American Journal of Otolaryngology最新文献_第10页

Cochlear implantation in cochlear nerve deficiency: A systematic review 人工耳蜗植入术治疗耳蜗神经缺损：系统综述

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-23 DOI: 10.1016/j.amjoto.2025.104694

Alexa N. Pearce, Peter Eckard, Andrew R. Mangan, Alaina Baggett, John Dornhoffer, Robert A. Saadi

Objectives

Our goal was to review the current literature to better understand outcomes following cochlear implantation (CI) in patients with cochlear nerve deficiency (CND).

Data sources

PubMed, MED-LINE, and Google Scholar.

Review methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol, PubMed, MED-LINE, and Google Scholar were queried for articles published from January 2000 to December 2023 describing cochlear implantation in patients with cochlear nerve agenesis or deficiency.

Results

Of 1820 articles initially identified, 28 articles met inclusion criteria, amounting to 514 patients and 513 cochlear implantations. Among the 24 studies that differentiated between cochlear nerve hypoplasia (CNH) and aplasia (CNA), there were 154 ears with hypoplasia and 364 ears with aplasia. The most common outcome measured was Categories of Auditory Performance; other outcomes used by multiple studies included hearing threshold, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale, and Speech Intelligibility Rating. The average pre-operative CAP was 0.5, and the average post-operative CAP was 3.6. The average pre-operative hearing threshold was 101.3 dB, and 85.5 % of participants had no response on pre-operative auditory brain response. The average post-operative aided hearing threshold was 42.5 dB, with 4.2 % of patients showing no response.

Conclusions

CI in children with CND offers the potential for significant improvement in hearing threshold and speech development, but outcomes are variable in those with more profound nerve hypoplasia or aplasia. Families should be counseled pre-operatively on the possibility of limited results and the potential benefit of alternative treatments like auditory brainstem implantation.

我们的目的是回顾现有文献，以更好地了解人工耳蜗神经缺损（CND）患者人工耳蜗植入术（CI）后的结果。数据来源pubmed， MED-LINE和谷歌Scholar。根据系统评价和荟萃分析方案的首选报告项目，我们查询了PubMed、MED-LINE和谷歌Scholar从2000年1月至2023年12月发表的关于耳蜗神经发育不全或缺陷患者人工耳蜗植入术的文章。结果在最初识别的1820篇文献中，28篇符合纳入标准，共涉及514例患者和513例人工耳蜗植入。在24项区分耳蜗神经发育不全（CNH）与发育不全（CNA）的研究中，发育不全154耳，发育不全364耳。最常见的测量结果是听觉表现类别；多项研究使用的其他结果包括听力阈值、有意义听觉整合量表、有意义言语使用量表和言语可理解度评分。术前平均CAP为0.5，术后平均CAP为3.6。术前平均听力阈值为101.3 dB， 85.5%的受试者术前听觉脑反应无反应。术后平均辅助听力阈值为42.5 dB， 4.2%的患者无反应。结论脊髓损伤对CND患儿的听力阈值和语言发育有显著的改善作用，但对深度神经发育不全或神经发育不全患儿的预后存在差异。术前应告知家庭，可能的有限结果和替代治疗的潜在好处，如听觉脑干植入。

{"title":"Cochlear implantation in cochlear nerve deficiency: A systematic review","authors":"Alexa N. Pearce, Peter Eckard, Andrew R. Mangan, Alaina Baggett, John Dornhoffer, Robert A. Saadi","doi":"10.1016/j.amjoto.2025.104694","DOIUrl":"10.1016/j.amjoto.2025.104694","url":null,"abstract":"<div><h3>Objectives</h3><div>Our goal was to review the current literature to better understand outcomes following cochlear implantation (CI) in patients with cochlear nerve deficiency (CND).</div></div><div><h3>Data sources</h3><div>PubMed, MED-LINE, and Google Scholar.</div></div><div><h3>Review methods</h3><div>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol, PubMed, MED-LINE, and Google Scholar were queried for articles published from January 2000 to December 2023 describing cochlear implantation in patients with cochlear nerve agenesis or deficiency.</div></div><div><h3>Results</h3><div>Of 1820 articles initially identified, 28 articles met inclusion criteria, amounting to 514 patients and 513 cochlear implantations. Among the 24 studies that differentiated between cochlear nerve hypoplasia (CNH) and aplasia (CNA), there were 154 ears with hypoplasia and 364 ears with aplasia. The most common outcome measured was Categories of Auditory Performance; other outcomes used by multiple studies included hearing threshold, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale, and Speech Intelligibility Rating. The average pre-operative CAP was 0.5, and the average post-operative CAP was 3.6. The average pre-operative hearing threshold was 101.3 dB, and 85.5 % of participants had no response on pre-operative auditory brain response. The average post-operative aided hearing threshold was 42.5 dB, with 4.2 % of patients showing no response.</div></div><div><h3>Conclusions</h3><div>CI in children with CND offers the potential for significant improvement in hearing threshold and speech development, but outcomes are variable in those with more profound nerve hypoplasia or aplasia. Families should be counseled pre-operatively on the possibility of limited results and the potential benefit of alternative treatments like auditory brainstem implantation.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104694"},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimal combination treatment for Locally Advanced Nasopharyngeal Carcinoma: A systematic review and Bayesian Network Meta-Analysis 局部晚期鼻咽癌的最佳联合治疗：系统回顾和贝叶斯网络荟萃分析

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-22 DOI: 10.1016/j.amjoto.2025.104692

Zexin Song , Likai Chen , Qi Zhang , Yueyue Huang , Hao Pan

Purpose

To identify the optimal therapeutic strategy for Locally Advanced Nasopharyngeal Carcinoma (LA-NPC).

Methods

Herein, four databases (PubMed, Web of Science, Embase, and Cochrane Library) were systematically searched for pertinent articles from inception to May 24, 2024. Risk of Bias (ROB) was assessed using Cochrane's risk of bias tool 2.0. Statistical analyses were performed using Stata 16.0 and R 4.4.0.

