Pub Date : 2025-12-05DOI: 10.1016/j.amjoto.2025.104776
Alec Kadrie , Jonathan Laredo , Evan Thomson , M. Boyd Gillespie
Objective
To compare short- and long-term clinical outcomes of continuous positive airway pressure versus palatal surgical interventions such as uvulopalatopharyngoplasty, including their impacts on sleep apnea-related cardiac, respiratory, and metabolic comorbidities.
Study design
Retrospective cohort study.
Setting
Database study using the TriNetX Network of Tennessee (2014–2024).
Methods
Adult patients diagnosed with obstructive sleep apnea and treated with either continuous positive airway pressure or palatal surgery were identified. Propensity score matching was performed to balance demographics and preexisting comorbidities between groups. Primary outcomes were cardiopulmonary events, and secondary outcomes were new-onset type 2 diabetes and weight change. Odds ratio with 95 % confidence intervals were computed across outcome measures.
Results
A total of 5030 continuous positive airway pressure and 220 palatal surgery patients met inclusion criteria. Following matching, 220 patients remained in each group. Patients treated with continuous positive airway pressure had significantly higher odds of post-treatment electronic medical record coding of acute respiratory failure (OR 4.67, [2.27, 9.60]), pulmonary hypertension (OR 20.0, [2.71, 147.7]), and new-onset atrial fibrillation/flutter (OR 3.32, [1.60, 6.96]) compared to the surgical cohort. No significant differences were observed in myocardial infarction, stroke, or new-onset type 2 diabetes.
Conclusion
Patients treated with continuous positive airway pressure had higher odds of post-treatment electronic medical recording coding of cardiorespiratory complications than those undergoing palatal surgery. These findings highlight potentially important differences between treatment modalities in long-term obstructive sleep apnea related comorbidities.
{"title":"Continuous positive airway pressure vs palatal surgery: Outcomes in obstructive sleep apnea treatment","authors":"Alec Kadrie , Jonathan Laredo , Evan Thomson , M. Boyd Gillespie","doi":"10.1016/j.amjoto.2025.104776","DOIUrl":"10.1016/j.amjoto.2025.104776","url":null,"abstract":"<div><h3>Objective</h3><div>To compare short- and long-term clinical outcomes of continuous positive airway pressure versus palatal surgical interventions such as uvulopalatopharyngoplasty, including their impacts on sleep apnea-related cardiac, respiratory, and metabolic comorbidities.</div></div><div><h3>Study design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Database study using the TriNetX Network of Tennessee (2014–2024).</div></div><div><h3>Methods</h3><div>Adult patients diagnosed with obstructive sleep apnea and treated with either continuous positive airway pressure or palatal surgery were identified. Propensity score matching was performed to balance demographics and preexisting comorbidities between groups. Primary outcomes were cardiopulmonary events, and secondary outcomes were new-onset type 2 diabetes and weight change. Odds ratio with 95 % confidence intervals were computed across outcome measures.</div></div><div><h3>Results</h3><div>A total of 5030 continuous positive airway pressure and 220 palatal surgery patients met inclusion criteria. Following matching, 220 patients remained in each group. Patients treated with continuous positive airway pressure had significantly higher odds of post-treatment electronic medical record coding of acute respiratory failure (OR 4.67, [2.27, 9.60]), pulmonary hypertension (OR 20.0, [2.71, 147.7]), and new-onset atrial fibrillation/flutter (OR 3.32, [1.60, 6.96]) compared to the surgical cohort. No significant differences were observed in myocardial infarction, stroke, or new-onset type 2 diabetes.</div></div><div><h3>Conclusion</h3><div>Patients treated with continuous positive airway pressure had higher odds of post-treatment electronic medical recording coding of cardiorespiratory complications than those undergoing palatal surgery. These findings highlight potentially important differences between treatment modalities in long-term obstructive sleep apnea related comorbidities.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104776"},"PeriodicalIF":1.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691265","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 : 2025-12-04DOI: 10.1016/j.amjoto.2025.104768
Joo Hyun Kim
Purpose
To evaluate how stone location and size influence surgical approach selection in submandibular sialolithiasis, and to identify computed tomography (CT)-based imaging predictors to aid preoperative planning.
Methods
We retrospectively reviewed 428 consecutive surgeries (March 2020–December 2024). Preoperative non-contrast CT classified stones as distal duct, mid-duct, hilum, or intraglandular. Surgical approaches were transoral ductal incision, sialendoscopy-assisted removal, and external submandibular gland excision. Group comparisons used standard parametric/non-parametric tests. Receiver operating characteristic (ROC) analysis assessed size thresholds associated with selection of an invasive approach.
