American Journal of Otolaryngology最新文献_第2页

Efficacy and safety of laser ablation and microwave ablation to treat papillary thyroid microcarcinoma: A retrospective study 激光消融和微波消融治疗甲状腺乳头状微癌的有效性和安全性：一项回顾性研究

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-14 DOI: 10.1016/j.amjoto.2024.104496

Yuqing Huang , Xinyu Zhao , Yu Yang , Lanyan Qiu , Junfeng Zhao , Linxue Qian , Xianquan Shi

Objective

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

Methods

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

Results

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

Conclusion

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

目的回顾性分析激光消融（LA）和微波消融（MWA）治疗甲状腺乳头状微癌（PTMC）的疗效和安全性。方法这是一项回顾性研究，研究对象为2019年10月至2023年3月期间接受热消融治疗PTMC的103例患者（109个结节），其中61例接受了LA治疗，48例接受了MWA治疗。患者平均年龄为（43.50±12.42）岁。消融术后，对不同时间点的肿瘤大小变化、局部复发、新病灶、淋巴结转移和并发症进行了评估和记录。分析了 LA 和 MWA 的可行性、成功率和安全性。在最后一次随访中，PTMC结节的平均体积从0.09±0.09毫升（LA组）减小到0.03±0.03毫升（MWA组）（均为P< 0.05）。各组之间的血容量变化无明显差异（P（组）：0.520；P（组）：0.520；P（组）：0.520）：0.520; P (groups over time)：0.423），表明两组疗效相似。在随访期间，除 3 个月外，各组的体积缩小率也无明显差异（P = 0.023）。结论在短期随访中，超声引导 LA 和 MWA 治疗 PTMC 有效且安全，两种方法的治疗效果无明显差异。

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引用次数: 0

Is video interpretation compromising care for the hearing loss population? 视频口译是否会影响对听力损失人群的护理？

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-14 DOI: 10.1016/j.amjoto.2024.104499

Julianna Mastropierro , Ritwik Sanyal , Alyssa Heiser , Emily Gjini , Kathryn Noonan

Objective

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

Methods

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

Results

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

Conclusion

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

目的听力障碍和语言障碍交织在一起，给患者和耳鼻喉科医生的沟通带来了独特的挑战。对听力损失患者的口译方法进行比较的数据有限。听力损失患者依赖于视觉提示、读唇、书面交流和/或综合互动技术，这些方法可能会受到远程服务的限制。本研究是一项前瞻性随机对照试验，研究对象为中重度双侧听力损失、英语能力有限且主要语言为普通话或粤语的患者。52 名患者被随机分配到现场或虚拟口译环境中。患者满意度采用 8 项李克特量表来评估沟通效果、会面效率和总体质量。耳鼻喉科医护人员的满意度采用 1 项李克特量表进行测量。结果与虚拟口译（医生平均分为 3.8 分）相比，患者和耳鼻喉科医生对现场口译的满意度得分明显更高（患者 8 个项目中的 7 个项目，p < 0.05；医生平均分为 4.9 分，p < 0.001，r = 0.54），而会诊的整体质量保持不变。两组患者的会诊时间和要求口译员重复翻译的次数没有明显差异。结论患者和耳鼻喉科医生对现场口译服务的总体满意度高于虚拟口译服务。在听力损失人群中，普通话和粤语患者对当面口译的理解能力更强，与虚拟口译相比具有成本优势。

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引用次数: 0

Analysis of antibiotic resistant infections associated with hirudotherapy 与水蛭素疗法相关的抗生素耐药性感染分析

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-14 DOI: 10.1016/j.amjoto.2024.104500

Philip R. Brauer , Malaak Saadah , Michael A. Fritz , Shannon S. Wu , Eric D. Lamarre