Results

The final analysis included 46 studies involving 15,667 patients. Compared to the Concurrent Chemoradiotherapy (CCRT) + Adjuvant Chemotherapy (AC) combination therapy, the Induction Chemotherapy (IC) + CCRT + Epidermal Growth Factor Receptor Antibody (anti-EGFR) combination treatment demonstrated better efficacy in improving Overall Survival (OS) (Hazard Ratio [HR]: 0.52; 95 % Confidence Interval [CI]: 0.33–0.83). The Surface Under the Cumulative Ranking (SUCRA) analysis revealed that the IC + CCRT + AC + anti-EGFR combination ranked the highest in terms of OS, with a SUCRA score of 87.49 %. It also ranked the highest in terms of Distant Metastasis-Free Survival (DMFS), with a SUCRA score of 85.90 %. Additionally, the CCRT + anti-EGFR combination therapy ranked the highest in terms of PFS, with a SUCRA score of 77.21 %, while the IC + RT combination had the fewest Adverse Effects (AEs) (3–4 grade), with a SUCRA score of 86.20 %.

Conclusion

The IC + CCRT + AC + anti-EGFR combination therapy significantly improved OS, DMFS, and LRFS, highlighting its great promise in LA-NPC treatment. However, owing to the relatively few studies on immunotherapy and targeted therapy, more well-designed studies will be required to validate this deduction.

目的探讨局部晚期鼻咽癌（LA-NPC）的最佳治疗策略。方法系统检索PubMed、Web of Science、Embase、Cochrane Library 4个数据库，检索自建校至2024年5月24日的相关文章。偏倚风险（ROB）采用Cochrane's风险偏倚工具2.0进行评估。采用Stata 16.0和r4.4.0进行统计学分析。结果最终分析纳入46项研究，涉及15667例患者。与同步放化疗(CCRT) +辅助化疗（AC）联合治疗相比，诱导化疗(IC) + CCRT +表皮生长因子受体抗体（anti-EGFR）联合治疗在改善总生存期（OS）方面表现出更好的疗效(风险比[HR]: 0.52；95%置信区间[CI]: 0.33-0.83)。表面下累积排名（SUCRA）分析显示，IC + CCRT + AC +抗egfr组合在OS方面排名最高，SUCRA评分为87.49%。它在无远处转移生存（DMFS）方面也排名最高，SUCRA评分为85.90%。此外，CCRT +抗egfr联合治疗在PFS方面排名最高，SUCRA评分为77.21%，而IC + RT联合治疗的不良反应（ae）最少（3-4级），SUCRA评分为86.20%。结论IC + CCRT + AC +抗egfr联合治疗可显著改善OS、DMFS和LRFS，在LA-NPC治疗中具有广阔的应用前景。然而，由于免疫治疗和靶向治疗的研究相对较少，需要更多精心设计的研究来验证这一推论。

{"title":"Optimal combination treatment for Locally Advanced Nasopharyngeal Carcinoma: A systematic review and Bayesian Network Meta-Analysis","authors":"Zexin Song , Likai Chen , Qi Zhang , Yueyue Huang , Hao Pan","doi":"10.1016/j.amjoto.2025.104692","DOIUrl":"10.1016/j.amjoto.2025.104692","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify the optimal therapeutic strategy for Locally Advanced Nasopharyngeal Carcinoma (LA-NPC).</div></div><div><h3>Methods</h3><div>Herein, four databases (PubMed, Web of Science, Embase, and Cochrane Library) were systematically searched for pertinent articles from inception to May 24, 2024. Risk of Bias (ROB) was assessed using Cochrane's risk of bias tool 2.0. Statistical analyses were performed using Stata 16.0 and R 4.4.0.</div></div><div><h3>Results</h3><div>The final analysis included 46 studies involving 15,667 patients. Compared to the Concurrent Chemoradiotherapy (CCRT) + Adjuvant Chemotherapy (AC) combination therapy, the Induction Chemotherapy (IC) + CCRT + Epidermal Growth Factor Receptor Antibody (anti-EGFR) combination treatment demonstrated better efficacy in improving Overall Survival (OS) (Hazard Ratio [HR]: 0.52; 95 % Confidence Interval [CI]: 0.33–0.83). The Surface Under the Cumulative Ranking (SUCRA) analysis revealed that the IC + CCRT + AC + anti-EGFR combination ranked the highest in terms of OS, with a SUCRA score of 87.49 %. It also ranked the highest in terms of Distant Metastasis-Free Survival (DMFS), with a SUCRA score of 85.90 %. Additionally, the CCRT + anti-EGFR combination therapy ranked the highest in terms of PFS, with a SUCRA score of 77.21 %, while the IC + RT combination had the fewest Adverse Effects (AEs) (3–4 grade), with a SUCRA score of 86.20 %.</div></div><div><h3>Conclusion</h3><div>The IC + CCRT + AC + anti-EGFR combination therapy significantly improved OS, DMFS, and LRFS, highlighting its great promise in LA-NPC treatment. However, owing to the relatively few studies on immunotherapy and targeted therapy, more well-designed studies will be required to validate this deduction.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104692"},"PeriodicalIF":1.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative analysis of AI-generated study guides in otolaryngology education 人工智能生成的耳鼻喉科学习指南在耳鼻喉科教学中的比较分析

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-20 DOI: 10.1016/j.amjoto.2025.104693

Evan A. Patel , Pierce T. Herrmann , Lindsay Fleischer , Peter Filip , Stephanie Joe , Rijul S. Kshirsagar , Edward C. Kuan , Peter Papagiannopoulos , Zara M. Patel , Sanjeet Rangarajan , Pete S. Batra , Bobby A. Tajudeen

Introduction

Resident physicians training in otolaryngology frequently utilize dense traditional textbooks like “Cummings: Otolaryngology Head and Neck Surgery,” widely regarded as the gold standard for educational content in the field. However, integrating artificial intelligence (AI) into educational methods offers potential enhancements to traditional methods of trainee learning. This study evaluates the accuracy, relevance, and clarity of AI-generated study guides for otolaryngology residents and their efficacy in graduate level education.

Methods

Study guides for four rhinology chapters of “Cummings Otolaryngology Head and Neck Surgery” were generated using ChatGPT-4 by a non-expert in otolaryngology to ensure replicability. Multiple board-certified Rhinologists evaluated the study guides with a structured assessment form. The guides were rated on accuracy, relevancy, and clarity using a 4-point scale. The item-level content validity index (I-CVI) was calculated for each parameter.

Results

The mean scores for accuracy, relevancy, and clarity across all chapters were 3.45 ± 0.19, 3.64 ± 0.17, and 3.36 ± 0.08, respectively. I-CVI scores for accuracy, relevancy, and clarity ranged from 0.8 to 1.0, signifying that the content was valid. Reviewers praised the comprehensive nature and clear formatting, although they suggested incorporating more detailed explanations and visual aids.

