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

Purpose of review: This contemporary review aims to outline the key components and protocols for assessing emergency readiness in institutional pediatric airway management. Emphasis is placed on identifying essential elements that ensure preparedness and effective response in pediatric airway emergencies within healthcare institutions.

Recent findings: Recent studies highlight several critical components of pediatric airway emergency readiness: dedicated pediatric airway teams, availability of specialized pediatric airway equipment, and simulation-based training to enhance the skills of healthcare providers. Additionally, interdisciplinary team coordination and regular drills have been shown to improve readiness and outcomes in pediatric airway emergencies.

Summary: Effective emergency readiness in pediatric airway management requires a multifaceted approach. Key components include availability of appropriate and accessible equipment, adherence to standardized protocols, and ongoing education and training. Regular simulation exercises and interprofessional collaboration are essential for maintaining high levels of preparedness. Implementing these strategies can significantly improve the quality of care and patient outcomes in pediatric airway emergencies.

Level of evidence: Level 3.

Purpose of review: To explore and summarize recent work examining the use of platelet-rich plasma (PRP) applications for vocal fold disorder.

Recent findings: Intrachordal PRP injections have recently emerged as a treatment option for patients with damage to the lamina propria of the vocal fold (scar, atrophy, sulcus and inflammatory lesions). Studies support significant improvements in patient-reported and clinician-reported outcomes, and objective phonatory parameters. PRP demonstrates a good safety profile, absence of immune reactions, affordable cost model and improvement in mucosal wave features with resultant improved voice quality up to 12 months following treatment.

Summary: PRP injection of the vocal folds is a novel repurposing of a previously validated technique, and emerging data shows consistent results across multiple centres, increasing confidence in use of this freely available material. Current published studies confirm improved voice outcomes compared with pretreatment measures and high patient satisfaction. Further research is required to properly assign the role of and ideal candidate for PRP applications, and to delineate durability of treatment.

Purpose of review: Dysphagia is a complication of several autoimmune rheumatic diseases and otorhinolaryngologists are likely to be involved in the assessment and management of patients with such conditions. This review provides an update on rheumatic diseases that may cause swallowing impairment, with particular focus on the epidemiology, pathophysiology and management of dysphagia in these conditions.

Recent findings: Dysphagia is a common complication of the following rheumatic diseases: idiopathic inflammatory myopathies, systemic sclerosis, Sjogren's syndrome, systemic lupus erythematosus and rheumatoid arthritis. It may also be a complication of rarer autoimmune conditions such as Bechet's syndrome, sarcoidosis and granulomatosis with polyangiitis. All three stages of swallowing (oral, pharyngeal and oesophageal) may be impaired in these conditions. Both medical therapy and surgical intervention play an important role in the management of autoimmune dysphagia.

Summary: The investigation and management of autoimmune dysphagia requires close collaboration between rheumatologists and otorhinolaryngologists. There is a need for further research to establish standardised guidelines on the assessment and management of autoimmune dysphagia.

Purpose of review: The rate of distant metastases in patients with head and neck squamous cell carcinoma (HNSCC) ranges between 4 and 26%. Their appearance marks a critical stage in disease progression, significantly reducing survival rates. Treatment options require a multidisciplinary approach and differ based on the number and extension of distant metastases. The aim of this narrative review is to provide a comprehensive and updated overview of the current state of the art in management of such a clinical scenario.

Recent findings: Accurate detection and staging of distant metastases are essential to determine prognosis and guide therapeutic strategies. Oligometastatic condition refers to patients with only a few distant metastases (up to 5). Surgery or stereotactic body radiotherapy are the best curative treatment options for oligometastatic. However, the majority of HNSCC has a polymetastatic disease, not amenable to curative approach. Therefore, systemic therapies, including chemotherapy (CHT) or target molecular therapy and/or best supportive care, are usually reserved to these patients. Rarely, head and neck region, in particular supraclavicular cervical lymph nodes, may be a site of distant metastases from non-head and neck cancer, particularly from the genitourinary and gastrointestinal tracts.

Summary: The occurrence of distant metastases in HNSCC represents a pivotal point in the disease progression, lowering survival rates. Pattern of distant metastases has been related to survival outcomes. Patients with distant metastases from an HNSCC always require a multidisciplinary approach and an accurate selection is necessary to individualize the best treatment strategy.