Objective

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

Methods

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

Results

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

Conclusion

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

方法从美国食品和药物管理局 MAUDE 数据库中检索 2012 年至 2021 年间所有涉及水蛭疗法（产品代码 "NRN"）的不良事件报告。抗生素耐药性通过细菌培养或使用抗生素后的感染来定义。结果共发现19例涉及水蛭疗法的抗生素耐药性病例。只有三例抗生素耐药性是在常规检测中发现的，其余 16 例均与患者受伤有关。26.3%的病例（5 例）出现血液培养阳性或发热。感染培养出嗜水气单胞菌（n = 13；68.4%）、弧菌（n = 3；15.8%）、铜绿假单胞菌（n = 2；10.5%）和普通变形杆菌（n = 1；5.3%）。耐多药感染有 9 例（47.4%）。感染最常见的耐药药物是氟喹诺酮类（9 人；47.4%）、三甲双氨-磺胺甲噁唑（9 人；47.4%）和厄他培南（4 人；21.1%）。此外，还发现了对最后一种药物厄他培南的耐药性。越来越多的文献指出，多种药物耐药性的趋势比以往报告的更为严重，本研究的结果支持了这一观点。

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引用次数: 0

The influence of tinnitus frequency on patients experiencing subjective tinnitus and the efficacy and prognosis of acoustic therapy 耳鸣频率对主观性耳鸣患者的影响以及声学疗法的疗效和预后

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-14 DOI: 10.1016/j.amjoto.2024.104498

Juan Li, Yu Zhang, Yuqin Chen, Songli Xi, Song Shi, Cong Li, Tiantian Su

Objective

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

Methods

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

Results

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

Conclusion

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

本研究探讨了声学疗法对不同耳鸣频率的慢性主观性耳鸣患者的治疗效果和预后。方法共选取了135名主观性耳鸣患者，根据他们的主音频率分为三组：高频组（43名患者，4-8 kHz）、中频组（40名患者，1-3 kHz）和低频组（42名患者，< 1 kHz）。所有患者都接受了针对其特定频率和响度水平的声学疗法，以及耳鸣认知行为疗法。结果与中频和高频组相比，低频组的耳鸣响度有统计学改善（P <0.05）。低频组的有效率为 93.55%，中频组为 82.88%，高频组为 58.82%。低频组的有效率明显高于高频组，但与中频组相比无统计学差异。

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引用次数: 0

Individualized sublingual immunotherapy with dynamic maintenance dose ascending for house dust mite-induced allergic rhinitis 针对屋尘螨诱发的过敏性鼻炎，采用动态维持剂量递增的个性化舌下免疫疗法。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-13 DOI: 10.1016/j.amjoto.2024.104476

Juan Wang , Ling Cai , Caiqin Huang , Jing Pei, Xinyi Shi, Yuejin Tao

Background

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

Methods

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

Results

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

Conclusions

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

背景：舌下免疫疗法（SLIT）的精确剂量逐渐成为热点，但目前尚无针对屋尘螨（HDM）-SLIT的标准化剂量调整模式。本研究旨在探讨个体化舌下免疫疗法动态维持剂量递增方案的临床可行性：这项回顾性研究共纳入了 258 名接受 HDM-SLIT 治疗的过敏性鼻炎（AR）患者。根据 SLIT 的不同维持剂量，患者被分为常规剂量（RD）组（n = 101）和高剂量（HD）组（n = 157）。在常规剂量组，患者接受生产商推荐的固定剂量。在高剂量组，患者接受的是动态剂量递增法确定的最大耐受剂量。临床疗效通过基线、0.5 年、1 年和 2 年的症状和用药综合评分（CSMS）和视觉模拟量表评分（VAS）进行评估。安全性通过不良事件（AEs）进行评估：与基线相比，RD 组和 HD 组在 0.5 年、1 年和 2 年的 CSMS 和 VAS 均显著下降（P 0.05）。在递增阶段和维持阶段，两组均未出现严重的AE，RD组和HD组的AE发生率也无明显差异：为期2年的HDM-SLIT动态维持剂量递增方案为AR患者提供了 "最佳 "治疗，同时保证了安全性。这项研究在临床实践中引入了个体化剂量调整模式，为 AR 患者带来了潜在的益处。