Discussion

The findings demonstrate the potential of Large Language Models (LLMs) in generating high-quality content. AI-generated resources can reduce the burden on educators and provide tailored resources for residents. Future research is necessary to explore refined AI models and multimodal inputs to enhance educational outcomes. LLM's, such as OpenAI's GPT-4, have revolutionized the opportunity for personalized learning experiences for graduate level trainees.

Level of evidence

Level 5

在耳鼻喉科培训的住院医师经常使用密集的传统教科书，如“卡明斯：耳鼻喉头颈外科”，被广泛认为是该领域教育内容的黄金标准。然而，将人工智能（AI）整合到教育方法中，为传统的培训生学习方法提供了潜在的增强。本研究评估人工智能生成的耳鼻喉科住院医师学习指南的准确性、相关性和清晰度，以及它们在研究生水平教育中的有效性。方法由非耳鼻喉科专家使用ChatGPT-4生成《Cummings Otolaryngology Head and Neck Surgery》四个鼻科章节的学习指南，以确保可重复性。多名委员会认证的鼻医生用结构化的评估表格评估研究指南。使用4分制对指南的准确性、相关性和清晰度进行评分。计算每个参数的项目级内容效度指数（I-CVI）。结果各章节的准确性、相关性和清晰度平均得分分别为3.45±0.19、3.64±0.17和3.36±0.08。准确性、相关性和清晰度的I-CVI评分范围从0.8到1.0，表明内容是有效的。审稿人称赞了这本书的全面性质和清晰的格式，尽管他们建议加入更详细的解释和视觉辅助。这些发现证明了大型语言模型（llm）在生成高质量内容方面的潜力。人工智能生成的资源可以减轻教育工作者的负担，并为居民提供量身定制的资源。未来的研究需要探索改进的人工智能模型和多模态输入，以提高教育成果。法学硕士，如OpenAI的GPT-4，已经彻底改变了研究生水平学员个性化学习体验的机会。证据等级：5级

{"title":"Comparative analysis of AI-generated study guides in otolaryngology education","authors":"Evan A. Patel , Pierce T. Herrmann , Lindsay Fleischer , Peter Filip , Stephanie Joe , Rijul S. Kshirsagar , Edward C. Kuan , Peter Papagiannopoulos , Zara M. Patel , Sanjeet Rangarajan , Pete S. Batra , Bobby A. Tajudeen","doi":"10.1016/j.amjoto.2025.104693","DOIUrl":"10.1016/j.amjoto.2025.104693","url":null,"abstract":"<div><h3>Introduction</h3><div>Resident physicians training in otolaryngology frequently utilize dense traditional textbooks like “Cummings: Otolaryngology Head and Neck Surgery,” widely regarded as the gold standard for educational content in the field. However, integrating artificial intelligence (AI) into educational methods offers potential enhancements to traditional methods of trainee learning. This study evaluates the accuracy, relevance, and clarity of AI-generated study guides for otolaryngology residents and their efficacy in graduate level education.</div></div><div><h3>Methods</h3><div>Study guides for four rhinology chapters of “Cummings Otolaryngology Head and Neck Surgery” were generated using ChatGPT-4 by a non-expert in otolaryngology to ensure replicability. Multiple board-certified Rhinologists evaluated the study guides with a structured assessment form. The guides were rated on accuracy, relevancy, and clarity using a 4-point scale. The item-level content validity index (I-CVI) was calculated for each parameter.</div></div><div><h3>Results</h3><div>The mean scores for accuracy, relevancy, and clarity across all chapters were 3.45 ± 0.19, 3.64 ± 0.17, and 3.36 ± 0.08, respectively. I-CVI scores for accuracy, relevancy, and clarity ranged from 0.8 to 1.0, signifying that the content was valid. Reviewers praised the comprehensive nature and clear formatting, although they suggested incorporating more detailed explanations and visual aids.</div></div><div><h3>Discussion</h3><div>The findings demonstrate the potential of Large Language Models (LLMs) in generating high-quality content. AI-generated resources can reduce the burden on educators and provide tailored resources for residents. Future research is necessary to explore refined AI models and multimodal inputs to enhance educational outcomes. LLM's, such as OpenAI's GPT-4, have revolutionized the opportunity for personalized learning experiences for graduate level trainees.</div></div><div><h3>Level of evidence</h3><div>Level 5</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104693"},"PeriodicalIF":1.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Steroid-eluting stents in challenging frontal sinus surgery: A critical real world experience 类固醇洗脱支架在具有挑战性的额窦手术：一个关键的现实世界的经验

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-14 DOI: 10.1016/j.amjoto.2025.104685

Sven Beckmann , Davina Gut , Raffael Fink , Marco Caversaccio , Urs Borner , Lukas Anschuetz

Objectives

This study investigates the impact of placing steroid-eluting stents in the frontal sinus outflow tract on the need for postoperative interventions and postoperative changes in symptoms.

Methods

We performed a retrospective case-control study between January 2018 and December 2022 in 21 patients in each group with and without a steroid-eluting stent placed in the frontal sinus outflow tract. The outcome between the two groups was investigated regarding the need for revision surgery and changes in pre- and postoperative symptoms.

Results

Comparison between the two groups in the postoperative course revealed no statistically significant differences with respect to postoperative interventions. Further analysis of the postoperative symptoms demonstrated statistically significant reduced hyposmia, rhinorrhea, and nasal obstruction in the group with stenting after surgery than before surgery, whereas pain and rhinorrhea were reported significantly less frequently in the group without stenting in the postoperative course.

Conclusions

This study revealed no statistically significant differences in the postoperative course between the stenting and no-stenting group regarding early postoperative interventions (local intervention, revision surgery). Accordingly, this study is the first to show no significant difference in the postoperative intervention rates, whereas previous studies have all shown a significant difference in the need for postoperative interventions.

