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

Purpose of review: There are currently five groups internationally involved in human clinical gene therapy trials for otoferlin-associated hearing loss. This includes (in alphabetical order) the Eye and ENT Hospital Fudan University (China), Lilly-Akouos (USA), Otovia (China), Regeneron (USA), and Sensorion (France). This review summarizes early work that led to these efforts and highlights early published data on clinical outcomes.

Recent findings: While published outcomes are currently limited, data emerging from each of these clinical trials is highly consistent. Using a dual vector approach to reconstitute full length Otoferlin, all groups report varying degrees of hearing improvement following cochlear gene therapy, with some cases of hearing restoration to normal levels. Recent data suggests that improvement is not limited only to young children but also adolescents and even young adults in some cases. The treatments all appear safe with limited adverse effects associated with the therapies reported.

Summary: Gene therapy for otoferlin-related deafness appears highly successful in most cases with limited reported adverse effects or outcomes. This success will undoubtably usher in a new era of gene therapy for other forms of genetic deafness.

Purpose of review: This paper aims to contribute to improved diagnostic accuracy, review outcomes of surgery, and provide guidance on how patients and caregivers are counselled about treatment options for juvenile otosclerosis (JO) and congenital stapes footplate fixation (CSFF).

Recent findings: In JO, there is abnormal bone resorption and recalcification leading to progressive conductive or mixed hearing loss depending on the location of affected bone. There is a higher rate of obliterative otosclerosis in children compared to adults and thus consideration should be given to proceed with earlier surgical intervention, with stapedotomy regarded as a safe option. CSFF occurs due to congenital abnormalities in the annular ligament of the footplate and can be associated with other genetic conditions and syndromes. It is characterized by maximal, nonprogressive conductive hearing loss. Stapedotomy can be curative for hearing loss, though the rate of success is reported to be less than in JO, so hearing aids and implants may be more appropriate in some cases.

Summary: Accurate diagnosis of JO and CSFF is of key importance because outcomes of surgery differ. High resolution computerized tomography of the petrous temporal bones should be performed to confirm diagnosis and to inform risks and benefits of operative intervention. Hearing rehabilitation should be addressed in a timely manner to optimize learning.

Purpose of review: Two-team approaches to head and neck cancer ablation and free flap reconstruction now occur concurrently in most centers. While the functional outcomes after head and neck ablation and reconstruction are typically examined through the lens of the reconstructive surgeon, optimizing the patient's functional outcome requires careful considerations of the entire surgical team. This review summarizes important intraoperative considerations for decision making by the surgical team, with a particular emphasis on ablative considerations, to optimize reconstructive outcomes after tumor extirpation.

Recent findings: Intraoperatively, dynamic and deliberate communication between the ablative and reconstructive surgeons are critical in two-team approaches. Surgical principles such as thoughtful skin incision planning, atraumatic dissection of neck vessels, preservation of draining veins in the neck, preservation of nerves to maximize sensation of the native tissue, atraumatic handling of native mucosa, and communication in planning osteotomies of the mandible and maxilla may help to optimize functional outcomes after reconstruction.

Summary: In two-team approaches to head and neck cancer ablation and free flap reconstruction, a focus on communication, flexibility, and trust between surgeons are of paramount importance. Importantly, the goals of the ablative and reconstructive surgeons are interdependent, yet in our experience, optimal reconstructive outcomes begin with the thoughtful peri-operative decision-making and intraoperative preservation of critical structures by the surgical team.

Purpose of review: To review the updated literature on middle ear adenomatous neuroendocrine tumors (MEANTS) and to discuss advances in classification, diagnosis, and management of these tumors.

Recent findings: The WHO updated its classification of head and neck neuroendocrine neoplasms in 2022. We discuss this classification system, and its implications on the diagnosis of these tumors from a histological and molecular perspective. Furthermore, this framework helps with our understanding of their clinical course and hence management.

Summary: In 2022, WHO classified head and neck neuroendocrine neoplasms into well differentiated neuroendocrine tumors (NET) (G1-G3, based on mitotic count/Ki67) and high-grade neuroendocrine carcinoma (NEC) (small/large cell), based on differentiation, atypia, and marker expression. Aside from histological characteristics, the WHO classification distinguishes NETs (site-specific epigenetic changes) from NECs (TP53/RB1 alterations). Small cell NECs show biallelic TP53/RB1 inactivation; large cell NECs are heterogeneous. Molecular profiling helps differentiate NET G3 from NEC. Recent reviews have shown higher rates of recurrence than previous studies, emphasizing the need for surgical modification based on tumor extent and biology, and for indefinite surveillance.

Purpose of review: Innovations in biomedical engineering have been instrumental in advancing skull base and head and neck surgical care. This review highlights the current state of the art of engineering in head and neck and skull base surgery and sheds light on future advances that will continue to revolutionize surgical care.