{"title":"Individualized sublingual immunotherapy with dynamic maintenance dose ascending for house dust mite-induced allergic rhinitis","authors":"Juan Wang , Ling Cai , Caiqin Huang , Jing Pei, Xinyi Shi, Yuejin Tao","doi":"10.1016/j.amjoto.2024.104476","DOIUrl":"10.1016/j.amjoto.2024.104476","url":null,"abstract":"<div><h3>Background</h3><p>Precision dosing in sublingual immunotherapy (SLIT) has become a hotspot gradually, yet no standardized dose adjustment pattern for house dust mite (HDM)-SLIT. This study aims to investigate the clinical feasibility of the dynamic maintenance dose ascending regimen for individualized SLIT.</p></div><div><h3>Methods</h3><p>A total of 258 allergic rhinitis (AR) patients treated with HDM-SLIT were included in this retrospective study. Patients were divided into the regular dose (RD) group (<em>n</em> = 101) and the high dose (HD) group (<em>n</em> = 157) according to different maintenance dosages of SLIT. In the RD group, patients received the fixed dose recommended by the manufacturer. In the HD group, patients received a maximum tolerance dose determined by dynamic dose ascending. The clinical efficacy was evaluated by combined symptom and medication score (CSMS) and visual analogue scale score (VAS) at the baseline, 0.5-year, 1-year, and 2-year. The safety was evaluated by adverse events (AEs).</p></div><div><h3>Results</h3><p>Significant reductions of CSMS and VAS at 0.5-year, 1-year, and 2-year were observed in both the RD group and the HD group compared to the baseline (<em>P</em> < 0.05). In addition, greater improvements in these clinical parameters from 0.5- to 2-year were found in the HD group compared to the RD group (<em>P</em> < 0.05). For subgroup analysis in the HD group, no significant differences in CSMS and VAS were observed among subgroups of patients <14 years old and patients ≥14 years old (<em>P</em> > 0.05). No serious AEs in the two groups and no significant differences were observed between the AE incidence rate of the RD group and HD group during the incremental and maintenance phases.</p></div><div><h3>Conclusions</h3><p>The 2-year HDM-SLIT with dynamic maintenance dose ascending regimen offers an “optimal” treatment for AR patients while maintaining safety. This study introduced a pattern for individualized dose adjustment in clinical practice, offering potential benefits for AR patients.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104476"},"PeriodicalIF":1.8,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008130","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

Association between blood transfusion and outcomes of free flap head and neck cancer surgery 输血与游离头颈癌皮瓣手术疗效之间的关系

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-13 DOI: 10.1016/j.amjoto.2024.104497

Kenzo M. Cotton , Andrew R. Mangan , James R. Gardner , Aryan Shay , Deanne King , Emre A. Vural , Mauricio Moreno-Vera , Geoffrey Muller , Jumin Sunde

Objective

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

Study design

Retrospective chart review.

Setting

Single tertiary referral center.

Methods

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

Results

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

Conclusion

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

研究设计回顾性病历审查。方法纳入2014年至2020年期间接受游离皮瓣重建术的400名患者。主要结果指标为红细胞输注量和输血量。评估种族、性别、皮瓣位置和组织类型、病理、依赖功能状态、住院时间和癌症复发与术中和/或术后输注红细胞的关系。输血适用于血红蛋白为 7-8 和/或有症状的贫血患者。进行了方差分析和Chi2统计分析。结果在纳入的 400 名患者中，58 人需要输注红细胞。其中 67.8% 为男性，种族人口统计学特征包括 9.00% 非裔美国人、1.30% 亚洲人、1.00% 西班牙/拉丁美洲人、87.8% 白人、1.00% 其他。与白人患者相比，非裔美国人患者输注的红细胞量更高（855.00 mL vs. 437.07 mL，p = 0.005）。住院时间与输注红细胞明显相关（5.95 天 vs. 7.22 天，p ≤0.001）。依赖性功能状态与输注红细胞的需求相关（p = 0.002）。游离皮瓣的类型与输注红细胞的需求有关（p≤0.001），其中大腿前外侧皮瓣是最常见的导致输血的皮瓣（34/58）。某些游离皮瓣的输血风险较高。

