addition to treatment plans, optimizing patient well-being.

Objective: The objective of this study is to investigate various demographic, socioeconomic, COVID-related, and clinical factors associated with missed otolaryngology appointments in the outpatient setting at Boston Medical Center (BMC), an urban safety net hospital.

Methods: A retrospective chart review was conducted on adults (≥18 years old) with scheduled appointments in the otolaryngology department at BMC from May 1, 2015, to May 1, 2022. Data were extracted from the electronic medical record and included appointment-related factors (eg, status and type), demographic variables (eg, age, sex, race, and ethnicity), and socioeconomic factors (eg, employment and insurance). Statistical analyses utilized a binary mixed-effects model to identify predictors of appointment non-attendance, with pre-COVID, during COVID, and post-COVID periods defined for comparative analysis.

Results: Out of 14 050 patients, 5725 (40.8%) were classified as no-show. Older age decreased the likelihood of missing appointments (OR = 0.989, 95% CI = [0.986, 0.992]). Males (OR = 1.090, 95% CI = [1.022, 1.161]), Black/African American (OR = 2.047, 95% CI = [1.878, 2.231]), and Hispanic or Latino individuals (OR = 1.369, 95% CI = [1.232, 1.521]) were more likely to not show up. Retired participants (OR = 0.859, 95% CI = [0.753, 0.981]) and those with private insurance (OR = 0.698, 95% CI = [0.643, 0.758]) were less likely to miss appointments. During the COVID-19 pandemic, appointment attendance improved (OR = 0.865, 95% CI = [0.767, 0.976]). In-person appointments had a significantly higher non-attendance rate compared to telemedicine appointments (OR = 6.133, 95% CI = [5.248, 7.167]).

Conclusions: Appointment non-attendance in otolaryngology is influenced by various demographic and socioeconomic factors, with significant disparities observed among racial and ethnic groups. The COVID-19 pandemic altered attendance patterns, highlighting the potential benefits of telemedicine. These findings underscore the need for targeted interventions to address healthcare disparities and improve appointment adherence, particularly among minority and socioeconomically disadvantaged populations. Future research should incorporate patient perspectives to better understand barriers to appointment attendance.

Objective: Airway replacement is a challenging surgical intervention and remains an unmet clinical need. Due to the risk of airway stenosis, anastomotic separation, poor vascularization, and necrosis, it is necessary to establish the gold-standard outcomes of tracheal replacement. In this study, we use a large animal autograft model to assess long-term outcomes following tracheal replacement.

Methods: Four New Zealand White rabbits underwent tracheal autograft surgery and were observed for 6 months. Clinical and radiographic surveillance were recorded, and grafts were analyzed histologically and radiographically at endpoint.

Results: All animals survived to the endpoint with minimal respiratory symptoms and normal growth rates. No complications were observed. Computed tomography scans of the post-surgical airway demonstrated graft patency at all time points. Histological sections showed no sign of stenosis or necrosis with preservation of the native structure of the trachea.

Conclusion: We established benchmarks for airway replacement. Our findings suggest that a rabbit model of tracheal autograft with direct reimplantation is feasible and does not result in graft stenosis or airway collapse.

Objectives: Photoangiolytic lasers have yielded significant innovation in laryngeal surgery in the last 25 years. After the discontinuation of the potassium titanyl phosphate (KTP) laser, a novel 445-nm blue laser was developed. The optimal balance between a laser's desired tissue effects and collateral tissue damage is a major determinant of laser selection in microlaryngeal surgery. The shell-less incubation system for the chick chorioallantoic membrane (CAM) simulates the microvasculature of the human vocal fold and is useful for testing effects of laser settings and in simulated surgery. The aim of this study is to compare the tissue effects of the KTP and blue lasers using the shell-less CAM model.

Methods: The shell-less incubation system contains: polymethylpentene film (used as a culture vessel), calcium lactate and distilled water supplementations. By using this system, the chick chorioallantoic membrane (CAM) can be fully exposed with a good field for surgery simulation. The effects of the 2 lasers (532 nm KTP and 445 nm blue) were quantified at clinically relevant energy settings and laser distances from target. Measures included imaging real-time vascular reactions in the CAM model, post-procedure histologic analysis of CAM tissue and temperature changes.

Results: Vessel coagulation and rupture rates were less common with the blue laser compared with the KTP laser. Histologic analysis demonstrated less tissue disruption with the blue laser. Temperature changes were less with the blue laser.

Conclusion: In this CAM model with specific conditions, the blue laser reveals less tissue damage than the KTP laser. Suitable working distance and power setting of the laser are necessary for desired tissue effects.Level of Evidence: Level 3.