目的探讨在额窦流出道放置类固醇洗脱支架对术后干预需求和术后症状变化的影响。方法2018年1月至2022年12月，我们对每组21例在额窦流出道放置或不放置类固醇洗脱支架的患者进行回顾性病例对照研究。两组之间的结果被调查关于翻修手术的需要和术前和术后症状的变化。结果两组在术后过程中比较，在术后干预措施方面无统计学差异。对术后症状的进一步分析显示，术后支架置入术组的通气不足、鼻漏和鼻塞比术前明显减少，而术后未支架置入术组的疼痛和鼻漏发生率明显降低。本研究显示，在术后早期干预（局部干预、翻修手术）方面，支架置入术组与非支架置入术组的术后病程无统计学差异。因此，本研究首次显示术后干预率无显著差异，而以往的研究均显示术后干预需求有显著差异。

{"title":"Steroid-eluting stents in challenging frontal sinus surgery: A critical real world experience","authors":"Sven Beckmann , Davina Gut , Raffael Fink , Marco Caversaccio , Urs Borner , Lukas Anschuetz","doi":"10.1016/j.amjoto.2025.104685","DOIUrl":"10.1016/j.amjoto.2025.104685","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigates the impact of placing steroid-eluting stents in the frontal sinus outflow tract on the need for postoperative interventions and postoperative changes in symptoms.</div></div><div><h3>Methods</h3><div>We performed a retrospective case-control study between January 2018 and December 2022 in 21 patients in each group with and without a steroid-eluting stent placed in the frontal sinus outflow tract. The outcome between the two groups was investigated regarding the need for revision surgery and changes in pre- and postoperative symptoms.</div></div><div><h3>Results</h3><div>Comparison between the two groups in the postoperative course revealed no statistically significant differences with respect to postoperative interventions. Further analysis of the postoperative symptoms demonstrated statistically significant reduced hyposmia, rhinorrhea, and nasal obstruction in the group with stenting after surgery than before surgery, whereas pain and rhinorrhea were reported significantly less frequently in the group without stenting in the postoperative course.</div></div><div><h3>Conclusions</h3><div>This study revealed no statistically significant differences in the postoperative course between the stenting and no-stenting group regarding early postoperative interventions (local intervention, revision surgery). Accordingly, this study is the first to show no significant difference in the postoperative intervention rates, whereas previous studies have all shown a significant difference in the need for postoperative interventions.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104685"},"PeriodicalIF":1.8,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Learning curves in endoscopic thyroidectomy: A literature review of different surgical approaches 内镜甲状腺切除术的学习曲线：不同手术入路的文献综述

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-13 DOI: 10.1016/j.amjoto.2025.104691

Wenkai Li , Xiaowei Peng , Aiping Wang

Objective

This review analyzes the learning curves of various endoscopic thyroidectomy approaches, aiming to guide surgeons in improving training efficiency, reducing learning time, and enhancing surgical safety and outcomes.

Methods

A literature search in PubMed and Web of Science for studies published from January 2014 to April 2024 on the learning curves of endoscopic thyroidectomy was conducted. Studies involving human subjects with specific case data were included; duplicates, non-English publications, animal studies, reviews, and unrelated thyroid conditions were excluded.

Results

A total of 47 studies were reviewed, covering various endoscopic thyroidectomy techniques. The trans-axillary procedure showed a learning curve peak between 30 and 90 cases (average 45.5 for endoscopic, 34.17 for robotic). The trans-breast/chest approach peaked between 25 and 60 cases (average 34.88). Transoral procedures peaked between 12 and 71 cases (average 37 for endoscopic, 28.63 for robotic). The bilateral axillo-breast approach (BABA) peaked at 30 cases for endoscopic surgeries and 15-51 cases for robotic-assisted surgeries (average 36.44).

Conclusion

This study highlights the learning curve differences among various approaches to endoscopic thyroidectomy, providing valuable insights for improving training and increasing the adoption of these techniques.

目的分析各种内镜甲状腺切除术入路的学习曲线，旨在指导外科医生提高培训效率，缩短学习时间，提高手术安全性和效果。方法检索2014年1月至2024年4月在PubMed和Web of Science上发表的关于内镜下甲状腺切除术学习曲线的文献。纳入了具有特定病例资料的人类受试者研究；排除重复、非英文出版物、动物研究、综述和不相关的甲状腺疾病。结果回顾了47项研究，涵盖了各种内镜下甲状腺切除术技术。经腋窝手术的学习曲线峰值在30 - 90例之间（内窥镜手术平均45.5，机器人手术平均34.17）。经胸入路25 ~ 60例（平均34.88例）。经口手术在12 - 71例之间达到高峰（内镜手术平均37例，机器人手术平均28.63例）。双侧腋窝-乳房入路（BABA）在内镜手术中最多30例，在机器人辅助手术中最多15-51例（平均36.44例）。结论本研究突出了内镜甲状腺切除术不同入路的学习曲线差异，为改进培训和提高这些技术的采用提供了有价值的见解。

{"title":"Learning curves in endoscopic thyroidectomy: A literature review of different surgical approaches","authors":"Wenkai Li , Xiaowei Peng , Aiping Wang","doi":"10.1016/j.amjoto.2025.104691","DOIUrl":"10.1016/j.amjoto.2025.104691","url":null,"abstract":"<div><h3>Objective</h3><div>This review analyzes the learning curves of various endoscopic thyroidectomy approaches, aiming to guide surgeons in improving training efficiency, reducing learning time, and enhancing surgical safety and outcomes.</div></div><div><h3>Methods</h3><div>A literature search in PubMed and Web of Science for studies published from January 2014 to April 2024 on the learning curves of endoscopic thyroidectomy was conducted. Studies involving human subjects with specific case data were included; duplicates, non-English publications, animal studies, reviews, and unrelated thyroid conditions were excluded.</div></div><div><h3>Results</h3><div>A total of 47 studies were reviewed, covering various endoscopic thyroidectomy techniques. The trans-axillary procedure showed a learning curve peak between 30 and 90 cases (average 45.5 for endoscopic, 34.17 for robotic). The trans-breast/chest approach peaked between 25 and 60 cases (average 34.88). Transoral procedures peaked between 12 and 71 cases (average 37 for endoscopic, 28.63 for robotic). The bilateral axillo-breast approach (BABA) peaked at 30 cases for endoscopic surgeries and 15-51 cases for robotic-assisted surgeries (average 36.44).</div></div><div><h3>Conclusion</h3><div>This study highlights the learning curve differences among various approaches to endoscopic thyroidectomy, providing valuable insights for improving training and increasing the adoption of these techniques.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104691"},"PeriodicalIF":1.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Determinants of inpatient treatment in children with orbital cellulitis 眼眶蜂窝织炎患儿住院治疗的决定因素

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-11 DOI: 10.1016/j.amjoto.2025.104686

Amani Kais, Erica McArdle, John Behnke, Ruifeng Cui, Chadi A. Makary, Hassan H. Ramadan

Background

Orbital cellulitis in children can lead to serious complications and necessitate hospitalization for management.

