American Journal of Otolaryngology最新文献

Objectives: This study aims to evaluate the efficiency of the two-surgeon assisted technique (one surgeon performs the dissection while an assistant holds the endoscope) for tympanomeatal (TM) flap elevation during endoscopic tympanoplasty.

Methods: We retrospectively reviewed 97 video recordings of endoscopic tympanoplasty performed in 97 patients from July 2016 to February 2023. Operative times of TM flap elevation for 38 one-surgeon and 59 two-surgeon techniques were compared. We also evaluated the result of the two-surgeon assisted technique in different diameters and shapes of the external auditory canal (EAC) of the operative ear, as determined by temporal high-resolution computed tomography.

Results: The two-surgeon technique significantly shortened the operative time for complete TM flap elevation (16.6 ± 5.8 vs. 22.7 ± 5.8 min, P < 0.001) and from the first incision to exposure of the chorda tympani nerve (7 ± 2 vs. 11.1 ± 3.4 min, P < 0.001). Operative times were not associated with EAC diameter, but were longer in cylindrical EACs (18.3 ± 6.3 min) compared to non-cylindrical EACs (14.8 ± 4.6 min, P = 0.016).

Conclusion: Within our controlled study setting, the two-surgeon technique served as an adjunctive strategy, reducing the operative time specifically for the TM flap elevation phase in endoscopic tympanoplasty compared to the conventional one-handed approach, without compromising the perforation closure rate. While this approach is not a prerequisite for efficient endoscopic tympanoplasty, our study suggests that it may serve as a valuable situational adjunct to enhance procedural efficiency during TM flap elevation.

Background/objective: Otitis media with effusion (OME) occurs when fluid builds up in the middle ear without an infection. Studies have shown high misdiagnosis rate. The objective of the study is to use machine learning (ML) to differentiate between OME and normal tympanic membrane (TM) images.

Methods: This is a prospective case-control study. Patients were divided into case/OME and control/Normal groups based on the consensus assessment of two otolaryngologists and objectively measured with a portable tympanometer. TM images were captured using a smartphone equipped with a video-otoscope. Supervised ML was used to classify the TM images into two categories; Normal and OME. A set of images were used for training the algorithm, while the rest were used to test how accurately the algorithm detected middle ear effusion.

Results: A total of 111 TM images were collected, 54 in the control group and 57 in the case group. A subset of these images was used for algorithm training resulting in a sensitivity rate of 96% (95% CI: 81.7-99.3), specificity rate of 81% (95% CI: 63.3-91.8), and an accuracy rate of 89% (95% CI: 77.8-94.8). The Algorithm post-training results indicated a sensitivity of 87% (95% CI: 70.3-94.7), specificity of 74% (95% CI: 55.3-86.8), and an accuracy of 81% (95% CI: 68.7-88.9).

Conclusion: The supervised ML model demonstrated promising performance in detecting middle ear effusion from smartphone-captured TM images, highlighting the potential of ML to support OME diagnosis by healthcare professionals.

Background: Contemporary clinical guidelines recommend the use of intraoperative parathyroid hormone (IOPTH) when treating parathyroid disease, yet the degree to which parathyroid surgeons adhere to this, and other guideline recommendations remains unknown. To evaluate parathyroid surgeon practices when managing primary (PHPT), secondary (SHPT), and tertiary (THPT) hyperparathyroidism.

Methods: A cross-sectional electronic survey characterizing parathyroid surgery practices was conducted according to CHEERS and AAPOR guidance and distributed to four North American surgeon societies from August-November 2024. The survey evaluated surgeon demographics, imaging practices, and surgical adjunct use. The primary outcome was the use of IOPTH. Descriptive and multivariable logistic regression analyses were used to explore parathyroid surgery practices and characteristics predictive of using IOPTH.

Results: 523 surgeons responded to this survey (response rate: 70.5%, range: 59.9%-85.7%). Most surgeons were from the US and Canada, while 56.3% of respondents were trained in otolaryngology-head and neck surgery. Ultrasonography was the most used modality, while IOPTH was most often used to guide parathyroid surgery [(376/426), 88.3%]. Intraoperative radioguidance and autofluorescence were used infrequently. IOPTH was used by US surgeons [adjusted odds ratio (aOR): 20.1; 95% CI: 1.9, 164.9; p < 0.01] who trained using IOPTH (aOR: 4.7; 95% CI: 1.2, 21.4; p < 0.05). Surveyed surgeons often used the Miami or modified Miami criteria when performing surgery for PHPT, while almost 30% of surgeons reported not using any IOPTH criteria during surgery for SHPT or THPT.