{"title":"Association between blood transfusion and outcomes of free flap head and neck cancer surgery","authors":"Kenzo M. Cotton , Andrew R. Mangan , James R. Gardner , Aryan Shay , Deanne King , Emre A. Vural , Mauricio Moreno-Vera , Geoffrey Muller , Jumin Sunde","doi":"10.1016/j.amjoto.2024.104497","DOIUrl":"10.1016/j.amjoto.2024.104497","url":null,"abstract":"<div><h3>Objective</h3><p>Investigate the impact of patient risk factors and blood transfusions in Head and Neck free flap surgeries.</p></div><div><h3>Study design</h3><p>Retrospective chart review.</p></div><div><h3>Setting</h3><p>Single tertiary referral center.</p></div><div><h3>Methods</h3><p>400 patients were included undergoing free flap reconstruction from 2014 to 2020. The primary outcome measures were red blood cell transfusion and volume transfused. Race, sex, flap location and tissue type, pathology, dependent functional status, length of stay, and cancer recurrence were evaluated for association with red blood cell transfusion intraoperatively and/or postoperatively. Transfusions were indicated on patients with Hemoglobin <7–8 and/or symptomatic anemia. ANOVA and Chi<sup>2</sup> statistical analysis were performed. The significance was set at <em>p</em> ≤0.05.</p></div><div><h3>Results</h3><p>Of the 400 patients included, 58 required red blood cell transfusion. Of these 67.8 % were males, racial demographics included 9.00 % African American, 1.30 % Asian, 1.00 % Hispanic/Latino, 87.8 % White, 1.00 % other. African American patients received a higher volume of transfused red blood cells versus white patients (855.00 mL vs. 437.07 mL, <em>p</em> = 0.005). Length of stay was significantly associated with red blood cell transfusion (5.95 days vs. 7.22 days, <em>p</em> ≤0.001). Dependent functional status and need for red blood cell transfusion were associated (<em>p</em> = 0.002). Type of free flap was associated with need for red blood cell transfusion (<em>p</em> ≤0.001) with anterolateral thigh flaps being the most common resulting in transfusion (34/58).</p></div><div><h3>Conclusion</h3><p>Red blood cell transfusion was significantly associated with race, dependent functional status and length of stay. Certain free flaps have a higher risk of blood transfusion.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104497"},"PeriodicalIF":1.8,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992855","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

A lightweight intelligent laryngeal cancer detection system for rural areas 适用于农村地区的轻型智能喉癌检测系统

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-08 DOI: 10.1016/j.amjoto.2024.104474

Yi-Fan Kang , Lie Yang , Kai Xu , Bin-Bin Hu , Lan-Jun Cai , Yin-Hao Liu , Xiang Lu

Objective

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

Methods

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

Results

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

Conclusion

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

目标喉癌（LC）的早期诊断至关重要，尤其是在农村地区。尽管目前已有关于喉癌识别深度学习模型的研究，但在为喉科医生短缺和计算机资源有限的农村地区选择合适的模型方面仍存在挑战。我们提出了智能喉癌检测系统（ILCDS），这是一种基于深度学习的解决方案，专为资源有限的农村地区提供有效的喉癌筛查。随后，我们使用了八种深度学习模型--AlexNet、VGG、ResNet、DenseNet、MobileNet、ShuffleNet、Vision Transformer 和 Swin Transformer--进行喉癌识别。结果在性能方面，所有模型在测试集上的平均准确率都超过了 90%。特别值得一提的是，VGG、DenseNet 和 MobileNet 的准确率超过了 95%，分别为 95.32%、95.75% 和 95.99%。在效率方面，MobileNet 由于体积小、推理速度快而表现出色，是集成到 ILCDS 中的理想模型。

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引用次数: 0

Efficacy and safety of SENS-401 in sudden sensorineural hearing loss: The AUDIBLE-S randomized placebo-controlled phase IIb trial SENS-401 对突发性感音神经性听力损失的疗效和安全性：AUDIBLE-S 随机安慰剂对照 IIb 期试验

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-08 DOI: 10.1016/j.amjoto.2024.104480

Itzhak Braverman , Maya Elziere , Zoran Komazec , Mauricio Cohen-Vaizer , Mahmut Tayyar Kalcioglu , Viktor Chrobok , Igor Kazmer , Ohad Hilly , Marie Jose Esteve-Fraysse , Ilana Doweck , Anne-Lise Glotin , Serge Fitoussi , Judith Laredo , Geraldine Honnet

Purpose

Safety and efficacy of SENS-401, a serotonin type 3 (5-HT₃) receptor antagonist and calcineurin inhibitor, in patients with acute sudden sensorineural hearing loss (SSNHL).