Objective

This study investigated predictors of inpatient hospitalization among pediatric patients receiving medical treatment for orbital cellulitis.

Methods

A retrospective cohort study of children treated for orbital cellulitis at West Virginia University Children's Hospital from January 2012–July 2022 was conducted. Patient characteristics, treatment setting (inpatient vs outpatient), orbital cellulitis type (preseptal vs postseptal), etiology of the orbital cellulitis (acute rhinosinusitis vs other), and presence of subperiosteal abscess were reviewed.

Results

The sample consisted of 100 pediatric patients with mean age of 7.0 years old (SD = 4.9). Inpatient treatment was required for 70 patients with a mean length of stay of 3.0 (SD = 1.7) days. In univariate regressions, acute rhinosinusitis (ARS), postseptal cellulitis, and subperiosteal abscess predicted necessitating inpatient treatment (p < 0.05 for all). In multivariate regressions, only ARS predicted treatment setting (p = 0.016) and no variables predicted length of stay (p > 0.05 for all).

Conclusion

In children who were treated medically for orbital cellulitis, ARS as the etiology was the main predictor necessitating inpatient treatment.

Level of evidence

4

背景：儿童眶蜂窝织炎可导致严重的并发症，需要住院治疗。目的探讨眼窝蜂窝织炎患儿住院的预测因素。方法对2012年1月至2022年7月在西弗吉尼亚大学儿童医院接受眼眶蜂窝织炎治疗的儿童进行回顾性队列研究。我们回顾了患者特征、治疗环境（住院与门诊）、眼眶蜂窝织炎类型（隔膜前与隔膜后）、眼眶蜂窝织炎的病因（急性鼻窦炎与其他）以及骨膜下脓肿的存在。结果100例儿童患者，平均年龄7.0岁（SD = 4.9）。70例患者需要住院治疗，平均住院时间为3.0 （SD = 1.7）天。在单变量回归中，急性鼻窦炎（ARS）、隔后蜂窝织炎和骨膜下脓肿预测需要住院治疗(p <；0.05)。在多变量回归中，只有ARS预测治疗环境（p = 0.016），没有变量预测住院时间(p >；0.05)。结论眼窝蜂窝织炎患儿接受内科治疗时，ARS为主要病因，是需要住院治疗的主要预测因素。证据水平4

{"title":"Determinants of inpatient treatment in children with orbital cellulitis","authors":"Amani Kais, Erica McArdle, John Behnke, Ruifeng Cui, Chadi A. Makary, Hassan H. Ramadan","doi":"10.1016/j.amjoto.2025.104686","DOIUrl":"10.1016/j.amjoto.2025.104686","url":null,"abstract":"<div><h3>Background</h3><div>Orbital cellulitis in children can lead to serious complications and necessitate hospitalization for management.</div></div><div><h3>Objective</h3><div>This study investigated predictors of inpatient hospitalization among pediatric patients receiving medical treatment for orbital cellulitis.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of children treated for orbital cellulitis at West Virginia University Children's Hospital from January 2012–July 2022 was conducted. Patient characteristics, treatment setting (inpatient vs outpatient), orbital cellulitis type (preseptal vs postseptal), etiology of the orbital cellulitis (acute rhinosinusitis vs other), and presence of subperiosteal abscess were reviewed.</div></div><div><h3>Results</h3><div>The sample consisted of 100 pediatric patients with mean age of 7.0 years old (SD = 4.9). Inpatient treatment was required for 70 patients with a mean length of stay of 3.0 (SD = 1.7) days. In univariate regressions, acute rhinosinusitis (ARS), postseptal cellulitis, and subperiosteal abscess predicted necessitating inpatient treatment (<em>p</em> < 0.05 for all). In multivariate regressions, only ARS predicted treatment setting (<em>p</em> = 0.016) and no variables predicted length of stay (<em>p</em> > 0.05 for all).</div></div><div><h3>Conclusion</h3><div>In children who were treated medically for orbital cellulitis, ARS as the etiology was the main predictor necessitating inpatient treatment.</div></div><div><h3>Level of evidence</h3><div>4</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104686"},"PeriodicalIF":1.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144306437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Percutaneous vocal fold steroid injections: a current reappraisal of indications and techniques 经皮声带类固醇注射：当前适应症和技术的重新评估

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-11 DOI: 10.1016/j.amjoto.2025.104688

Leonardo Franz, Giovanna Baracca, Alessandro Matarazzo, Cosimo de Filippis, Gino Marioni

Objective

Vocal fold steroid injections have been proposed for benign lesions (e.g. vocal nodules, polyps, cysts and Reinke's edema), based on their inflammatory background. Although several studies reported the trans-nasal fiber-endoscopic techniques, evidence regarding transcervical percutaneous approaches is limited. This review aimed to critically analyze the available evidence on percutaneous steroid injections for benign laryngeal lesions, providing an updated summary of indications, surgical techniques and results.

Methods

The Pubmed and Scopus databases were searched, according to the following keywords: percutaneous AND (steroid OR corticosteroid) AND injection AND (larynx OR laryngeal OR vocal fold). Articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Original reports, in English, describing treatment with percutaneous vocal fold steroid injection were included. Articles lacking relevant reported data, single case reports, non-original studies, or preclinical studies were excluded.

Results

603 papers were retrieved. After duplicates removal and exclusion of studies not complying with the inclusion/exclusion criteria, 16 articles were included. The treated benign lesions were pre-nodular swelling/nodules, polyps, granulomas, fibrosis/scars, laryngeal stenosis and Reinke's edema. The described percutaneous approaches included the trans-thyrohyoid, trans-cricothyroid and trans-thyroid cartilage routes.

Conclusion

The available evidence describes percutaneous vocal fold steroid injection as feasible and effective in benign laryngeal lesions. In terms of clinical effectiveness, nodules and polyps seemed to show potentially more benefit compared to other lesion types. However, the heterogeneity of the available studies may prevent generalizability. To obtain more conclusive data, further studies, preferably in a prospective multicenter setting, are advocated.