Results
Distal duct stones were most often treated by transoral incision (83.7 %), mid-duct stones by sialendoscopy-assisted removal (58.1 %), and intraglandular stones by external excision (71.0 %). Stones in the hilum/intraglandular regions were significantly larger than those in distal or mid-duct locations (p < 0.001). ROC analysis identified 5.5 mm as the optimal cutoff for predicting selection of an invasive approach (AUC = 0.83; sensitivity 74.2 %; specificity 78.9 %). Overall surgical success was 97.8 %. Complication rates varied by approach, lowest after sialendoscopy-assisted removal (4.4 %) and highest after external excision (15.2 %).
Conclusions
A simple CT-based framework incorporating stone location and size was associated with approach selection and outcomes in submandibular sialolithiasis. Using a 5.5 mm size threshold alongside anatomic zoning may help guide minimally invasive, gland-preserving strategies and reduce morbidity. Prospective validation is warranted.
{"title":"Surgical strategy in submandibular sialolithiasis: Impact of stone location and size on approach selection and outcomes","authors":"Joo Hyun Kim","doi":"10.1016/j.amjoto.2025.104768","DOIUrl":"10.1016/j.amjoto.2025.104768","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate how stone location and size influence surgical approach selection in submandibular sialolithiasis, and to identify computed tomography (CT)-based imaging predictors to aid preoperative planning.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 428 consecutive surgeries (March 2020–December 2024). Preoperative non-contrast CT classified stones as distal duct, mid-duct, hilum, or intraglandular. Surgical approaches were transoral ductal incision, sialendoscopy-assisted removal, and external submandibular gland excision. Group comparisons used standard parametric/non-parametric tests. Receiver operating characteristic (ROC) analysis assessed size thresholds associated with selection of an invasive approach.</div></div><div><h3>Results</h3><div>Distal duct stones were most often treated by transoral incision (83.7 %), mid-duct stones by sialendoscopy-assisted removal (58.1 %), and intraglandular stones by external excision (71.0 %). Stones in the hilum/intraglandular regions were significantly larger than those in distal or mid-duct locations (<em>p</em> < 0.001). ROC analysis identified 5.5 mm as the optimal cutoff for predicting selection of an invasive approach (AUC = 0.83; sensitivity 74.2 %; specificity 78.9 %). Overall surgical success was 97.8 %. Complication rates varied by approach, lowest after sialendoscopy-assisted removal (4.4 %) and highest after external excision (15.2 %).</div></div><div><h3>Conclusions</h3><div>A simple CT-based framework incorporating stone location and size was associated with approach selection and outcomes in submandibular sialolithiasis. Using a 5.5 mm size threshold alongside anatomic zoning may help guide minimally invasive, gland-preserving strategies and reduce morbidity. Prospective validation is warranted.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104768"},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713001","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 : 2025-12-04DOI: 10.1016/j.amjoto.2025.104766
Joong Ho Ahn
Dexamethasone palmitate (DXP) is a lipophilic, esterified corticosteroid with sustained-release properties that may provide advantages over conventional water-soluble dexamethasone in intratympanic therapy for sudden sensorineural hearing loss (SSNHL). We report the safety and clinical outcomes of intratympanic DXP injection in three patients with profound SSNHL. All patients also received systemic steroids and hyperbaric oxygen therapy, along with six sessions of intratympanic DXP. Two patients demonstrated substantial improvement in hearing thresholds and speech discrimination within 3 months, whereas one patient who presented late showed no recovery. No adverse effects, such as pain, inflammation, or tympanic membrane complications, were observed. The increased viscosity and lipophilicity of DXP likely enhance cochlear drug delivery and prolong therapeutic retention. These findings suggest that DXP is a safe and potentially effective intratympanic option for SSNHL, particularly when administered early.
{"title":"Dexamethasone palmitate: A promising intratympanic treatment option for severe sudden hearing loss","authors":"Joong Ho Ahn","doi":"10.1016/j.amjoto.2025.104766","DOIUrl":"10.1016/j.amjoto.2025.104766","url":null,"abstract":"<div><div>Dexamethasone palmitate (DXP) is a lipophilic, esterified corticosteroid with sustained-release properties that may provide advantages over conventional water-soluble dexamethasone in intratympanic therapy for sudden sensorineural hearing loss (SSNHL). We report the safety and clinical outcomes of intratympanic DXP injection in three patients with profound SSNHL. All patients also received systemic steroids and hyperbaric oxygen therapy, along with six sessions of intratympanic DXP. Two patients demonstrated substantial improvement in hearing thresholds and speech discrimination within 3 months, whereas one patient who presented late showed no recovery. No adverse effects, such as pain, inflammation, or tympanic membrane complications, were observed. The increased viscosity and lipophilicity of DXP likely enhance cochlear drug delivery and prolong therapeutic retention. These findings suggest that DXP is a safe and potentially effective intratympanic option for SSNHL, particularly when administered early.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104766"},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773166","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 : 2025-12-04DOI: 10.1016/j.amjoto.2025.104779
Iris Lee , Sonam Verma , John S. Schneider , Nyssa F. Farrell , Peggy L. Kendall , Lauren T. Roland
Background
Invasive Fungal Sinusitis (IFS) is a deadly and morbid disease of the paranasal sinuses. Immunocompromised patients are at risk of developing IFS, and survival at 6 months is approximately 50%. Previously studied treatments such as granulocyte stimulating factor have not improved survival. Thus, the immune cells responsible for survival in this vulnerable population are not well defined.
