American Journal of Otolaryngology最新文献

Objective

Compare the vestibulo-ocular reflex (VOR) gain, compensatory saccades and head and eye coordination during head impulses between patients with dizziness but normal VOR gain and healthy controls.

Methods

Video head impulses test (vHIT; ICS impulse, Otometrics, Denmark) was reviewed in 40 participants (20 patients with dizziness; 20 controls). VOR gain, saccades characteristics (frequency of occurrence, amplitude, latency) and time difference between head and eye velocity was compared.

Results

No significant difference between groups was observed for VOR gain. However, saccade frequency was greater and time difference between head and eye was prolonged in patients with dizziness. No significant difference was observed for saccade amplitude, nor for saccade latency between groups.

Conclusions

The present study highlights that saccades observed in patients with normal VOR gain could reflect a clinical marker for dizziness in patients with normal VOR gain. We propose that theses saccades are caused by a prolonged time delay between head and eye velocity leading to a gaze position error.

Significance

The results support previous findings suggesting additional value of saccades and time delay when interpreting vHIT results. This study goes further by proposing time delay as a possible mechanism to explain increased saccade frequency in dizzy patients with normal VOR gain.

Objective

To evaluate the extent of payments from medical device and pharmaceutical companies to editorial board members of leading otolaryngology journals.

Methods

Editorial board members of the top 10 otolaryngology journals from Google Scholar rankings were identified in this cross-sectional study.

Payments between 2017 and 2022 were identified via the Open Payments Database from the Centers for Medicare and Medicaid Services. All payment data was adjusted for inflation in 2022 US dollars. Descriptive analyses were performed and journal websites were evaluated for individual editor disclosures.

Results

Out of 581 board members, 306 (53 %) received industry payments between 2017 and 2022, median journal percentage 55 % (interquartile range: 26.5 %–73.5 %). A sum of $45.8 million was paid out between 2017 and 2022, comprising $32.0 million in associated research funding, $1.2 million in research payments, $1.4 million in ownership and investment interests, and $11.2 million in general payments. The largest general payments were made out for “services other than consulting and speaking” ($3.9 million), “consulting” ($3.8 million), “travel and lodging” ($0.99 million), “education” ($0.87 million), “royalty or license” ($0.56 million), and “food and beverage” ($0.55 million). Individual editor disclosures were only available for International Forum of Allergy and Rhinology (9 % of all included editors).

Conclusions

Industry payments to editors of otolaryngology journals are not uncommon. We highlight the need for improved reporting of individual editor disclosures for transparency to journal readers and for minimizing biased editorial decisions.

Objective

To compare the graft success rates and hearing outcomes of underlay myringoplasty with or without perichondrium tucking of the attached perichondrium, graft perforation margins when repairing chronic large central dry perforations.

Study design

Randomized controlled trial.

Material and methods

Chronic large central dry perforations were prospectively randomized to tucking perichondrium graft underlay (TPGU) and no-tucking perichondrium graft underlay (NTPG) groups. The graft outcomes and complications were compared between the two groups at 12 months postoperatively.

Results

In total, 61 patients with large central dry perforations were included. All patients completed 12-month follow-ups. Residual perforations occurred in 0.0 % of the TPGU group and in 12.9 % of the NTPG group (P = 0.129), and re-perforations occurred within 6 months in 0.0 % and 3.2 % of the two groups, respectively (P = 0.987). The graft success rates were 100.0 % (30/30) and 83.9 % (26/31) (P = 0.067). No significant between-group differences were observed in terms of preoperative (P = 0.547) or postoperative (P = 0.612) air bone gaps (ABGs) or mean ABG gains (P = 0.597). No graft-related complications were observed in either group during follow-up. No patients exhibited significant graft blunting or medialization; graft lateralization was noted in one patient of the NTPG group.

Conclusions

Endoscopic cartilage with tucking of the attached perichondrium perforation margins during underlay myringoplasty may improve the graft success rate compared to that of the cartilage push-through technique when repairing large central dry perforations; however, the hearing improvements were comparable in the two groups.

Objective

To retrospectively analyze the efficacy and safety of laser ablation (LA) and microwave ablation (MWA) in the treatment of papillary thyroid microcarcinoma (PTMC).

Methods

This was a retrospective study of 103 patients (109 nodules) who underwent thermal ablation for PTMC between October 2019 and March 2023; 61 underwent LA and 48 underwent MWA. The mean patients' age was 43.50 ± 12.42 years. After ablation, changes in tumor size at different time points, local recurrence, new lesions, lymph node metastasis, and complications were evaluated and recorded. The feasibility, success rate, and safety of LA and MWA were analyzed.