目的声带类固醇注射已被建议用于良性病变（如声带结节、息肉、囊肿和Reinke水肿），基于其炎症背景。虽然一些研究报道了经鼻纤维内窥镜技术，但关于经颈经皮入路的证据有限。本综述旨在批判性地分析经皮类固醇注射治疗良性喉部病变的现有证据，提供适应症、手术技术和结果的最新总结。方法检索Pubmed和Scopus数据库，关键词：经皮and（类固醇或皮质类固醇）、注射and（喉或喉或声带）。根据系统评价和荟萃分析的首选报告项目（PRISMA）筛选文章。原始报告，英文，描述治疗经皮声带类固醇注射纳入。缺乏相关报告数据、单例报告、非原创研究或临床前研究的文章被排除在外。结果共检索论文603篇。在删除重复项并排除不符合纳入/排除标准的研究后，纳入了16篇文献。治疗的良性病变包括结节前肿胀/结节、息肉、肉芽肿、纤维化/疤痕、喉狭窄和Reinke水肿。经皮入路包括经甲状舌骨、经环甲状软骨和经甲状软骨入路。结论经皮声带类固醇注射治疗喉良性病变是可行和有效的。就临床疗效而言，与其他类型的病变相比，结节和息肉似乎显示出潜在的更多益处。然而，现有研究的异质性可能会妨碍推广。为了获得更多的结论性数据，建议进一步的研究，最好是在前瞻性的多中心环境中进行。

{"title":"Percutaneous vocal fold steroid injections: a current reappraisal of indications and techniques","authors":"Leonardo Franz, Giovanna Baracca, Alessandro Matarazzo, Cosimo de Filippis, Gino Marioni","doi":"10.1016/j.amjoto.2025.104688","DOIUrl":"10.1016/j.amjoto.2025.104688","url":null,"abstract":"<div><h3>Objective</h3><div>Vocal fold steroid injections have been proposed for benign lesions (e.g. vocal nodules, polyps, cysts and Reinke's edema), based on their inflammatory background. Although several studies reported the trans-nasal fiber-endoscopic techniques, evidence regarding transcervical percutaneous approaches is limited. This review aimed to critically analyze the available evidence on percutaneous steroid injections for benign laryngeal lesions, providing an updated summary of indications, surgical techniques and results.</div></div><div><h3>Methods</h3><div>The Pubmed and Scopus databases were searched, according to the following keywords: percutaneous AND (steroid OR corticosteroid) AND injection AND (larynx OR laryngeal OR vocal fold). Articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Original reports, in English, describing treatment with percutaneous vocal fold steroid injection were included. Articles lacking relevant reported data, single case reports, non-original studies, or preclinical studies were excluded.</div></div><div><h3>Results</h3><div>603 papers were retrieved. After duplicates removal and exclusion of studies not complying with the inclusion/exclusion criteria, 16 articles were included. The treated benign lesions were pre-nodular swelling/nodules, polyps, granulomas, fibrosis/scars, laryngeal stenosis and Reinke's edema. The described percutaneous approaches included the trans-thyrohyoid, trans-cricothyroid and trans-thyroid cartilage routes.</div></div><div><h3>Conclusion</h3><div>The available evidence describes percutaneous vocal fold steroid injection as feasible and effective in benign laryngeal lesions. In terms of clinical effectiveness, nodules and polyps seemed to show potentially more benefit compared to other lesion types. However, the heterogeneity of the available studies may prevent generalizability. To obtain more conclusive data, further studies, preferably in a prospective multicenter setting, are advocated.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104688"},"PeriodicalIF":1.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Microvascular free tissue transfer repair of pharyngoesophageal perforation following anterior cervical discectomy and fusion 颈前路椎间盘切除术融合术后咽食管穿孔微血管游离组织移植修复

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-11 DOI: 10.1016/j.amjoto.2025.104687

Danielle M. Gillard , Karolina A. Plonowska-Hirschfeld , Chase Heaton , Rahul Seth , Andrea M. Park , P. Daniel Knott

Background

There are no current best practice guidelines for management of pharyngoesophageal perforation (PEP), a rare complication of anterior cervical discectomy and fusion (ACDF). We describe our institution's experience with free flap reconstruction of PEP after ACDF.

Methods

Retrospective review of patients who underwent free flap reconstruction of PEP after ACDF.

Results

Thirteen patients underwent 13 microvascular free tissue transfers. There was 1 partial flap failure and no complete flap losses. One patient (7.7 %) had a persistent salivary leak following PEP repair. Ten (77 %) patients were able to resume oral intake. Five (38 %) developed esophageal diverticula and 2 (15.4 %) developed esophageal stenosis an average of 7.4 months after repair.

Conclusions

PEP after ACDF poses a unique reconstructive challenge. While majority of these patients can successfully achieve oral diet following microvascular repair, clinically significant esophageal diverticula and stenoses may require long-term follow-up and management.

咽食管穿孔（PEP）是颈前路椎间盘切除术融合术（ACDF）的一种罕见并发症，目前尚无最佳治疗指南。我们介绍了我院在ACDF后自由皮瓣重建PEP的经验。方法回顾性分析ACDF术后行游离皮瓣重建的PEP患者。结果13例患者共进行了13次微血管游离组织移植。皮瓣部分失败1例，皮瓣完全丢失1例。1例患者（7.7%）在PEP修复后出现持续唾液漏。10例（77%）患者能够恢复口服摄入。5例（38%）出现食管憩室，2例（15.4%）在修复后平均7.4个月出现食管狭窄。结论ACDF后spep具有独特的重建挑战。虽然大多数患者在微血管修复后可以成功实现口服饮食，但临床上明显的食管憩室和狭窄可能需要长期随访和治疗。

{"title":"Microvascular free tissue transfer repair of pharyngoesophageal perforation following anterior cervical discectomy and fusion","authors":"Danielle M. Gillard , Karolina A. Plonowska-Hirschfeld , Chase Heaton , Rahul Seth , Andrea M. Park , P. Daniel Knott","doi":"10.1016/j.amjoto.2025.104687","DOIUrl":"10.1016/j.amjoto.2025.104687","url":null,"abstract":"<div><h3>Background</h3><div>There are no current best practice guidelines for management of pharyngoesophageal perforation (PEP), a rare complication of anterior cervical discectomy and fusion (ACDF). We describe our institution's experience with free flap reconstruction of PEP after ACDF.</div></div><div><h3>Methods</h3><div>Retrospective review of patients who underwent free flap reconstruction of PEP after ACDF.</div></div><div><h3>Results</h3><div>Thirteen patients underwent 13 microvascular free tissue transfers. There was 1 partial flap failure and no complete flap losses. One patient (7.7 %) had a persistent salivary leak following PEP repair. Ten (77 %) patients were able to resume oral intake. Five (38 %) developed esophageal diverticula and 2 (15.4 %) developed esophageal stenosis an average of 7.4 months after repair.</div></div><div><h3>Conclusions</h3><div>PEP after ACDF poses a unique reconstructive challenge. While majority of these patients can successfully achieve oral diet following microvascular repair, clinically significant esophageal diverticula and stenoses may require long-term follow-up and management.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104687"},"PeriodicalIF":1.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Timing of Eustachian tube balloon dilation: Impact on resource utilization and cost 咽鼓管球囊扩张时机：对资源利用和成本的影响

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-10 DOI: 10.1016/j.amjoto.2025.104689

Robert M. Conway, Masanari Kato, Seilesh C. Babu

Importance

Eustachian tube balloon dilation (ETBD) is a novel treatment option for adult patients with ETD, with superior efficacy to medical therapy. However, appropriate timing of performing ETBD hasn't been thoroughly examined.