Objective
The goal of this study was to immunophenotype cells associated with IFS survival.
Methods
Blood samples from consenting patients were collected at the time of surgery for IFS between April 2022 and December 2023. Peripheral blood mononuclear cells (PBMCs) were evaluated for major lymphoid and myeloid subsets using mass Cytometry by Time of Flight (CyTOF) between IFS survivors and non-survivors, defined by vital status 6 months after the time of diagnosis. Data were analyzed using the dimensionality reduction algorithm optimized t-distributed stochastic neighbor embedding (opt-SNE).
Results
Seven patients had PBMCs viable for analysis (3 survivors and 4 non-survivors). Total white blood cell counts were lower in non-survivors. Total T cell and B cell counts were decreased in non-survivors as compared to survivors, but there were no differences in other immune cell populations, such as NK cells or monocytes. Percentage differences were identified as deficiencies in CD4 T cells, particularly memory cells, in the IFS non-survivors.
Conclusion
Future work includes the investigation of CD4 T cells as a biomarker for IFS survival and the study of T cell manipulation or stimulation in IFS patients.
{"title":"Preservation of adaptive immunity is associated with survival in invasive fungal sinusitis","authors":"Iris Lee , Sonam Verma , John S. Schneider , Nyssa F. Farrell , Peggy L. Kendall , Lauren T. Roland","doi":"10.1016/j.amjoto.2025.104779","DOIUrl":"10.1016/j.amjoto.2025.104779","url":null,"abstract":"<div><h3>Background</h3><div>Invasive Fungal Sinusitis (IFS) is a deadly and morbid disease of the paranasal sinuses. Immunocompromised patients are at risk of developing IFS, and survival at 6 months is approximately 50%. Previously studied treatments such as granulocyte stimulating factor have not improved survival. Thus, the immune cells responsible for survival in this vulnerable population are not well defined.</div></div><div><h3>Objective</h3><div>The goal of this study was to immunophenotype cells associated with IFS survival.</div></div><div><h3>Methods</h3><div>Blood samples from consenting patients were collected at the time of surgery for IFS between April 2022 and December 2023. Peripheral blood mononuclear cells (PBMCs) were evaluated for major lymphoid and myeloid subsets using mass Cytometry by Time of Flight (CyTOF) between IFS survivors and non-survivors, defined by vital status 6 months after the time of diagnosis. Data were analyzed using the dimensionality reduction algorithm optimized t-distributed stochastic neighbor embedding (opt-SNE).</div></div><div><h3>Results</h3><div>Seven patients had PBMCs viable for analysis (3 survivors and 4 non-survivors). Total white blood cell counts were lower in non-survivors. Total T cell and B cell counts were decreased in non-survivors as compared to survivors, but there were no differences in other immune cell populations, such as NK cells or monocytes. Percentage differences were identified as deficiencies in CD4 T cells, particularly memory cells, in the IFS non-survivors.</div></div><div><h3>Conclusion</h3><div>Future work includes the investigation of CD4 T cells as a biomarker for IFS survival and the study of T cell manipulation or stimulation in IFS patients.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104779"},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712990","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}
To evaluate the incidence, diagnostic accuracy, surgical outcomes, complications, and patient-reported aesthetic satisfaction among patients with surgically treated Warthin's tumor (WT) over a 14-year period in a single tertiary center.
Methods
A retrospective review of 150 patients undergoing parotidectomy (2009–2022) was performed. Fifty-four patients with histopathologically confirmed WT comprised the primary analysis group. Demographics, smoking history, preoperative diagnostics [fine-needle aspiration cytology (FNAC), ultrasonography (US), magnetic resonance imaging (MRI)], surgical technique, and outcomes were recorded. Aesthetic satisfaction was assessed in a prospective subgroup (n = 37) using a 5-point Likert scale. Statistical analyses were applied with significance at p < 0.05.
