Pub Date : 2025-07-11DOI: 10.1016/j.amjoto.2025.104696
Ilker Sengul , Demet Sengul
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Pub Date : 2025-06-23DOI: 10.1016/j.amjoto.2025.104695
Sabri Baki Eren , Alper Yenigun , Erol Senturk , Abdullah Ozdem , Remzi Dogan , Orhan Ozturan
Background
Mastoid obliteration is a useful surgical step in the treatment of chronic ear operation. The technique of mastoid obliteration involves filling the cavity with self-tissue and/or osseocartilaginous graft material, following removing the mastoid air cell.
Objective
The aim of this study is to show the advantages of mastoid obliteration using a mixture of CGF and bone dust.
Material and method
Bone dust was collected with an apparatus from the healthy mastoid cortex. Collected bone dust was mixed with CGF to form a gel. Then, mastoid cavity and epitympanum obliteration were performed.
Results
Fifteen patients who underwent canal wall down mastoidectomy for cholesteatoma were included in the study. In all patients, the targeted external ear canal and hearing results were obtained after obliteration.
Conclusion
It is an effective surgical technique for creating a natural external ear path after mastoidectomy applied for mastoid obliteration, chronic ear infections and cholesteatoma treatment with CGF. Mastoid obliteration using bone dust mixed with CFG is an effective surgical technique to create a natural and healthy external ear canal.
{"title":"Mastoid obliteration with bone dust mixed with concentrated growth factor","authors":"Sabri Baki Eren , Alper Yenigun , Erol Senturk , Abdullah Ozdem , Remzi Dogan , Orhan Ozturan","doi":"10.1016/j.amjoto.2025.104695","DOIUrl":"10.1016/j.amjoto.2025.104695","url":null,"abstract":"<div><h3>Background</h3><div>Mastoid obliteration is a useful surgical step in the treatment of chronic ear operation. The technique of mastoid obliteration involves filling the cavity with self-tissue and/or osseocartilaginous graft material, following removing the mastoid air cell.</div></div><div><h3>Objective</h3><div>The aim of this study is to show the advantages of mastoid obliteration using a mixture of CGF and bone dust.</div></div><div><h3>Material and method</h3><div>Bone dust was collected with an apparatus from the healthy mastoid cortex. Collected bone dust was mixed with CGF to form a gel. Then, mastoid cavity and epitympanum obliteration were performed.</div></div><div><h3>Results</h3><div>Fifteen patients who underwent canal wall down mastoidectomy for cholesteatoma were included in the study. In all patients, the targeted external ear canal and hearing results were obtained after obliteration.</div></div><div><h3>Conclusion</h3><div>It is an effective surgical technique for creating a natural external ear path after mastoidectomy applied for mastoid obliteration, chronic ear infections and cholesteatoma treatment with CGF. Mastoid obliteration using bone dust mixed with CFG is an effective surgical technique to create a natural and healthy external ear canal.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104695"},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517111","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}
Pub Date : 2025-06-23DOI: 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.
{"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}
Pub Date : 2025-06-22DOI: 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}
Pub Date : 2025-06-20DOI: 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}
Pub Date : 2025-06-14DOI: 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.
{"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}
Pub Date : 2025-06-13DOI: 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}
Pub Date : 2025-06-11DOI: 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.
{"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}
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.
{"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}
Pub Date : 2025-06-11DOI: 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.
{"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}
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