Objective

This study compared healthcare resource utilization among patients with ETD that are treated early with ETBD (i.e., within 3 months of ETD diagnosis) versus those treated later (i.e., 3–12 months of ETD diagnosis).

Design

Retrospective cohort study.

Setting

Utilizing Optum Clinoformatics Socio-Economic Status (SES) Database.

Participants

Patients aged 18 and older who had ETBD procedure between January 2017 to June 2021.

Interventions

Patients were classified into two groups based on the treatment timing of their incident diagnosis of ETD: early treated and late treated.

Main outcomes and measures

Outcomes including 12-month ETD-related surgical procedure rate, number of office visits, medication use, and total cost were assessed and compared among the study cohorts. Study outcomes were assessed using generalized linear regression.

Results

Two hundred seventy-seven patients were identified, with 173 patients in the early ETBD cohort and 104 patients in the late ETBD cohort. Early treated patients had significantly lower ETD-related surgical procedure rates (8.7 % vs. 17.3 %) lower rates (28.9 % vs. 48.1 %) and fewer (0.47 vs. 1.12) ETD-related office visits, and fewer medication claims (2.19 vs. 3.06). The early treated cohort had significantly lower ETD-related costs ($212.15 vs. $551) compared to patients treated later after diagnosis.

Conclusions and relevance

Among ETD patients undergoing ETBD, those treated early had significantly lower healthcare resource utilization and cost in comparison to those treated later. These results will hopefully add evidence to promote the early use of ETBD for purposes of patient benefit and decreased costs.

Level of evidence

IV

耳咽管球囊扩张术（ETBD）是一种治疗成人ETD的新方法，其疗效优于药物治疗。然而，实施ETBD的适当时机尚未得到彻底的研究。目的：本研究比较早期（即诊断为ETD后3个月内）与晚期（即诊断为ETD后3 - 12个月）ETD患者的医疗资源利用情况。设计回顾性队列研究。建立和利用Optum社会经济地位数据库。参与者：在2017年1月至2021年6月期间接受ETBD手术的18岁及以上患者。干预措施根据ETD事件诊断的治疗时间将患者分为早期治疗和晚期治疗两组。主要结果和测量结果包括12个月etd相关的外科手术率、办公室就诊次数、药物使用和总费用在研究队列中进行评估和比较。研究结果采用广义线性回归进行评估。结果共纳入277例患者，其中早期ETBD组173例，晚期ETBD组104例。早期治疗患者的etd相关手术率（8.7% vs. 17.3%）显著降低（28.9% vs. 48.1%），与etd相关的办公室就诊次数（0.47 vs. 1.12）减少（2.19 vs. 3.06）。与诊断后较晚治疗的患者相比，早期治疗组的etd相关费用显著降低（212.15美元对551美元）。结论及相关性在接受ETBD的ETD患者中，早期治疗的患者的医疗资源利用率和成本明显低于较晚治疗的患者。这些结果有望为促进早期使用ETBD提供证据，以达到患者受益和降低成本的目的。证据水平

{"title":"Timing of Eustachian tube balloon dilation: Impact on resource utilization and cost","authors":"Robert M. Conway, Masanari Kato, Seilesh C. Babu","doi":"10.1016/j.amjoto.2025.104689","DOIUrl":"10.1016/j.amjoto.2025.104689","url":null,"abstract":"<div><h3>Importance</h3><div>Eustachian tube balloon dilation (ETBD) is a novel treatment option for adult patients with ETD, with superior efficacy to medical therapy. However, appropriate timing of performing ETBD hasn't been thoroughly examined.</div></div><div><h3>Objective</h3><div>This study compared healthcare resource utilization among patients with ETD that are treated early with ETBD (i.e., within 3 months of ETD diagnosis) versus those treated later (i.e., 3–12 months of ETD diagnosis).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Utilizing Optum Clinoformatics Socio-Economic Status (SES) Database.</div></div><div><h3>Participants</h3><div>Patients aged 18 and older who had ETBD procedure between January 2017 to June 2021.</div></div><div><h3>Interventions</h3><div>Patients were classified into two groups based on the treatment timing of their incident diagnosis of ETD: early treated and late treated.</div></div><div><h3>Main outcomes and measures</h3><div>Outcomes including 12-month ETD-related surgical procedure rate, number of office visits, medication use, and total cost were assessed and compared among the study cohorts. Study outcomes were assessed using generalized linear regression.</div></div><div><h3>Results</h3><div>Two hundred seventy-seven patients were identified, with 173 patients in the early ETBD cohort and 104 patients in the late ETBD cohort. Early treated patients had significantly lower ETD-related surgical procedure rates (8.7 % vs. 17.3 %) lower rates (28.9 % vs. 48.1 %) and fewer (0.47 vs. 1.12) ETD-related office visits, and fewer medication claims (2.19 vs. 3.06). The early treated cohort had significantly lower ETD-related costs ($212.15 vs. $551) compared to patients treated later after diagnosis.</div></div><div><h3>Conclusions and relevance</h3><div>Among ETD patients undergoing ETBD, those treated early had significantly lower healthcare resource utilization and cost in comparison to those treated later. These results will hopefully add evidence to promote the early use of ETBD for purposes of patient benefit and decreased costs.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104689"},"PeriodicalIF":1.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Modeling complex relationships in laryngeal pathologies: A structural equation analysis of dysphonia in Saudi Arabian patients 模拟喉病理的复杂关系：沙特阿拉伯患者发音障碍的结构方程分析

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-06-10 DOI: 10.1016/j.amjoto.2025.104690

Omar Ibrahim Alanazi , Sameer Al-bahkaly , Feras Alkholaiwi , Yousef Aljathlany , Mohammed Khalid Alhussaini , Omar Ahmed Alrashood , Ahmed Ibrahim Alanazi , Faisal A. Althwiny , Khaled Eid Alotibi , Alwaleed Abdullah Altamimi , Abdulaziz Saleh Alobaid , Abdullah Ahmed Alzamil , Faisal Abohelaibah , Faisal Alhussaini , Ahmed Y. Azzam

Introduction

Dysphonia is a prevalent laryngological condition that impairs communication and quality of life in several cases, however the interplay between risk factors and specific laryngeal pathologies remains poorly understood. Previous studies often lack structured modeling of these multifactorial interactions. We utilized structural equation modeling (SEM) in a large Saudi-based cohort to investigate the direct and indirect pathways linking demographic factors, behavioral variables, as well as the types of laryngeal pathologies.