Results
WT accounted for 41.2 % of benign parotid tumors, nearly equal to pleomorphic adenoma (42.0 %). Mean age was 59.5 ± 8.9 years; 75.9 % were male. Mean smoking exposure was 42 ± 12.5 pack-years, and all patients with metachronous contralateral tumors continued smoking. FNAC sensitivity was 77.8 % overall and 91.3 % for adequate samples (PPV 94.4 %). US suggested WT in 5/43 (11.6 %) of reported examinations; MRI suggested WT in 34/39 (87.2 %) of US/MRI reports available. Superficial parotidectomy was performed in 70.4 % and partial superficial parotidectomy in 29.6 %. The most common complication was great auricular nerve sensory deficit (35.2 %); permanent facial nerve paralysis occurred in 1.9 %. In the aesthetic subgroup, 8.1 % rated contour deformity as “Poor/Very Poor,” and 10.8 % reported similar dissatisfaction with scarring.
Conclusion
Our 14-year analysis confirms that WT now constitutes a substantial proportion of benign parotid tumors, approaching the incidence of pleomorphic adenoma, with a strong association with smoking. FNAC and MRI demonstrated high diagnostic accuracy, supporting their role in reliable preoperative evaluation. While surgical treatment remains safe, postoperative sensory deficits and aesthetic concerns are not uncommon and may meaningfully affect patient satisfaction, even after limited surgery. Individualized management—particularly active surveillance for small, asymptomatic tumors in elderly or comorbid patients—may help balance oncologic safety with quality-of-life considerations.
{"title":"Warthin's tumor of the parotid gland: A 14-year retrospective review of surgical outcomes, diagnostic accuracy and patient-reported aesthetic satisfaction","authors":"Ethem İlhan , Melek Uyar , Sibel Bektaş , Çağla Arukan","doi":"10.1016/j.amjoto.2025.104775","DOIUrl":"10.1016/j.amjoto.2025.104775","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence, diagnostic accuracy, surgical outcomes, complications, and patient-reported aesthetic satisfaction among patients with surgically treated Warthin's tumor (WT) over a 14-year period in a single tertiary center.</div></div><div><h3>Methods</h3><div>A retrospective review of 150 patients undergoing parotidectomy (2009–2022) was performed. Fifty-four patients with histopathologically confirmed WT comprised the primary analysis group. Demographics, smoking history, preoperative diagnostics [fine-needle aspiration cytology (FNAC), ultrasonography (US), magnetic resonance imaging (MRI)], surgical technique, and outcomes were recorded. Aesthetic satisfaction was assessed in a prospective subgroup (<em>n</em> = 37) using a 5-point Likert scale. Statistical analyses were applied with significance at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>WT accounted for 41.2 % of benign parotid tumors, nearly equal to pleomorphic adenoma (42.0 %). Mean age was 59.5 ± 8.9 years; 75.9 % were male. Mean smoking exposure was 42 ± 12.5 pack-years, and all patients with metachronous contralateral tumors continued smoking. FNAC sensitivity was 77.8 % overall and 91.3 % for adequate samples (PPV 94.4 %). US suggested WT in 5/43 (11.6 %) of reported examinations; MRI suggested WT in 34/39 (87.2 %) of US/MRI reports available. Superficial parotidectomy was performed in 70.4 % and partial superficial parotidectomy in 29.6 %. The most common complication was great auricular nerve sensory deficit (35.2 %); permanent facial nerve paralysis occurred in 1.9 %. In the aesthetic subgroup, 8.1 % rated contour deformity as “Poor/Very Poor,” and 10.8 % reported similar dissatisfaction with scarring.</div></div><div><h3>Conclusion</h3><div>Our 14-year analysis confirms that WT now constitutes a substantial proportion of benign parotid tumors, approaching the incidence of pleomorphic adenoma, with a strong association with smoking. FNAC and MRI demonstrated high diagnostic accuracy, supporting their role in reliable preoperative evaluation. While surgical treatment remains safe, postoperative sensory deficits and aesthetic concerns are not uncommon and may meaningfully affect patient satisfaction, even after limited surgery. Individualized management—particularly active surveillance for small, asymptomatic tumors in elderly or comorbid patients—may help balance oncologic safety with quality-of-life considerations.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104775"},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145720103","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 : 2025-12-04DOI: 10.1016/j.amjoto.2025.104780
Brooke Swain , Clara D. Si , Daniel R.S. Habib , Whitney Jin , Pamela Duvall , Robert J. Sinard , Kyle Mannion , Sarah L. Rohde , Alexander J. Langerman , Eben L. Rosenthal , Melanie D. Hicks , Michael C. Topf
Background
Dysphagia is a common and challenging long-term sequela following total laryngectomy (TL) that can negatively impact patient quality of life. Following TL, many patients require repeat esophageal dilations to maintain swallowing function. This study aimed to identify surgical and non-surgical risk factors associated with dysphagia following TL, defined as clinically diagnosed postoperative dysphagia based on patient-reported symptoms and dysphagia requiring dilation.
