Current Opinion in Otolaryngology & Head and Neck Surgery最新文献

Purpose of review: Fibro-osseous lesions (FOL) are benign, slow-growing lesions that are often incidentally discovered in the sinonasal cavity. They may necessitate surgical resection in patients with postobstructive sinusitis, or in cases of cranial nerve and orbital compression. We examine the recent advancements in otolaryngology relating to diagnostic characteristics and treatments for FOL, with emphasis on new technologies to improve outcomes and reduce recurrence.

Recent findings: We discuss distinguishing characteristics across FOL subtypes, including osteomas, fibrous dysplasia, and ossifying fibroma. Recent literature encompasses clinical case series and animal model studies examining mechanistic, diagnostic, and therapeutic findings in FOL. Recent advancements include emerging pharmacological therapies, development of imaging guidance for surgical planning, and focus on the importance of complete surgical resection for improved outcomes.

Summary: Management of most FOL may be approached by endoscopic techniques, harnessing recent improvements in image guidance and surgical innovation. Improved diagnostic imaging, including the use of 3-D surgical planning, has been shown to enhance treatment outcomes. Improved understanding of the genetic and pathophysiological characteristics of FOL could further reveal targeted therapies, reducing recurrence and improving patient quality of life.

Purpose of review: To summarize current understanding of and recent literature on the management of sialorrhea in children.

Recent findings: Sialorrhea is a symptom of oropharyngeal dysphagia and reduced clearance. Sialorrhea can be anterior, with forward overflow of saliva, causing skin rash, social embarrassment and spillage on communication devices; or posterior, where there is pharyngeal pooling of saliva, which may cause aspiration.Assessment of sialorrhea involves a clinical evaluation, focusing on the individual's age, development, underlying medical condition and whether the sialorrhea is anterior, posterior or both. Craniomaxillofacial structure, posture, airway patency, neuromotor control, level of social awareness, motivation and caregiver concerns are assessed. To manage sialorrhea, integration of multiple strategies is usually needed. There is good evidence for behavioral intervention, oral appliances, anticholinergic medications, botulinum toxin injection and surgery. The role of various options of surgery in providing a longer lasting effect is supported. Adjunctive airway and craniomaxillofacial surgery may be indicated.

Summary: Sialorrhea is a modifiable condition with multifactorial causes requiring multimodal therapy by an inter-disciplinary team. There is increasing evidence on the role of saliva surgery in improving the quality of life for the person with sialorrhea and their caregivers.

Purpose of review: Gastroesophageal reflux disease (GERD) is a commonly recognized cause of dysphagia. Conversely, eosinophilic esophagitis (EoE) and celiac disease are rarer and often overlooked as dysphagia culprits. Overlap between these conditions complicates diagnosis and delays appropriate treatment. This review aims to clarify the distinctive dysphagia characteristics in each condition, explore potential overlaps, and offer guidance on differentiation.

Recent findings: Recent studies have advanced our understanding of dysphagia mechanisms in GERD, EoE, and celiac disease, particularly in characterizing disordered motility and dysphagia's natural history. While upper endoscopy, biopsies, and manometry remain crucial in dysphagia assessment, novel diagnostic tools are emerging. New insights highlight the significance of cytokine-induced mucosal injury in all three conditions, revealing potential connections where mucosal damage in one disorder may contribute to the development of others.

Summary: GERD, EoE, and celiac disease can coexist and present with similar symptoms. Distinguishing between them often entails upper endoscopy, esophageal biopsies, pH testing, and celiac serologies. EoE should be considered when GERD patients fail proton pump inhibitor therapy or when celiac patients have persistent esophageal symptoms despite a gluten-free diet. Consider celiac disease if dysphagia accompanies iron deficiency anemia, malabsorptive diarrhea, or osteoporosis. Recognizing the potential overlap between these conditions is crucial for guiding clinical evaluation and therapy.

Purpose of review: Otolaryngologists are vital to successfully managing chronic cough in adults. This review presents updates regarding rapidly evolving concepts in chronic cough.

Recent findings: Significant growth is occurring in chronic cough research, strengthening the evidence of its major psychosocial impacts. Elucidation of the neural underpinnings of normal and abnormal cough within both the peripheral and central nervous systems highlight the previously underappreciated complexity of cough. Recent clinical practice recommendations emphasize personalized treatment approaches through addressing treatable traits of chronic cough. Investigations are ongoing to better distinguish chronic cough subgroups, and multiple types of important clinical outcome measures are being characterized. Newer research about chronic cough treatment encompasses pharmacologic and nonpharmacologic interventions, including oral and inhaled medications, superior laryngeal nerve blocks, and behavioral therapy.

Summary: As knowledge about chronic cough in adults continues to expand in both research and clinical practice, otolaryngologists can continue to raise awareness of the role of the larynx in cough and promote ongoing multidisciplinary collaborations. In the coming years, more pharmacologic options and personalized treatment approaches will likely emerge for chronic cough.

Purpose of review: Choanal atresia (CA) is a congenital nasal airway anomaly that, when present bilaterally, requires urgent surgical intervention. Surgical technique has evolved since its inception with most practices now favoring an endoscopic repair. Restenosis requiring revision surgery is a frequent complication, occurring in as many as 50% of cases. This review aims to highlight the most common surgical approaches, techniques used to prevent restenosis, and newer adjuncts to surgery that may improve outcomes.

