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

Purpose of review: Sleep complaints are exceedingly common in children and are associated with cognitive and psychosocial impairment. Obstructive sleep apnea (OSA) accounts for only a small percentage of pediatric sleep problems. A comprehensive understanding of nonbreathing-related sleep disorders in pediatric patients is, therefore, needed to adequately assess and treat pediatric patients presenting with sleep concerns.

Recent findings: The review below summarizes the most common non-OSA sleep disorders in pediatric patients, focusing on comprehensive evaluation and evidence-based treatment recommendations. We also describe and review the literature on the newest pediatric sleep disorder, restless sleep disorder (RSD).

Summary: Pediatric otolaryngologists should be equipped to take a concise yet thorough sleep history, identify features of non-OSA sleep disorders, counsel patients and families regarding key sleep hygiene measures, and appropriately refer patients with suspected non-OSA sleep disorders such as circadian rhythm disorders, parasomnias, and/or narcolepsy for additional sleep medicine evaluation, testing and/or treatment whenever indicated.

Purpose of review: This review aims to explore the integration of artificial intelligence (AI) in laryngology, with specific focus on the barriers preventing translation from pilot studies into routine clinical practice and strategies for successful implementation.

Recent findings: Laryngology has seen an increasing number of pilot and proof-of-concept studies demonstrating AI's ability to enhance diagnostics, treatment planning, and patient outcomes. Despite these advancements, few tools have been successfully adopted in clinical settings. Effective implementation requires the application of established implementation science frameworks early in the design phase. Additional factors required for the successful integration of AI applications include addressing specific clinical needs, fostering diverse and interdisciplinary teams, and ensuring scalability without compromising model performance. Governance, epistemic, and ethical considerations must also be continuously incorporated throughout the project lifecycle to ensure the safe, responsible, and equitable use of AI technologies.

Summary: While AI hold significant promise for advancing laryngology, its implementation in clinical practice remains limited. Achieving meaningful integration will require a shift toward practical solutions that prioritize clinicians' and patients' needs, usability, sustainability, and alignment with clinical workflows.

Purpose of review: This is a comprehensive overview of current trends in the prevalence, clinical presentation, diagnostic challenges and management of granulomatous disorders involving the nose and paranasal sinuses in low- and middle-income countries. Emphasis is placed on infective aetiologies contributing to granulomatous diseases and the emerging innovations in the diagnosis and management of these conditions.

Recent findings: Granulomatous inflammations represent a distinctive spectrum of conditions arising from infectious, autoimmune, neoplastic, and chemical exposures. The prevalence of these disorders varies globally, with infectious aetiologies being more common in subtropical regions and autoimmune inflammatory conditions predominating in Western countries. Notably, the global burden of certain infectious granulomatous diseases is declining due to improved awareness, socio-economic conditions, and enhanced access to healthcare.However, the incidence of invasive fungal mucormycosis has risen sharply following the COVID-19 pandemic, particularly in the Indian subcontinent. Contributing factors include diabetes mellitus, excessive use of high-dose corticosteroids, and environmental influences. Early diagnosis, along with aggressive surgical debridement and antifungal therapy, remains critical for successful management.

Summary: Otolaryngologists must be aware of granulomatous conditions affecting the nose and paranasal sinuses, given their potential to cause significant morbidity if left untreated. Timely diagnosis relies on clinical suspicion supported by blood tests, imaging, and histopathology for effective intervention.

Purpose of review: The Cheshire and Merseyside (C&M) integrated head and neck cancer (HNC) speech and language therapy (SLT) service based in Liverpool in the UK successfully developed and delivered an in house, fast-track education programme for the primary purpose of advancing SLT clinicians from specialist to highly specialist roles to deliver care to the C&M HNC population as part of a novel integrated service. The bespoke curriculum, competency and assessment framework were intensively delivered through a range of workplace-based training.The aim of this review is to share the principles underpinning the developed frameworks.