Recent findings: Recent impacts of biomedical engineering include 3D virtual planning, custom prosthetics, reconstruction with inert polymers or metals, and biosynthesis for reconstructive surgery. 3D virtual planning has revolutionized the surgical management of oral cavity squamous cell carcinoma, with preoperative simulation leading to decreased operative time and improved patient-centered outcomes. The field of prosthetics has also benefited greatly from the customization gained with patient tailored, 3D printed prosthetics. Other facets of biomedical engineering, such as tissue engineering, have great potential to aid in complex reconstruction with limited resources.

Summary: The intimate anatomy of the head and neck leads to unique reconstructive needs that require creative solutions. As one example, 3D surgical planning is becoming the mainstay for osteocutaneous resections and reconstructions, particularly for oral cavity cancer. With patient-centered thinking, there are numerous opportunities for the use of evolving technology to improve patient outcomes.

Purpose of review: To review literature on telehealth and digital applications in the field of pediatric otolaryngology in the last 18 months.

Recent findings: Eleven new papers were identified as adding information in this field. Recent studies exploring service level benefits continue to demonstrate that asynchronous telehealth service models support early intervention, alternative access, and improved monitoring for patients in rural and remote areas. However, policy changes and reimbursement rules need to support these models of care. Effective, reliable remote diagnoses for patients have been achieved using live video-otoscopy, hearing evaluation via telehealth, and artificial-intelligence driven models. Successful telehealth and digital application models for remote rehabilitation, education, and support for children and caregivers are described in the growing evidence-base.

Summary: Telehealth and broader digital modalities continue to expand within the field of pediatric otolaryngology, improving equity of access for children to healthcare. Although challenges and limitations exist, evidence continues to support the benefits of technology-assisted care within clinical practice. High quality research and ongoing technological improvements will continue to drive advancements in this field. Health policy needs to continue to support the advancement of digitally enhanced health services to optimize services and enhance patient-centered care.

Purpose of review: This review evaluates current evidence on outcomes following supraglottoplasty in children with laryngomalacia. Emphasis is placed on surgical indications, perioperative care, and short-term and long-term functional outcomes.

Recent findings: Contemporary studies confirm that supraglottoplasty significantly improves respiratory obstruction, feeding, and sleep-related symptoms for moderate-to-severe laryngomalacia. Patient selection remains critical, with prematurity, neurologic comorbidities, and swallowing dysfunction associated with higher revision and complication rates. Adjunctive investigations such as polysomnography and drug-induced sleep endoscopy increasingly guide tailored intervention strategies.

Summary: Supraglottoplasty remains the cornerstone of surgical management for severe laryngomalacia, with high success rates and generally low complication profiles. Surgical techniques, comorbidity profiles, and preoperative evaluation methods continue to evolve to optimize outcomes and minimize revision surgery.

Purpose of review: This review explores the current understanding and clinical considerations of ossiculoplasty in pediatric patients, focusing on ossicular chain reconstruction associated with congenital or acquired cholesteatoma. The goals of this review are to review the current literature on diagnostic approaches, surgical timing and techniques of pediatric ossiculoplasty.

Recent findings: Current literature suggests that pediatric cholesteatoma tends to be more aggressive than in adults, often necessitating staged ossiculoplasty for better long-term outcomes. Diffusion-weighted MRI, particularly nonecho planar imaging (non-EPI DWI), is a valuable surveillance tool, though its diagnostic accuracy in children remains lower than in adults. The choice of prosthesis - total vs. partial ossicular replacement and titanium vs. autologous materials - significantly influences outcomes. Additionally, endoscopic ossiculoplasty has emerged as a viable and often preferable alternative to microscopic approaches, offering comparable audiologic outcomes with fewer complications.

Summary: The success of pediatric ossiculoplasty after treatment of cholesteatoma depends on several factors including timing of surgery, prosthesis type, and middle ear status. Because cholesteatoma can be more aggressive in children, a tailored and staged approach, combined with advances in imaging and endoscopic techniques, is essential for optimal management. Future directions point toward personalized solutions using 3D modeling and biocompatible implants to further enhance outcomes.

Purpose of review: Chronic rhinosinusitis in pediatric patients is commonly managed with medical therapy; however, there are a significant number of patients who will require endoscopic sinus surgery for refractory disease. In this review, we aim to elucidate the best practices for postoperative care in this patient population.

Recent findings: Overall, there is limited data in the pediatric patient population to direct all aspects of postoperative care and many recommendations have been developed from older literature or extrapolated from adult studies. Nasal saline rinses and topical nasal steroid sprays are cornerstones of management following surgery. The use of steroid impregnated saline is gaining more traction in the adult world but it has not been adequately studied among pediatric patients and should be carefully considered. Routine postsurgical antibiotics and second look endoscopy are not widely recommended but can be implemented on a case by case basis.

Summary: The use of saline irrigation and topical steroids sprays are safe and effective measures to maximize healing after sinus surgery and to help prevent recurrence of symptoms. More research is needed to understand the implications and indications for systemic steroids, antibiotics, and debridement after sinus surgery.