Conclusions: Surgeons adhere to clinical guidelines when managing parathyroid disease, especially with reference to IOPTH in minimally invasive parathyroidectomy. Practice heterogeneity, however, exists with reference to parathyroid imaging and the use of intraoperative adjuncts for parathyroid surgery in parathyroid disease, especially SHPT and THPT.

Objective: To evaluate whether topical autologous platelet-rich plasma (PRP) applied to the tonsillar fossae reduces postoperative pain and improves wound healing after bilateral tonsillectomy.

Methods: In this prospective randomized controlled trial with blinded patients and postoperative outcome assessors, 200 patients undergoing bilateral tonsillectomy were randomized 1:1 to receive topical autologous PRP or control treatment. The primary endpoint was postoperative pain trajectory over days 1-10 measured using a visual analog scale (VAS). Secondary endpoints were wound healing, complete mucosal healing by day 14, post tonsillectomy hemorrhage, and postoperative complications. Pain trajectory was analyzed using a repeated-measures mixed effects model.

Results: Of 200 randomized patients, 195 contributed evaluable post-baseline data, with no significant baseline differences between groups. In the primary repeated-measures analysis, the PRP group showed lower postoperative pain over days 1-10 than the control group (difference: -0.8 VAS units; 95% CI, -1.2 to -0.4; p = 0.001). Wound healing was significantly better in the PRP group on postoperative days 7, 10, and 14, and complete mucosal healing by day 14 was more frequent with PRP (78% vs 59%; absolute difference 18.8 percentage points, 95% CI 6.0 to 31.6). Secondary hemorrhage rates did not differ significantly between groups (2.0% vs 5.2%; p = 0.28). No serious adverse events occurred.

Conclusions: Topical autologous PRP applied during tonsillectomy was associated with reduced postoperative pain and improved wound healing compared with control treatment. PRP may be a useful adjunct for enhancing early recovery after tonsillectomy.

Objective: In patients with oral cancer, unfavourable clinical and histological features may require postoperative radiotherapy or chemoradiation. Our study investigated the impact of the invasive front of the tumor on oncological outcomes. In our cohort, we investigated the impact of worst pattern of infiltration (WPOI) and tumor budding (TB) on oncological outcomes.

Materials and methods: We included 142 patients with primary oral cancer in our prospective cohort study. We excluded 19 patients with other malignancy than oral squamosus cell carcinoma. Two groups were created of 123 cases based on WPOI; (Group A (WPOI 1-4) 39 cases - Group B (WPOI 5) 84 cases). The TB score was determined from the analysis of the postoperative sample. Locoregional control, overall and disease-specific survival were assessed after 39.8 months.

Results: Disease-specific survival and overall survival in group A were 97.5% and 87.1%, in group B 81% and 51.2%. Looking at early-stage tumors separately, cervical lymph node metastasis was confirmed in 13,6% of group A and 56% of group B. A TB score ≥ 3 was associated with a higher risk of metastasis. In patients with the best risk factor profile (cT1-2, WPOI1-4, TB ≤ 3), an occult cervical metastasis rate of 4.7% and no disease specific mortality was observed.

Conclusion: WPOI 5 is a reliable predictor of worse oncological outcome, and Tumor Budding may provide additional prognostic information. Examining and categorization of the tumor-host interface may give rationale to perform staged elective neck dissection, based on the histopathological result.

Bamboo nodes are rare and often-overlooked autoimmune lesions, arising from the upper surface of the vocal folds, with a transversal band-like appearance. To date, only few cases of such conditions have been described, but their actual prevalence is likely to be underestimated, since bamboo nodes may be mistaken for common vocal fold nodules. We herein describe the case of a female patient with mixed connective tissue disease, presenting with bamboo nodes, who responded to a multimodal treatment, including systemic immunosuppressants, vocal fold corticosteroid injection and speech therapy. A 43-year-old woman with mixed connective tissue developed progressive dysphonia. The first-line ENT evaluation showed bilateral nodular thickening of the vocal folds. The patient responded only slightly to speech therapy, so she was submitted to a second-level phoniatric evaluation, unveiling bamboo nodes. After a multidisciplinary discussion between the Phoniatric and Rheumatologic teams, the chosen therapeutic approach was adding a bilateral vocal fold corticosteroid injection to the baseline immunosuppressant therapy, followed by another course of ten speech therapy sessions. Two months after treatment, a significant reduction of bamboo nodes was found, along with an improvement in acoustic voice parameters. Such results remained stable over a five-month follow-up. To develop evidence-based approaches to vocal fold autoimmune lesions, a greater awareness regarding such conditions is advocated, also allowing for the accumulation of larger series.