Recent findings: The development of the bespoke SLT HNC education programme and competency framework was informed by Macmillan AHP competencies, the Aspirant Cancer Career Education and Development (ACCEND) programme and with reference to the four pillars of practice as described in the advanced clinical practitioner framework. The C&M framework was centred around evidence based principles of medical education specifically Constructivist Learning theory and included foundation theory teaching, self-directed learning, technical skills mastery, delivered by blended and workplace-based learning events. The assessment framework incorporated peer and clinical supervision, viva and case reviews and workplace-based assessment including Direct Observation of Procedural Skills (DOPS) with entrustable professional activities (EPA).

Summary: The education programme was successful in progressing SLT staff within 18 months to achieve appropriate competencies to deliver a new integrated service across C&M. The detailed competency and assessment frameworks developed spans the whole of the HNC patient pathway. Next steps are sharing the success of this work and further development of the learning programme for C&M and other services.

Purpose of review: Septorhinoplasty is considered a complex procedure as it aims at addressing the functional and aesthetic issues of the nose. An integral part of the procedure is the utilization of grafting materials and techniques to achieve these goals.In this review article, authors explore the various grafting materials available including autologous, allogenic, and synthetic options, emphasizing their indications, advantages, limitations, and potential complications with emphasis on their experience on choice of materials for Middle-Eastern patients.

Recent findings: This review delves into recent grafting techniques including dorsal, septal and lower third grafts. There is special emphasis on dorsal grafts highlighting the latest surgical techniques and dorsal grafting constructs.

Summary: By providing a comprehensive overview, this review aims to guide surgeons in making decision regarding graft selection and application, optimizing patient outcomes in septorhinoplasty.

Purpose of review: The purpose of this review is to share the implementation of an integrated care systems approach for head and neck cancer speech and language therapy services. Facilitating factors and barriers to change are highlighted and links to relevant literature are indicated. The intention is that this paper will provide a 'non blueprint' for others embarking on large scale integrative change.

Recent findings: Integrating health and social care provision across organizations is necessary for improving outcomes for people, reducing health inequalities and improving efficiencies in care. Whilst recognizing this intention, the current structure for providing care in NHS organizations does not foster cross-organizational working.

Summary: Integration enhances patient centred care, however implementation of change across organizations is challenging. Managerial support is pivotal and differences in organizational culture need to be acknowledged, respected and overcome. A clearly defined vision, to which all staff are committed provides an anchor in challenging situations. Transformational change is iterative and cannot always be predetermined. Success is possible; tenacity, flexibility and agility are key.

Purpose of review: The aim of this review was to evaluate the current information available on the provision of rhinological services in sub-Saharan Africa and discuss the challenges and opportunities for improving care.

Recent findings: We found that there were very little data available. Some information had been gathered as part of ENT surveys and there were some local and regional reports looking at rhinological care.

Summary: Despite the lack of data, it is clear that specialist rhinological services in sub-Saharan Africa are generally very poor, particularly in rural areas. There are exceptions in some major cities but there exists a huge unmet need in this part of the world. We discussed the importance of the availability of endoscopy for evaluation and management of diseases of the nose and sinuses. We also look at ways of providing training. Partnership and collaboration with high income countries offer benefits for all. Fellowships are particularly valuable in developing specialist services. The availability of the internet provides a powerful way of imparting knowledge through lectures, guidance, courses and educational material such as open access journals and books. It is incumbent on high income countries to help develop healthcare services in areas of greatest need.

Purpose of review: The purpose of this study was to review epistaxis management in Nigeria in the context of current global rhinology practice. It aimed to identify the current strengths in practice that require consolidation and the gaps that require recommendations.

Recent findings: The consistent predominance of otolaryngological interventions in tertiary hospitals reflects the paucity of specialists and lack of equipment for the optimal management of epistaxis in primary and secondary healthcare facilities in Nigeria. Endoscopic intervention was apparent in the most recent publications, but it is still a key limitation, given that it is not widely available in all facilities. The commencement of rhinology fellowships and the emergence of interventional radiology is a ray of hope for an imminent, excellent practice.

Summary: Management of nosebleeds in Nigeria is safe despite limited resources. We believe that there has been progress in endoscopic management; however, this is not widely available. Therefore, there is a need for inclusive advancement. Moreover, local management guidelines would be an excellent tool for unified practice in the advent of rhinology fellowships and evolving interventional radiology. It is vital to fortify primary and secondary health systems.