Introduction: Pediatric Relapsing Polychondritis (RP) is a rare autoimmune disorder that causes inflammation and damage to cartilage in children. Common symptoms include pain, swelling and deformities in the ears, nose, trachea, joints, and eyes. The lack of research on the pediatric population necessitates further evaluation of the literature on pediatric RP to summarize existing patterns in presentation, management, and treatment.

Methods: A systematic review was conducted on PubMed and Embase from 1947 to April 2023 on RP in patients under 21 years old abiding by the 2020 PRISMA checklist. Only patient presentations meeting McAdam criteria for RP and including information on management were included.

Results: From the 304 initial studies, 54 studies were included for final analysis with a total of 68 patients, who were predominantly female (65%). With a median diagnostic delay of 1 year, the mean age of onset was 12 years old. The most common symptoms on presentation included bilateral auricular chondritis (69%), nasal cartilage inflammation (62%), and respiratory tract chondritis (63%). The most commonly reported information in the literature for the initial workup usually included CT/MRI (72%), bronchoscopy (57%), biopsy (51%), and labs (88%), which most commonly displayed elevated ESR (59%). The most common medications were corticosteroids (91%) and methotrexate (35%) and the most common procedural treatment was tracheostomy (38%). The most efficacious treatment options were monoclonal antibodies (87%, n = 15) and corticosteroids (66%, n = 62) used in 22% and 91% of patients, respectively. The most commonly used monoclonal antibody therapy was infliximab (13%, n = 9).

Conclusion: The most common presentation for pediatric RP includes chondritis of the ear, nose, and respiratory tract. The most effective treatment options include corticosteroids and monoclonal antibody therapy, such as infliximab. Our findings highlight increasing remission achieved with anti-rheumatic drugs and monoclonal antibody treatment, especially alongside corticosteroids.

Objective: To characterize the institutional utilization of pneumococcal vaccination during an index hospital admission for acute cerebrospinal fluid (CSF) leakage and associated infectious and clinical outcomes.

Methods: This retrospective cohort study included patients hospitalized and treated for an acute CSF leak from January 2017 to June 2022. The primary outcome evaluated the incidence of pneumococcal vaccination during the index admission in patients without prior vaccination. Secondary outcomes evaluated the incidence of meningitis, time from CSF leak identification to meningitis, and mortality within 1 year of the index admission.

Results: A total of 94 patients were included. Nineteen (20.2%) patients received pneumococcal vaccination prior to admission. Of the 75 patients without prior vaccination, 4 (5.3%) patients received vaccination during the admission. Meningitis occurred in 5/94 (5.3%) patients and occurred 4-24 days from CSF leak identification. Mortality was observed in 9/94 (9.6%) patients. None of the meningitis cases were attributed to culture-positive findings of pneumococcal disease.

Conclusions: The results of this study demonstrate an overall low institutional utilization of pneumococcal vaccination in patients with an acute CSF leak. Infectious and clinical outcomes reflected comparable to previous reported literature. Further evaluation into the risk-benefit relationship of vaccination omission is warranted in this patient population.

Objectives: Acute post-thyroidectomy bilateral vocal cord paresis or paralysis (BVCP) is often managed with observation, botulinum toxin injection or tracheostomy. However, only a few cases discuss obstructive sleep apnea (OSA) in the context of BVCP with limited exploration of home sleep test (HST) and continuous positive airway pressure (CPAP) as post-operative assessment and management tools. This study suggests CPAP as a less invasive approach while awaiting vocal cord recovery.

Methods: A retrospective chart review was conducted on 2 female patients who presented with dyspnea and sleep-disordered breathing (SDB) symptoms post-thyroidectomy. Both patients underwent laryngoscopy and HSTs, followed by CPAP prescription.

Results: Case 1 (body mass index [BMI]: 32.6 kg/m²) and Case 2 (BMI: 20.1 kg/m²), aged 66 and 77 respectively, presented with post-surgery dyspnea and SDB symptoms. Laryngoscopy revealed left vocal cord paresis and right vocal cord paralysis in both cases. Although tracheostomy could provide definitive treatment, both cases were deferred for non-invasive options, which led to HST, confirming moderate OSA (PAT-derived apnea-hypopnea index (pAHI): 18/hour and 27.1/hour) leading to CPAP recommendation. In Case 2, 5 weeks of CPAP use resulted in dramatic improvements in her sleep quality, with continued benefits at 3-month follow-up.

Conclusion: These cases underscore the value of considering sleep studies and CPAP as adjunctive tools in acute post-thyroidectomy BVCP management while awaiting vocal motion recovery. This report also further supports that BVCP sufficiently narrows the glottic airway, predisposing patients to OSA.