Annals of Otology Rhinology and Laryngology最新文献

Objectives: Intraoperative parathyroid hormone (IOPTH) monitoring has become routine in parathyroid surgery to facilitate less invasive techniques to treat hyperparathyroidism. Despite this, little is known about in vivo IOPTH kinetics, which can greatly affect the reliability of its interpretation.

Methods: A prospective cohort of patients undergoing routine parathyroidectomy was studied. During each case, IOPTH was measured frequently, during all key perioperative events. Qualitative, univariate, and multivariate analysis was performed to better understand the patterns of in vivo IOPTH kinetics.

Results: The IOPTH increased from preoperative baseline in every case, but some patients had a rapid spike after gland manipulation while others had a more gradual increase. The IOPTH peak occurred prior to excision in almost every case. The IOPTH began to fall prior to excision, typically returning to preoperative baseline levels just before excision. The average in vivo half-life of parathyroid hormone (PTH) was 5.2 minutes.

Conclusion: There is substantial variation in the in vivo IOPTH kinetics and more research is needed to understand predictors of kinetic patterns and PTH half-life during parathyroidectomy.

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: Otoscopy is a key clinical examination used by multiple healthcare providers but training and testing of otoscopy skills remain largely uninvestigated. Simulator-based assessment of otoscopy skills exists, but evidence on its validity is scarce. In this study, we explored automated assessment and performance metrics of an otoscopy simulator through collection of validity evidence according to Messick's framework.

Methods: Novices and experienced otoscopists completed a test program on the Earsi otoscopy simulator. Automated assessment of diagnostic ability and performance were compared with manual ratings of technical skills. Reliability of assessment was evaluated using Generalizability theory. Linear mixed models and correlation analysis were used to compare automated and manual assessments. Finally, we used the contrasting groups method to define a pass/fail level for the automated score.

Results: A total of 12 novices and 12 experienced otoscopists completed the study. We found an overall G-coefficient of .69 for automated assessment. The experienced otoscopists achieved a significantly higher mean automated score than the novices (59.9% (95% CI [57.3%-62.6%]) vs. 44.6% (95% CI [41.9%-47.2%]), P < .001). For the manual assessment of technical skills, there was no significant difference, nor did the automated score correlate with the manually rated score (Pearson's r = .20, P = .601). We established a pass/fail standard for the simulator's automated score of 49.3%.

Conclusion: We explored validity evidence supporting an otoscopy simulator's automated score, demonstrating that this score mainly reflects cognitive skills. Manual assessment therefore still seems necessary at this point and external video-recording is necessary for valid assessment. To improve the reliability, the test course should include more cases to achieve a higher G-coefficient and a higher pass/fail standard should be used.

Objectives: We aimed to estimate the global prevalence of hearing loss among adults and to explore its associated factors.

Methods: Our systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). We retrieved corresponding documents published up to Sep 24, 2021 in PubMed and Web of Science. Random-effects models were used to calculate the pooled prevalence of hearing loss. Subgroup analyses were conducted to explore potential heterogeneity.

Results: The pooled prevalence of any hearing loss across 100 studies was 31.0% (95% CI: 26.9-35.1, P < .001, I² = 99.9%), and the pooled prevalence of disabling hearing loss across 34 studies was 15.9% (95% CI: 11.1-20.7, P < .001, I² = 99.9%). The prevalence of hearing loss was higher in the year range of 2000 to 2009, among the elder (≥70) or males, in studies using either ear side of hearing loss definition or in the region of the Americas. Ear disease or surgery, job noise exposure, current smoking, off-work noise exposure, males, cardiovascular disease, past drinking, diabetes mellitus, hypertension, older age, and past smoking are risk factors of hearing loss while education level surpasses high school acts as a protect factor for hearing.

Conclusion: Our results demonstrate high prevalence of hearing loss among adults worldwide and verify several related factors of the disease. Prevention and intervention measures should be implemented.

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.

Background: Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients.

Objective: To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS.

Methods: Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m²) and non-obese (18.5 kg/m² ≤ BMI < 30 kg/m²) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI).

Results: A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments.

Conclusion: Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population.

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.

Objectives: To describe patient positioning maneuvers that optimize visualization of the oropharynx during flexible endoscopy.

Methods: An institutional database of videos obtained from 2021 to 2023 during flexible endoscopy of patients with oropharyngeal carcinoma (OPC) was reviewed. Patients seen outside the specialty head and neck clinic, those with tonsillar primary tumors, and those only with videos of fiberoptic swallowing evaluations were excluded. A total of 10 videos were then independently analyzed by 2 reviewers to assess the effects of 4 maneuvers on oropharyngeal tumor visualization: chin elevation, phonation, tongue protrusion, and contralateral head turn. After segmentation analysis in Label Studio, total surface area (SA) of visualized tumor in pixels was calculated in Python and compared against the maximum width of the epiglottis to calculate relative SA.

Results: Four different maneuvers were evaluated in this study: (1) chin elevation [n = 4]; (2) phonation [n = 9]; (3) tongue protrusion [n = 4]; and (4) contralateral head turn [n = 9]. The maneuvers on average increased the visualization of tumor surface area(SA) compared to baseline view: contralateral turn increased SA by 1.7 fold (95% CI = 1.11-2.34), phonation increased SA by 1.7 fold (95% CI = 1.11-2.37), tongue protrusion increased SA by 1.5 fold (95% CI = 1.16-1.80), and chin elevation increased SA by an average of 2.7 fold (95% CI = 0.74-4.72).

Conclusion: Instituting simple additional positioning techniques during flexible endoscopy for patients with oropharyngeal tumors can improve visualization and staging for baseline assessment and staging.

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: The utility of lateral neck X-rays is unclear in pediatric otolaryngology. Past research showed that lateral neck X-ray did not change treatment decisions for children with suspected foreign body aspiration. This study examines the utility of lateral neck X-ray for patients also receiving otolaryngology consults for any indication.

Methods: This is a retrospective chart review of pediatric patients between 2012 and 2022 who received a lateral neck X-ray for any indication and an otolaryngology consultation at a tertiary pediatric hospital. X-ray indication, diagnosis, and influence on interventional decisions were recorded from chart review.

Results: Of patients who received lateral neck X-rays, 494 patients (8.17%) also had an otolaryngology consult. Average patient age was 3.15 years. The most common indications for X-ray were foreign body aspiration (22%), croup (21%), breathing difficulties (20%), abscess or retropharyngeal infection (7%), and upper airway obstruction (5%). Lateral neck X-ray changed the Otolaryngologist's decision in 15% of patients. Intervention occurred in 25% of Otolaryngology consults, and this decision was never based on the X-ray.

Conclusion: Lateral neck X-ray is unlikely to change Otolaryngology management. It is least indicated in patients presenting with concern of abscess and foreign body aspiration. Consultation with Otolaryngology before ordering diagnostic testing for those presenting with breathing difficulties, croup and upper airway obstruction may have cost savings and prevent unnecessary radiation exposure.