Recent findings: Bioabsorbable, steroid-eluting stents were first developed for the adult chronic rhinosinusitis population but have been adapted for use in choanal atresia since 2017. The existing literature consists of multiple case series and one case-control study comparing these stents to traditional stents. To date, there have been no reports of restenosis or stent-related complications with these newer products.

Summary: Choanal atresia remains a difficult surgical pathology for which sustainable surgical results can be challenging. There is reason for optimism in bioabsorbable, steroid-eluting stents as an adjunct to CA repair if future studies expound upon their safety and efficacy.

Purpose of review: This year marks 10 years from the publication of the clinical consensus statement on pediatric chronic rhinosinusitis (CRS). Balloon sinuplasty did not meet criteria for consensus at that time because there was insufficient evidence on its efficacy and safety. The purpose of this review is to summarize the current evidence on balloon sinuplasty treatment for pediatric CRS.

Recent findings: Balloon sinuplasty is not a cost-effective measure compared to adenoidectomy and endoscopic sinus surgery (ESS). In the pediatric population, benefits include short operative time, reduced tissue manipulation, and potential for decreased antibiotic courses. Alternatively, balloon dilation has increased equipment costs and there is a lack of robust prospective data that fully elucidates balloon sinuplasty's role in the management of pediatric CRS.

Summary: Pediatric otolaryngologists should continue to perform first-line adenoidectomy and consider ESS based on imaging and other validated clinical scoring systems. Balloon sinuplasty has not yet been proven as an effective treatment for pediatric CRS and further large-scale investigations are required to overcome its lack of cost-effectiveness.

Purpose of review: The incidence of thyroid carcinoma is increasing among children and adolescents, particularly in female individuals. Children and adolescents require special considerations in management as the molecular genetics of pediatric thyroid tumors are inherently different from their adult counterparts. The increased risk of malignancy, nodal metastases, and pulmonary metastases in pediatric patients warrants pediatric-specific management recommendations and pediatric-specific multidisciplinary teams.

Recent findings: This article highlights the molecular origins of pediatric thyroid carcinoma and the implications of tumor genetics for the course of disease and treatment considerations. We highlight specific surgical considerations to optimize outcomes while minimizing lifelong risks of vocal paralysis and hypoparathyroidism. The landscape of treatment options is rapidly evolving with development of sophisticated molecular approaches to understand the genetic landscape, and this review features updated recommendations and systemic treatment options for the management of pediatric thyroid malignancy.

Summary: Pediatric thyroid carcinoma is a lifelong burden and the treatment tailored to optimize outcomes minimizes long-term risks of treatments, surgery, radiation and targeted systemic therapies. Multidisciplinary teams that treat pediatric thyroid carcinoma should focus surgical experience and use the most updated guidelines and treatments available, particularly considering the landscape of molecular genetics in pediatric thyroid carcinoma.

Purpose of review: Pediatric cochlear implantation has evolved considerably over the past three decades to include more patients at earlier ages with greater degrees of residual hearing. As an extension, a significant focus of research over the past decade has surrounded preservation of existing acoustic hearing.

Recent findings: Multiple studies published within the last 5 years demonstrate aidable acoustic hearing preservation in 60-90% of pediatric patients, with 40-60% experiencing complete hearing preservation following cochlear implantation. Durability of preserved hearing varies among patients, with some patients losing residual hearing within 1 year of surgery whereas others maintain acoustic hearing through at least 5 years of follow-up. Speech outcomes appear superior among patients with preserved acoustic hearing, particularly in the presence of background noise. Several recent studies suggest a music appreciation advantage in children with preserved acoustic hearing following cochlear implantation.

Summary: Hearing preservation rates during cochlear implantation in children matches, if not often exceeds, hearing preservation rates observed among adults. Preservation of acoustic hearing during cochlear implantation confers multiple advantages for the pediatric population. Beyond improved speech understanding and music appreciation, minimizing intracochlear trauma and resultant scarring facilitates potential future regenerative treatments or revision surgery.

Purpose of review: The purpose of this review is to summarize the existing literature on artificial intelligence technology utilization in laryngology, highlighting recent advances and current barriers to implementation.

Recent findings: The volume of publications studying applications of artificial intelligence in laryngology has rapidly increased, demonstrating a strong interest in utilizing this technology. Vocal biomarkers for disease screening, deep learning analysis of videolaryngoscopy for lesion identification, and auto-segmentation of videofluoroscopy for detection of aspiration are a few of the new ways in which artificial intelligence is poised to transform clinical care in laryngology. Increasing collaboration is ongoing to establish guidelines and standards for the field to ensure generalizability.

Summary: Artificial intelligence tools have the potential to greatly advance laryngology care by creating novel screening methods, improving how data-heavy diagnostics of laryngology are analyzed, and standardizing outcome measures. However, physician and patient trust in artificial intelligence must improve for the technology to be successfully implemented. Additionally, most existing studies lack large and diverse datasets, external validation, and consistent ground-truth references necessary to produce generalizable results. Collaborative, large-scale studies will fuel technological innovation and bring artificial intelligence to the forefront of patient care in laryngology.