Methods
We conducted a retrospective single-institution cohort study of patients who underwent total laryngectomy from 1999 to 2024. Outcomes included clinically diagnosed dysphagia and dysphagia requiring esophageal dilations, with covariates including age, BMI, preoperative PEG tube, cricomyotomy, flap reconstruction type, pharyngectomy, glossectomy, base of tongue resection, postoperative complication, neoadjuvant radiation, and adjuvant radiation. Associations between dysphagia and covariates were assessed using univariable and multivariable logistic regressions.
Results
A total of 787 patients underwent total laryngectomy. Median follow-up was 28.5 months (Interquartile range [IQR]: 10.3–68.2 months). During the follow-up period, 212 patients (26.9 %) reported dysphagia, and 131 patients underwent dilation (16.6 %). Prior radiation (adjusted odds ratio [aOR]: 2.51, 95 % CI: 1.56–4.05, p < 0.001), adjuvant radiation (aOR: 1.86; 95 % CI 1.10 to 3.17; p = 0.021), and tongue base resection (aOR: 2.14, 95 % CI: 1.24–3.70, p = 0.006) were independently associated with postoperative clinical dysphagia. Total pharyngectomy (odds ratio [OR]: 1.83, 95 % CI 1.17–2.83, p = 0.008) was associated with dysphagia on univariable analysis. Pedicled reconstruction (OR: 1.38, 95 % CI 1.00–1.90, p = 0.053) showed a trend towards increased odds of clinical dysphagia. Only prior radiation was independently associated with dysphagia requiring esophageal dilation (aOR: 2.92, 95 % CI: 1.62–5.26, p < 0.001).
Conclusions
Dysphagia is common following total laryngectomy. Prior radiation, adjuvant radiation, total pharyngectomy, tongue base resection, and pedicled reconstruction were factors influencing swallowing outcomes following TL. Salvage TL patients should be counseled on the possible need for post-laryngectomy esophageal dilations.
吞咽困难是全喉切除术（TL）后常见且具有挑战性的长期后遗症，会对患者的生活质量产生负面影响。术后，许多患者需要重复食管扩张以维持吞咽功能。本研究旨在确定与术后吞咽困难相关的手术和非手术危险因素，吞咽困难的定义是根据患者报告的症状和需要扩张的吞咽困难临床诊断的术后吞咽困难。方法对1999年至2024年接受全喉切除术的患者进行回顾性单机构队列研究。结果包括临床诊断的吞咽困难和需要食管扩张的吞咽困难，协变量包括年龄、BMI、术前PEG管、环肌切开术、皮瓣重建类型、咽切除术、舌切除术、舌底切除术、术后并发症、新辅助放疗和辅助放疗。使用单变量和多变量logistic回归评估吞咽困难和协变量之间的关联。结果共787例患者行全喉切除术。中位随访28.5个月（四分位数间距：10.3-68.2个月）。在随访期间，212名患者（26.9%）报告了吞咽困难，131名患者（16.6%）进行了扩张。既往放疗（调整比值比[aOR]: 2.51, 95% CI: 1.56 ~ 4.05, p < 0.001）、辅助放疗（aOR: 1.86, 95% CI 1.10 ~ 3.17, p = 0.021）和舌基切除（aOR: 2.14, 95% CI: 1.24 ~ 3.70, p = 0.006）与术后临床吞咽困难独立相关。单变量分析显示，全咽切除术（优势比[OR]: 1.83, 95% CI 1.17-2.83, p = 0.008）与吞咽困难相关。带蒂重建（OR: 1.38, 95% CI 1.00-1.90, p = 0.053）显示临床吞咽困难的几率增加。只有既往放疗与需要扩张食管的吞咽困难独立相关（aOR: 2.92, 95% CI: 1.62-5.26, p < 0.001）。结论全喉切除术后常见吞咽困难。术前放疗、辅助放疗、全咽切除术、舌底切除术和带蒂重建是影响TL术后吞咽结果的因素。应告知补救性TL患者喉切除术后可能需要食管扩张。
{"title":"Risk factors for dysphagia following total laryngectomy","authors":"Brooke Swain , Clara D. Si , Daniel R.S. Habib , Whitney Jin , Pamela Duvall , Robert J. Sinard , Kyle Mannion , Sarah L. Rohde , Alexander J. Langerman , Eben L. Rosenthal , Melanie D. Hicks , Michael C. Topf","doi":"10.1016/j.amjoto.2025.104780","DOIUrl":"10.1016/j.amjoto.2025.104780","url":null,"abstract":"<div><h3>Background</h3><div>Dysphagia is a common and challenging long-term sequela following total laryngectomy (TL) that can negatively impact patient quality of life. Following TL, many patients require repeat esophageal dilations to maintain swallowing function. This study aimed to identify surgical and non-surgical risk factors associated with dysphagia following TL, defined as clinically diagnosed postoperative dysphagia based on patient-reported symptoms and dysphagia requiring dilation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-institution cohort study of patients who underwent total laryngectomy from 1999 to 2024. Outcomes included clinically diagnosed dysphagia and dysphagia requiring esophageal dilations, with covariates including age, BMI, preoperative PEG tube, cricomyotomy, flap reconstruction type, pharyngectomy, glossectomy, base of tongue resection, postoperative complication, neoadjuvant radiation, and adjuvant radiation. Associations between dysphagia and covariates were assessed using univariable and multivariable logistic regressions.