Methods

Multicentre randomized, double blind, placebo-controlled trial enrolled adult subjects with sudden sensorineural hearing loss (SSNHL) or unilateral/bilateral acute acoustic trauma leading to SSNHL within 96 h of disease onset. Subjects were randomly assigned to one of the three oral dose groups: 29 mg, 43.5 mg or placebo given twice daily for 28 days. The primary endpoint was the change from baseline in Pure Tone Average (PTA) in the affected ear to the end of treatment visit (day 28). Subjects were further followed up 8 weeks after the end of the treatment period (day 84).

Results

A total of 115 subjects were randomized. SENS-401 was well tolerated. Although the primary efficacy endpoint was not met at day 28, post-hoc analyses revealed clinically significant and meaningful efficacy outcomes with SENS-401 when compared to placebo in a substantial group of participants diagnosed with idiopathic SSNHL and who had received corticosteroid treatment. Notable improvements were observed in the PTA change from baseline, the complete hearing recovery rate, and the Word Recognition Score (WRS), particularly at day 84. The responder rate consistently favored treated subjects over those who received the placebo.

Conclusion

While the primary endpoint was not achieved at the end of the treatment period, the study revealed consistently positive efficacy results of clinical relevance in patients with idiopathic SSNHL who received SENS-401, particularly in the 8-weeks follow-up phase after the completion of the treatment.

目的SENS-401是一种5-羟色胺3型（5-HT3）受体拮抗剂和钙神经蛋白抑制剂，用于急性突发性感音神经性听力损失（SSNHL）患者的安全性和疗效。方法多中心随机、双盲、安慰剂对照试验招募了发病96小时内患有突发性感音神经性听力损失（SSNHL）或单侧/双侧急性声外伤导致SSNHL的成年受试者。受试者被随机分配到三个口服剂量组中的一个：29 毫克、43.5 毫克或安慰剂，每天两次，连续服用 28 天。主要终点是患耳的纯音平均值（PTA）从基线到治疗结束时（第28天）的变化。治疗结束 8 周后（第 84 天）对受试者进行进一步随访。SENS-401 的耐受性良好。虽然在第 28 天未达到主要疗效终点，但事后分析表明，与安慰剂相比，SENS-401 对大部分被诊断为特发性 SSNHL 并接受过皮质类固醇治疗的受试者具有显著的临床意义和疗效。与基线相比，PTA 的变化、听力完全恢复率和词汇识别评分 (WRS) 都有明显改善，尤其是在第 84 天。结论虽然在治疗期结束时没有达到主要终点，但该研究显示，接受 SENS-401 治疗的特发性 SSNHL 患者的临床疗效一直很好，尤其是在治疗结束后的 8 周随访阶段。

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引用次数: 0

Perioperative opioids in high-risk children undergoing tonsillectomy – A single institution experience 在接受扁桃体切除术的高风险儿童中使用围手术期阿片类药物 - 单个机构的经验

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-08 DOI: 10.1016/j.amjoto.2024.104453

Asher C. Park , Kathleen Billings , John Maddalozzo , Richard Dsida , Hubert A. Benzon , Jennifer Lavin , Inbal Hazkani

Background

Patients undergoing tonsillectomy/ adenotonsillectomy (T/AT) can experience substantial postoperative pain. The aims of this study are to assess perioperative pain management in high-risk children (children with severe obstructive sleep apnea and other complex medical comorbidities or age younger than 2 years) undergoing T/AT, and the impact on oxygen levels and pain during extended Post-Anesthesia Care Unit (PACU) admission.

Methods

A retrospective case series study at a tertiary care children's hospital.