Results

Complete absence of enhancement on contrast-enhanced ultrasonography was observed in all target tumors after ablation. At the last follow-up, the mean volume of the PTMC nodules decreased from 0.09 ± 0.09 to 0.03 ± 0.03 ml (LA group) and from 0.11 ± 0.10 to 0.06 ± 0.08 ml (MWA group) (both, P < 0.05). There was no significant difference in volume change between the groups (P (groups): 0.520; P (groups over time): 0.423), indicating similar efficacy between the groups. There was also no significant difference in the volume reduction rate between the groups during follow-up, except for at 3 months (P = 0.023). The complication rates did not differ between the LA group (8.2 %) and MWA group (6.3 %) (P > 0.05).

Conclusion

During the short-term follow-up, ultrasound-guided LA and MWA were effective and safe for PTMC, and there were no significant differences in treatment outcomes between the methods.

Objective

The convergence of hearing impairment and language barriers presents unique communication challenges to patients and practicing otolaryngologists. Limited data exist comparing interpretation methods for patients with hearing loss. Patients with hearing loss rely on visual cues, lip-reading, written communication, and/or comprehensive interaction techniques, which may encounter limitations by remote services. Herein, we examine patient and otolaryngology provider satisfaction, cost, and encounter efficiency between virtual and in-person interpretation among adults who speak Mandarin and Cantonese.

Methods

This study is a prospective, randomized controlled trial in patients with moderate-to-severe bilateral hearing loss, Limited English Proficiency, and a primary language of Mandarin or Cantonese. Fifty-two patients were randomized to either in-person or virtual interpretation conditions. Patient satisfaction was measured using an 8-item Likert scale assessing communication effectiveness, encounter efficiency, and overall quality. Otolaryngology provider satisfaction was measured using a 1-item Likert scale. Encounter time, cost, and communication difficulty were measured and compared using independent sample t-tests.

Results

Patient and otolaryngology provider satisfaction scores were significantly higher with in-person interpretation (p < 0.05 for 7 of 8 patient items; physician mean score 4.9, p < 0.001, r = 0.54) compared to virtual interpretation (physician mean 3.8) conditions, while overall quality of the encounter remained the same. There was no significant difference in the length of encounters or in the number of times patients requested interpreter repetition between groups. A difference in average cost existed for in-person interpretation ($14.50) compared to video interpretation ($25) services for an average length appointment.

Conclusion

Patients and otolaryngologists reported higher overall satisfaction with in-person compared to virtual interpretation services. In-person interpretation yielded better comprehension in the hearing loss population among Mandarin and Cantonese-speaking patients and demonstrated a cost advantage over virtual interpretation.

Objective

Given rising concern regarding antibiotic resistance, our objective was to evaluate antibiotic-resistant infections following leech therapy and to characterize the use of prophylactic antibiotics.

Methods

All reports of adverse events involving hirudotherapy (product code “NRN”) were retrieved from the U.S. Food and Drug Administration MAUDE database between 2012 and 2021. Antibiotic resistance was defined by bacterial culture or infection after antibiotic administration.

Results

Nineteen cases of antibiotic resistance involving hirudotherapy were identified. Only three cases of antibiotic resistance were discovered on routine testing and the remaining 16 cases were associated with patient injury. Positive blood cultures or fever were present in 26.3 % (n = 5) of cases. Cultures of the infection grew Aeromonas hydrophilia (n = 13; 68.4 %), Vibrio vulnificus (n = 3; 15.8 %), Pseudomonas aeruginosa (n = 2; 10.5 %), and Proteus vulgaris (n = 1; 5.3 %). There were nine (47.4 %) multi-drug resistant infections. Infection was most commonly resistant to fluoroquinolones (n = 9; 47.4 %), trimethoprim-sulfamethoxazole (n = 9; 47.4 %) and ertapenem (n = 4; 21.1 %).

Conclusion

Antibiotic-resistant infections involving hirudotherapy are frequently resistant to multiple drugs, including fluoroquinolones and trimethoprim-sulfamethoxazole. Resistance to ertapenem, a drug of last resort, was also documented. The findings presented in this study support growing literature that the trend in multi-drug resistance is more severe than previously reported.

Objective

This study examines the therapeutic impact and prognosis of acoustic therapy in patients with chronic subjective tinnitus across different tinnitus frequencies.

Methods

A total of 135 patients with subjective tinnitus were selected and categorized based on their primary tone frequency into three groups: high frequency (43 patients, 4–8 kHz), mid frequency (40 patients, 1–3 kHz), and low frequency (42 patients, < 1 kHz). All patients received acoustic therapy customized to their specific frequency and loudness levels, along with tinnitus cognitive behavioral therapy. Changes in tinnitus loudness and efficacy rates before and after treatment in the different groups, as well as before and after tinnitus cognitive behavioral therapy were evaluated and assessed.

Results

The low frequency group showed a statistical improvement in tinnitus loudness compared to the mid and high frequency groups (P < 0.05). The efficacy rate was 93.55 % in the low frequency group, 82.88 % in the mid frequency group, and 58.82 % in the high frequency group. The efficacy rate in the low frequency group was significantly higher than in the high frequency group, but there was no statistical difference when compared to the mid frequency group.