</div></div><div><h3>Results</h3><div>A total of 787 patients underwent total laryngectomy. Median follow-up was 28.5 months (Interquartile range [IQR]: 10.3–68.2 months). During the follow-up period, 212 patients (26.9 %) reported dysphagia, and 131 patients underwent dilation (16.6 %). Prior radiation (adjusted odds ratio [aOR]: 2.51, 95 % CI: 1.56–4.05, <em>p</em> < 0.001), adjuvant radiation (aOR: 1.86; 95 % CI 1.10 to 3.17; <em>p</em> = 0.021), and tongue base resection (aOR: 2.14, 95 % CI: 1.24–3.70, <em>p</em> = 0.006) were independently associated with postoperative clinical dysphagia. Total pharyngectomy (odds ratio [OR]: 1.83, 95 % CI 1.17–2.83, <em>p</em> = 0.008) was associated with dysphagia on univariable analysis. Pedicled reconstruction (OR: 1.38, 95 % CI 1.00–1.90, <em>p</em> = 0.053) showed a trend towards increased odds of clinical dysphagia. Only prior radiation was independently associated with dysphagia requiring esophageal dilation (aOR: 2.92, 95 % CI: 1.62–5.26, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Dysphagia is common following total laryngectomy. Prior radiation, adjuvant radiation, total pharyngectomy, tongue base resection, and pedicled reconstruction were factors influencing swallowing outcomes following TL. Salvage TL patients should be counseled on the possible need for post-laryngectomy esophageal dilations.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 2","pages":"Article 104780"},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996480","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 : 2025-12-02DOI: 10.1016/j.amjoto.2025.104770
Amy S. Wong , Dean P. McKenzie , Benjamin J. Dixon
Objectives
To evaluate quality-of-life (QoL) in patients undergoing extracapsular dissection or partial superficial parotidectomy for benign parotid disease.
Methods
A retrospective cohort study was conducted in 155 patients who underwent limited parotidectomy, via an extracapsular dissection or partial superficial parotidectomy approach, between July 2015 and June 2020. Patients with malignancy and revision surgery where the primary operation was performed at another institution were excluded. QoL assessment was prospectively evaluated via telephone interviews. General QoL, health-related QoL and patient satisfaction were assessed with validated patient-reported outcome instruments.
Results
62 patients which fit the inclusion criteria were included for postoperative evaluation. General QoL assessment for overall health and QoL demonstrated minimal impacts after parotid surgery. Sensory impairment was the most common patient-reported symptom. In particular, numbness was the most common and severe adverse effect and correlated with greater auricular nerve sacrifice (p = 0.038). Aesthetic outcomes and patient satisfaction were high amongst the patient group. Tingling, itching, discomfort and scar tenderness correlated negatively with overall health but not overall QoL. Post operative complications were not associated with reduced overall health, overall QoL or patient satisfaction.
Conclusion
Extracapsular dissection and partial superficial parotidectomy for benign parotid disease can result in high patient satisfaction, aesthetic outcomes and QoL. Evaluation of outcomes should incorporate assessment tools with a broader perspective on patient satisfaction including cosmetic results.