Methods

Our retrospective cohort study retrieved and analyzed the relevant data from dysphonia patients at a tertiary-care hospital in Riyadh, Saudi Arabia. Laryngeal pathologies were categorized into structural, inflammatory, neurological, and functional types. Our proposed SEM framework has assessed both of the direct and indirect pathways from risk factors to these categories, including cross-pathology links and moderation effects.

Results

Our study cohort has included a total of 998 eligible dysphonia patients. Structural pathologies were most prevalent (33.9 %). The SEM demonstrated excellent fit (CFI = 0.961, RMSEA = 0.049) and identified significant pathways: female gender strongly predicted structural (β = 0.412) and functional pathologies; increasing age associated positively with inflammatory, neurological, and functional types; smoking strongly predicted inflammatory pathologies (β = 0.338); occupational voice use predicted structural (β = 0.356) and functional (β = 0.297).

Conclusions

This SEM-based etiological model reveals peculiar and significant important dysphonia pathways with clear demographic signatures in a Saudi-based population. Findings highlight specific high-risk groups (as female voice professionals, older smokers) and important progression patterns (inflammatory-to-neurological, structural-to-functional). This framework helps to offer a more precise risk profiling, supporting targeted screening protocols and tailored preventive interventions based on specific risk factors and interconnected pathology development.

语音障碍是一种常见的喉部疾病，在一些情况下会损害沟通和生活质量，然而，危险因素与特定喉部病变之间的相互作用仍然知之甚少。以往的研究往往缺乏对这些多因素相互作用的结构化建模。我们利用结构方程模型（SEM）在一个基于沙特的大型队列研究直接和间接途径连接人口因素，行为变量，以及喉部病理类型。方法回顾性队列研究检索并分析沙特阿拉伯利雅得一家三级医院的发声障碍患者的相关资料。喉部病理分为结构性、炎性、神经性和功能性。我们提出的扫描电镜框架评估了从危险因素到这些类别的直接和间接途径，包括交叉病理联系和调节作用。结果本研究共纳入998例符合条件的发声障碍患者。结构病变最常见（33.9%）。扫描电镜显示了极好的拟合（CFI = 0.961, RMSEA = 0.049），并发现了显著的途径：女性性别强烈预测结构（β = 0.412）和功能病理；年龄增长与炎症、神经和功能类型呈正相关；吸烟与炎症病理有显著相关性（β = 0.338）；职业语音使用预测结构（β = 0.356）和功能（β = 0.297）。结论：这种基于扫描电镜的病因模型揭示了沙特人口中具有明确人口特征的特殊和重要的语音障碍通路。研究结果强调了特定的高风险群体（如女性声音专业人士、老年吸烟者）和重要的进展模式（炎症到神经系统、结构到功能）。该框架有助于提供更精确的风险分析，支持基于特定风险因素和相互关联的病理发展的有针对性的筛查方案和量身定制的预防干预措施。

{"title":"Modeling complex relationships in laryngeal pathologies: A structural equation analysis of dysphonia in Saudi Arabian patients","authors":"Omar Ibrahim Alanazi , Sameer Al-bahkaly , Feras Alkholaiwi , Yousef Aljathlany , Mohammed Khalid Alhussaini , Omar Ahmed Alrashood , Ahmed Ibrahim Alanazi , Faisal A. Althwiny , Khaled Eid Alotibi , Alwaleed Abdullah Altamimi , Abdulaziz Saleh Alobaid , Abdullah Ahmed Alzamil , Faisal Abohelaibah , Faisal Alhussaini , Ahmed Y. Azzam","doi":"10.1016/j.amjoto.2025.104690","DOIUrl":"10.1016/j.amjoto.2025.104690","url":null,"abstract":"<div><h3>Introduction</h3><div>Dysphonia is a prevalent laryngological condition that impairs communication and quality of life in several cases, however the interplay between risk factors and specific laryngeal pathologies remains poorly understood. Previous studies often lack structured modeling of these multifactorial interactions. We utilized structural equation modeling (SEM) in a large Saudi-based cohort to investigate the direct and indirect pathways linking demographic factors, behavioral variables, as well as the types of laryngeal pathologies.</div></div><div><h3>Methods</h3><div>Our retrospective cohort study retrieved and analyzed the relevant data from dysphonia patients at a tertiary-care hospital in Riyadh, Saudi Arabia. Laryngeal pathologies were categorized into structural, inflammatory, neurological, and functional types. Our proposed SEM framework has assessed both of the direct and indirect pathways from risk factors to these categories, including cross-pathology links and moderation effects.</div></div><div><h3>Results</h3><div>Our study cohort has included a total of 998 eligible dysphonia patients. Structural pathologies were most prevalent (33.9 %). The SEM demonstrated excellent fit (CFI = 0.961, RMSEA = 0.049) and identified significant pathways: female gender strongly predicted structural (β = 0.412) and functional pathologies; increasing age associated positively with inflammatory, neurological, and functional types; smoking strongly predicted inflammatory pathologies (β = 0.338); occupational voice use predicted structural (β = 0.356) and functional (β = 0.297).</div></div><div><h3>Conclusions</h3><div>This SEM-based etiological model reveals peculiar and significant important dysphonia pathways with clear demographic signatures in a Saudi-based population. Findings highlight specific high-risk groups (as female voice professionals, older smokers) and important progression patterns (inflammatory-to-neurological, structural-to-functional). This framework helps to offer a more precise risk profiling, supporting targeted screening protocols and tailored preventive interventions based on specific risk factors and interconnected pathology development.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104690"},"PeriodicalIF":1.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0