Results

There were 278 children enrolled in the study. The Apnea-Hypopnea index and mean oxygen nadir on preoperative polysomnography were 31.3 ± 25.76/h and 79.5 ± 9.5 % respectively. Overall, 246 (89 %) patients received intraoperative opioids alone (n = 35, 13 %) or in combination with non-opioid analgesia (n = 209, 75 %). While the median dose of opioid-free medications (acetaminophen, ibuprofen) ranged from 93 to 100 % of standard maximal dosing by weight and age, the median dose of opioids was significantly lower and ranged from 54 to 63 % of standard maximal dosing by weight and age, with 43 % of the patients receiving less than half the recommended maximum dose. Oxygen desaturation was charted in 21 patients (8 %) during their PACU admission. Patients who received opioid-free analgesia were as likely to develop oxygen desaturations (n = 17 (81 %) vs. n = 228 (89.4 %), p = 0.27) and to receive rescue pain medication during their PACU stay as patients who received opioids intraoperatively (n = 18 (56 %) vs. n = 167 (68 %), p = 0.23).

Conclusions

Intraoperative pain management varies across high-risk pediatric tonsillectomies. Opioid-free analgesia was not associated with an increased need for pain medications during PACU admission, or with a decreased likelihood of oxygen desaturations compared to intra-operative opioid analgesia use.

背景接受扁桃体切除术/腺样体切除术（T/AT）的患者可能会经历剧烈的术后疼痛。本研究的目的是评估接受扁桃体切除术/腺扁桃体切除术的高风险儿童（患有严重阻塞性睡眠呼吸暂停和其他复杂并发症或年龄小于 2 岁的儿童）的围术期疼痛管理，以及在麻醉后护理病房（PACU）住院期间对氧气水平和疼痛的影响。术前多导睡眠图显示的呼吸暂停-低通气指数和平均血氧饱和度分别为 31.3 ± 25.76/h 和 79.5 ± 9.5 %。总体而言，246 名（89%）患者在术中单独使用阿片类药物（35 人，13%）或与非阿片类药物镇痛联合使用（209 人，75%）。不含阿片类药物（对乙酰氨基酚、布洛芬）的中位剂量为标准最大剂量的 93% 至 100%（按体重和年龄），而阿片类药物的中位剂量则明显较低，为标准最大剂量的 54% 至 63%（按体重和年龄），其中 43% 的患者接受的剂量不到建议最大剂量的一半。有 21 名患者（8%）在入住 PACU 期间出现了血氧饱和度下降。与术中接受阿片类药物的患者相比，接受无阿片类药物镇痛的患者发生氧饱和度下降的几率（n = 17 (81 %) vs. n = 228 (89.4 %)，p = 0.27）和在 PACU 留院期间接受止痛药物抢救的几率（n = 18 (56 %) vs. n = 167 (68 %)，p = 0.23）相同。与术中使用阿片类镇痛药相比，无阿片类镇痛与PACU住院期间对镇痛药的需求增加无关，也与氧饱和度降低的可能性无关。

{"title":"Perioperative opioids in high-risk children undergoing tonsillectomy – A single institution experience","authors":"Asher C. Park , Kathleen Billings , John Maddalozzo , Richard Dsida , Hubert A. Benzon , Jennifer Lavin , Inbal Hazkani","doi":"10.1016/j.amjoto.2024.104453","DOIUrl":"10.1016/j.amjoto.2024.104453","url":null,"abstract":"<div><h3>Background</h3><p>Patients undergoing tonsillectomy/ adenotonsillectomy (T/AT) can experience substantial postoperative pain. The aims of this study are to assess perioperative pain management in high-risk children (children with severe obstructive sleep apnea and other complex medical comorbidities or age younger than 2 years) undergoing T/AT, and the impact on oxygen levels and pain during extended Post-Anesthesia Care Unit (PACU) admission.</p></div><div><h3>Methods</h3><p>A retrospective case series study at a tertiary care children's hospital.</p></div><div><h3>Results</h3><p>There were 278 children enrolled in the study. The Apnea-Hypopnea index and mean oxygen nadir on preoperative polysomnography were 31.3 ± 25.76/h and 79.5 ± 9.5 % respectively. Overall, 246 (89 %) patients received intraoperative opioids alone (<em>n</em> = 35, 13 %) or in combination with non-opioid analgesia (<em>n</em> = 209, 75 %). While the median dose of opioid-free medications (acetaminophen, ibuprofen) ranged from 93 to 100 % of standard maximal dosing by weight and age, the median dose of opioids was significantly lower and ranged from 54 to 63 % of standard maximal dosing by weight and age, with 43 % of the patients receiving less than half the recommended maximum dose. Oxygen desaturation was charted in 21 patients (8 %) during their PACU admission. Patients who received opioid-free analgesia were as likely to develop oxygen desaturations (<em>n</em> = 17 (81 %) vs. <em>n</em> = 228 (89.4 %), <em>p</em> = 0.27) and to receive rescue pain medication during their PACU stay as patients who received opioids intraoperatively (<em>n</em> = 18 (56 %) vs. <em>n</em> = 167 (68 %), <em>p</em> = 0.23).</p></div><div><h3>Conclusions</h3><p>Intraoperative pain management varies across high-risk pediatric tonsillectomies. Opioid-free analgesia was not associated with an increased need for pain medications during PACU admission, or with a decreased likelihood of oxygen desaturations compared to intra-operative opioid analgesia use.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104453"},"PeriodicalIF":1.8,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141991235","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