{"title":"Patient-reported quality-of-life outcomes following parotidectomy for benign parotid disease","authors":"Amy S. Wong , Dean P. McKenzie , Benjamin J. Dixon","doi":"10.1016/j.amjoto.2025.104770","DOIUrl":"10.1016/j.amjoto.2025.104770","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate quality-of-life (QoL) in patients undergoing extracapsular dissection or partial superficial parotidectomy for benign parotid disease.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted in 155 patients who underwent limited parotidectomy, via an extracapsular dissection or partial superficial parotidectomy approach, between July 2015 and June 2020. Patients with malignancy and revision surgery where the primary operation was performed at another institution were excluded. QoL assessment was prospectively evaluated via telephone interviews. General QoL, health-related QoL and patient satisfaction were assessed with validated patient-reported outcome instruments.</div></div><div><h3>Results</h3><div>62 patients which fit the inclusion criteria were included for postoperative evaluation. General QoL assessment for overall health and QoL demonstrated minimal impacts after parotid surgery. Sensory impairment was the most common patient-reported symptom. In particular, numbness was the most common and severe adverse effect and correlated with greater auricular nerve sacrifice (<em>p</em> = 0.038). Aesthetic outcomes and patient satisfaction were high amongst the patient group. Tingling, itching, discomfort and scar tenderness correlated negatively with overall health but not overall QoL. Post operative complications were not associated with reduced overall health, overall QoL or patient satisfaction.</div></div><div><h3>Conclusion</h3><div>Extracapsular dissection and partial superficial parotidectomy for benign parotid disease can result in high patient satisfaction, aesthetic outcomes and QoL. Evaluation of outcomes should incorporate assessment tools with a broader perspective on patient satisfaction including cosmetic results.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104770"},"PeriodicalIF":1.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676069","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 : 2025-12-02DOI: 10.1016/j.amjoto.2025.104773
Alexandra T. Bourdillon , Peter Callas , Mirabelle Sajisevi , Karolina A. Plonowska-Hirschfeld , Andrew Holcomb , William R. Ryan
Purpose
The oncologic benefit of adjuvant radiotherapy (aRT) and the impact of facial nerve sacrifice have not been examined for early-stage low- and intermediate-grade salivary gland carcinomas (LIG-SGCs) with isolated perineural invasion (PNI) and no other adverse features.
Methods
Using a multi-institutional, international cohort established by the American Head and Neck Society (AHNS) Salivary Gland Section, we examined T1-2N0 LIG-SGCs, excluding tumor spillage, positive margins, positive lymphovascular invasion, and unreported PNI. We compared local recurrence rates between the isolated PNI and control arms. Multivariate hazard regression was used to evaluate the risk of local recurrence across PNI, adjuvant radiation therapy (aRT), and facial nerve sacrifice.
Results
Among 336 patients across 35 centers, 24 (7 %) patients had isolated PNI as the only high-risk feature. aRT was significantly more common among patients with isolated PNI (n = 10/24 or 42 %, RR: 2.32, 95 % CI: 1.37–3.94) than controls (n = 56/312 or 18 %). aRT was not significantly associated with local control, even after controlling for PNI and facial nerve sacrifice (HR: 0.34, 95 % CI: 0.04–3.06). Within the isolated PNI cohort, one recurrence occurred in the aRT group (n = 1/10, 10 %) and one in the group without aRT (n = 1/14 or 7 %). Thirty (91 %) patients who underwent facial nerve sacrifice had no PNI on final histopathology, with all 30 having full preoperative facial nerve function.
Conclusions
aRT may not necessarily reduce local recurrence for early-stage LIG-SGCs with isolated PNI. In patients with preoperative normal facial nerve function, facial nerve sacrifice may not be necessary.
{"title":"Evaluating safety of observation after resection of low- and intermediate-grade major salivary cancers with isolated perineural invasion with or without facial nerve sacrifice","authors":"Alexandra T. Bourdillon , Peter Callas , Mirabelle Sajisevi , Karolina A. Plonowska-Hirschfeld , Andrew Holcomb , William R. Ryan","doi":"10.1016/j.amjoto.2025.104773","DOIUrl":"10.1016/j.amjoto.2025.104773","url":null,"abstract":"<div><h3>Purpose</h3><div>The oncologic benefit of adjuvant radiotherapy (aRT) and the impact of facial nerve sacrifice have not been examined for early-stage low- and intermediate-grade salivary gland carcinomas (LIG-SGCs) with isolated perineural invasion (PNI) and no other adverse features.</div></div><div><h3>Methods</h3><div>Using a multi-institutional, international cohort established by the American Head and Neck Society (AHNS) Salivary Gland Section, we examined T1-2N0 LIG-SGCs, excluding tumor spillage, positive margins, positive lymphovascular invasion, and unreported PNI. We compared local recurrence rates between the isolated PNI and control arms. Multivariate hazard regression was used to evaluate the risk of local recurrence across PNI, adjuvant radiation therapy (aRT), and facial nerve sacrifice.</div></div><div><h3>Results</h3><div>Among 336 patients across 35 centers, 24 (7 %) patients had isolated PNI as the only high-risk feature. aRT was significantly more common among patients with isolated PNI (<em>n</em> = 10/24 or 42 %, RR: 2.32, 95 % CI: 1.37–3.94) than controls (<em>n</em> = 56/312 or 18 %). aRT was not significantly associated with local control, even after controlling for PNI and facial nerve sacrifice (HR: 0.34, 95 % CI: 0.04–3.06). Within the isolated PNI cohort, one recurrence occurred in the aRT group (<em>n</em> = 1/10, 10 %) and one in the group without aRT (n = 1/14 or 7 %). Thirty (91 %) patients who underwent facial nerve sacrifice had no PNI on final histopathology, with all 30 having full preoperative facial nerve function.</div></div><div><h3>Conclusions</h3><div>aRT may not necessarily reduce local recurrence for early-stage LIG-SGCs with isolated PNI. In patients with preoperative normal facial nerve function, facial nerve sacrifice may not be necessary.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104773"},"PeriodicalIF":1.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676144","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 : 2025-12-02DOI: 10.1016/j.amjoto.2025.104765
Ping Xue , Jing Yan , Jianwei Li
Background
Stapokibart (CM310), a humanized anti-IL-4Rα monoclonal antibody, blocks IL-4/IL-13 signaling for type 2 inflammatory diseases like seasonal allergic rhinitis (SAR), where standard of care often fails.