Purpose of review: This review examines the impact of skull base surgery on olfactory function, a critical yet often overlooked aspect of postoperative quality of life. As surgical techniques continue to evolve, understanding their impact on olfaction is key to optimizing patient outcomes.

Recent findings: The relationship between skull base surgery and olfactory function continues to be debated in the literature. With the adoption of transnasal surgical approaches, a significant concern has been its impact on olfaction. Prior studies have shown evidence of olfactory dysfunction following transnasal skull base surgery, though these findings are not universal. A particular area of discussion involves the use of the pedicled nasoseptal flap, which has demonstrated potentially negative short-term olfactory impacts. Additional concerns surround flap design (olfactory strip preservation) and technique of flap harvest (cold knife versus electrocautery). Evidence suggests that olfactory strip preservation may effectively maintain postoperative olfactory performance, while cold knife techniques offer no clear advantage over electrocautery.

Summary: The inconsistencies in the literature underscore the need for standardized, large-scale studies that directly compare surgical techniques to better understand the impact of transnasal skull base surgery on olfaction. This is essential to optimizing surgical outcomes and improving patient quality of life postoperatively.

Purpose of review: Nasoseptal flaps are a frequently used and well characterized means of reconstruction following endoscopic endonasal approach surgery (EEA). However, there are alternative means of reconstruction, including the extracranial pericranial flap (ePCF), that while used infrequently fulfill a specialized need in larger or salvage reconstructions. This review aims to better characterize long-term outcomes using ePCF where there is currently a paucity of objective data on use and outcomes.

Recent findings: A traditional pericranial flap involves elevating and rotating the flap through a craniotomy defect to reconstruct defects of the ventral skull base. The ePCF is implemented without performing a craniotomy, and instead tunnels the flap through a bony opening created at the level of the nasion. This review presents outcomes in a large single-center cohort of patients with ePCFs to better characterize the short- and long-term success, risks, and complications of this reconstructive method.

Summary: Long-term follow-up demonstrates that obstruction of the frontal sinus outflow may occur but rarely requires surgical intervention. ePCF are a reasonable alternative to consider in cases where local tissue would be insufficient, is not available, or has already failed. There is a low risk of flap complications.

Purpose of review: This review highlights recent advances in facial reanimation surgery particularly related to muscle transposition and free functional muscle transfer (FFMT).

Recent findings: FFMT and muscle transposition are mainstays in the treatment of chronic facial paralysis. Recent literature evaluates single versus dual innervated FFMT, reanimation of the periocular region and lower lip depressors, and indications for such methods over gold standard FFMT techniques. New donor sites for muscle transposition and FFMT are also described.

Summary: Gracilis FFMT (GFMT) continues to be the gold standard in dynamic facial reanimation for patients with chronic facial paralysis. Muscle transposition should be considered in older patients, those medically unfit for long operative procedures, and individuals who prefer more immediate results. With respect to FFMT, described nerve coaptation patterns, surgical stages, and donor muscle choice vary. Standardization of data reporting and outcome measures is needed in future studies.

Purpose of review: The aim of this work is to summarize the main advances on the pathophysiology, diagnosis, and treatment of Meniere's disease (MD).

Recent findings: Different immune responses to biotic stimuli may trigger MD, with subgroups identified based on cytokine and genetic profile, suggesting potential benefits from immune therapy, including antiallergic medication. Genetic and epigenetic research, along with imaging studies, reveal the complexity of MD, involving inflammation, immunity, and metabolic processes. Advanced imaging techniques define specific temporal bone features and endolymphatic hydrops, while machine learning models enhance diagnostic accuracy through clinical and laboratory data analysis. Differentiating MD from vestibular migraine remains challenging due to overlapping symptoms, but combining vestibular tests, audiological assessments, and biomarkers like cytokines and chemokines shows promise. Pharmacological treatments such as betahistine or corticosteroids show varying effectiveness and require further research according to immune subgroups. Surgical options like endolymphatic sac decompression, semicircular canal occlusion and labyrinthectomy are restricted to intractable cases.

Summary: Research into MD aims to improve diagnosis and treatment through genetic, immunological, and advanced imaging studies. Current treatments include pharmacological, intratympanic, and surgical interventions, but current research supports a personalized approach based on clinical and molecular re-definition of patient subgroups.