The association between amblyopia and the risks of hearing loss: A propensity matched analysis 弱视与听力损失风险之间的关系：倾向匹配分析

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-08-08 DOI: 10.1016/j.amjoto.2024.104495

Hejin Jeong , Chelsea Cleveland , Todd Otteson

Introduction

Amblyopia occurs due to an imbalance in the visual input between the eyes. This can induce structural changes in the central nervous system and, if left untreated, eventually lead to permanent blindness in the affected eye. As these changes may also impact the auditory system, which closely interacts with the visual system, this study aimed to investigate the risk of hearing loss in patients with amblyopia.

Materials and methods

This study was a retrospective review of the electronic medical records contained in a United States national database of medical records. Patients younger than 18 years old with and without amblyopia were matched and compared to evaluate the relative risk (RR) of having a hearing loss. Stratified analyses were further performed to explore whether the disease laterality and the amblyopia subtype influenced the risks.

Results

Compared to the controls, patients with amblyopia had a higher overall risk of having hearing loss (RR: 1.09, CI: 1.03–1.14), specifically sensorineural hearing loss (SNHL) (RR: 1.24, CI: 1.08–1.42). The stratified analysis further revealed that SNHL was associated with refractive amblyopia (RR: 1.84, CI: 1.50–2.26), but not strabismic amblyopia (RR: 1.23, CI: 1.10–1.38). The laterality of amblyopia did not influence the risk of hearing loss.

Conclusions

Children with amblyopia have a higher rate of SNHL than children without amblyopia. As vision and hearing are essential in the proper cognitive development, language acquisition, and social and emotional well-being of children, patients with amblyopia may benefit from more frequent audiologic screening.

简介弱视的发生是由于双眼视觉输入不平衡。这可能会引起中枢神经系统的结构变化，如果不及时治疗，最终会导致患眼永久失明。由于这些变化也可能影响与视觉系统密切相关的听觉系统，本研究旨在调查弱视患者听力损失的风险：本研究对美国国家医疗记录数据库中的电子医疗记录进行了回顾性审查。对年龄小于 18 岁的弱视患者和非弱视患者进行配对和比较，以评估听力损失的相对风险 (RR)。我们还进一步进行了分层分析，以探讨疾病侧位和弱视亚型是否会影响风险：与对照组相比，弱视患者出现听力损失的总体风险更高（RR：1.09，CI：1.03-1.14），尤其是感音神经性听力损失（SNHL）（RR：1.24，CI：1.08-1.42）。分层分析进一步显示，SNHL 与屈光性弱视有关（RR：1.84，CI：1.50-2.26），但与斜视性弱视无关（RR：1.23，CI：1.10-1.38）。弱视的侧向性并不影响听力损失的风险：结论：弱视儿童的SNHL发病率高于非弱视儿童。由于视力和听力对儿童的正常认知发展、语言习得、社交和情感健康至关重要，因此弱视患者可能会从更频繁的听力筛查中获益。

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引用次数: 0