Conclusion

The frequency of tinnitus in patients with chronic subjective tinnitus might be a key factor affecting treatment effectiveness and could account for the differences in treatment outcomes among patients.

Background

Precision dosing in sublingual immunotherapy (SLIT) has become a hotspot gradually, yet no standardized dose adjustment pattern for house dust mite (HDM)-SLIT. This study aims to investigate the clinical feasibility of the dynamic maintenance dose ascending regimen for individualized SLIT.

Methods

A total of 258 allergic rhinitis (AR) patients treated with HDM-SLIT were included in this retrospective study. Patients were divided into the regular dose (RD) group (n = 101) and the high dose (HD) group (n = 157) according to different maintenance dosages of SLIT. In the RD group, patients received the fixed dose recommended by the manufacturer. In the HD group, patients received a maximum tolerance dose determined by dynamic dose ascending. The clinical efficacy was evaluated by combined symptom and medication score (CSMS) and visual analogue scale score (VAS) at the baseline, 0.5-year, 1-year, and 2-year. The safety was evaluated by adverse events (AEs).

Results

Significant reductions of CSMS and VAS at 0.5-year, 1-year, and 2-year were observed in both the RD group and the HD group compared to the baseline (P < 0.05). In addition, greater improvements in these clinical parameters from 0.5- to 2-year were found in the HD group compared to the RD group (P < 0.05). For subgroup analysis in the HD group, no significant differences in CSMS and VAS were observed among subgroups of patients <14 years old and patients ≥14 years old (P > 0.05). No serious AEs in the two groups and no significant differences were observed between the AE incidence rate of the RD group and HD group during the incremental and maintenance phases.

Conclusions

The 2-year HDM-SLIT with dynamic maintenance dose ascending regimen offers an “optimal” treatment for AR patients while maintaining safety. This study introduced a pattern for individualized dose adjustment in clinical practice, offering potential benefits for AR patients.

Objective

Investigate the impact of patient risk factors and blood transfusions in Head and Neck free flap surgeries.

Study design

Retrospective chart review.

Setting

Single tertiary referral center.

Methods

400 patients were included undergoing free flap reconstruction from 2014 to 2020. The primary outcome measures were red blood cell transfusion and volume transfused. Race, sex, flap location and tissue type, pathology, dependent functional status, length of stay, and cancer recurrence were evaluated for association with red blood cell transfusion intraoperatively and/or postoperatively. Transfusions were indicated on patients with Hemoglobin <7–8 and/or symptomatic anemia. ANOVA and Chi² statistical analysis were performed. The significance was set at p ≤0.05.

Results

Of the 400 patients included, 58 required red blood cell transfusion. Of these 67.8 % were males, racial demographics included 9.00 % African American, 1.30 % Asian, 1.00 % Hispanic/Latino, 87.8 % White, 1.00 % other. African American patients received a higher volume of transfused red blood cells versus white patients (855.00 mL vs. 437.07 mL, p = 0.005). Length of stay was significantly associated with red blood cell transfusion (5.95 days vs. 7.22 days, p ≤0.001). Dependent functional status and need for red blood cell transfusion were associated (p = 0.002). Type of free flap was associated with need for red blood cell transfusion (p ≤0.001) with anterolateral thigh flaps being the most common resulting in transfusion (34/58).

Conclusion

Red blood cell transfusion was significantly associated with race, dependent functional status and length of stay. Certain free flaps have a higher risk of blood transfusion.

Objective

Early diagnosis of laryngeal cancer (LC) is crucial, particularly in rural areas. Despite existing studies on deep learning models for LC identification, challenges remain in selecting suitable models for rural areas with shortages of laryngologists and limited computer resources. We present the intelligent laryngeal cancer detection system (ILCDS), a deep learning-based solution tailored for effective LC screening in resource-constrained rural areas.

Methods

We compiled a dataset comprised of 2023 laryngoscopic images and applied data augmentation techniques for dataset expansion. Subsequently, we utilized eight deep learning models—AlexNet, VGG, ResNet, DenseNet, MobileNet, ShuffleNet, Vision Transformer, and Swin Transformer—for LC identification. A comprehensive evaluation of their performances and efficiencies was conducted, and the most suitable model was selected to assemble the ILCDS.

Results

Regarding performance, all models attained an average accuracy exceeding 90 % on the test set. Particularly noteworthy are VGG, DenseNet, and MobileNet, which exceeded an accuracy of 95 %, with scores of 95.32 %, 95.75 %, and 95.99 %, respectively. Regarding efficiency, MobileNet excels owing to its compact size and fast inference speed, making it an ideal model for integration into ILCDS.

Conclusion

The ILCDS demonstrated promising accuracy in LC detection while maintaining modest computational resource requirements, indicating its potential to enhance LC screening accuracy and alleviate the workload on otolaryngologists in rural areas.