Objective
Assess stapokibart's efficacy on the primary endpoint (reflective Total Nasal Symptom Score, rTNSS) and safety as add-on therapy in SoC-inadequate moderate-to-severe SAR.
Methods
Data from a Phase II trial (MERAK, n = 92) and the pivotal Phase III PHECDA trial (n = 108; enriched for blood eosinophils ≥300 cells/μL) were reviewed. Patients received subcutaneous stapokibart (600 mg loading, then 300 mg Q2W) or placebo + SoC for 4 weeks.
Results
In MERAK, stapokibart Q2W showed a trend for rTNSS improvement (LSMD -1.0 vs placebo, p = 0.065). In PHECDA, stapokibart significantly improved rTNSS at Week 4 (LSMD -1.7, 95 % CI: −2.5, −0.8; p = 0.0002). Treatment-emergent adverse event rates were comparable to placebo in both trials (e.g., PHECDA: 52.0 % vs 46.6 %), mostly mild/moderate.
Conclusion
Add-on stapokibart is a valuable therapeutic option for adults with SoC-inadequate moderate-to-severe SAR and elevated eosinophils, providing statistically significant improvements in nasal symptoms and quality of life, with an acceptable safety profile.
背景：Stapokibart （CM310）是一种人源化抗il - 4r α单克隆抗体，可阻断IL-4/IL-13信号通路，治疗2型炎症性疾病，如季节性变应性鼻炎（SAR），标准治疗往往失败。目的：评估stapokibart在主要终点（反射性鼻症状总评分，rTNSS）的疗效和作为soc不足的中重度sars附加治疗的安全性。方法：回顾II期试验（MERAK, n = 92）和关键的III期PHECDA试验（n = 108，富血嗜酸性粒细胞≥300细胞/μL）的数据。患者接受皮下stapokibart （600mg负荷，然后300mg Q2W）或安慰剂+ SoC治疗4周。结果：在MERAK中，stapokibart Q2W显示rTNSS改善的趋势（LSMD -1.0 vs安慰剂，p = 0.065）。在PHECDA中，stapokibart在第4周显著改善了rTNSS （LSMD -1.7, 95% CI: -2.5, -0.8; p = 0.0002）。在两项试验中，治疗后出现的不良事件发生率与安慰剂相当（例如，pheecda: 52.0% vs 46.6%），主要是轻度/中度。结论：对于soc不足的中重度SAR和嗜酸性粒细胞升高的成人患者，加药斯塔波吉巴是一种有价值的治疗选择，在统计学上显著改善了鼻症状和生活质量，具有可接受的安全性。
{"title":"Stapokibart (CM310): A review in seasonal allergic rhinitis","authors":"Ping Xue , Jing Yan , Jianwei Li","doi":"10.1016/j.amjoto.2025.104765","DOIUrl":"10.1016/j.amjoto.2025.104765","url":null,"abstract":"<div><h3>Background</h3><div>Stapokibart (CM310), a humanized anti-IL-4Rα monoclonal antibody, blocks IL-4/IL-13 signaling for type 2 inflammatory diseases like seasonal allergic rhinitis (SAR), where standard of care often fails.</div></div><div><h3>Objective</h3><div>Assess stapokibart's efficacy on the primary endpoint (reflective Total Nasal Symptom Score, rTNSS) and safety as add-on therapy in SoC-inadequate moderate-to-severe SAR.</div></div><div><h3>Methods</h3><div>Data from a Phase II trial (MERAK, <em>n</em> = 92) and the pivotal Phase III PHECDA trial (<em>n</em> = 108; enriched for blood eosinophils ≥300 cells/μL) were reviewed. Patients received subcutaneous stapokibart (600 mg loading, then 300 mg Q2W) or placebo + SoC for 4 weeks.</div></div><div><h3>Results</h3><div>In MERAK, stapokibart Q2W showed a trend for rTNSS improvement (LSMD -1.0 vs placebo, <em>p</em> = 0.065). In PHECDA, stapokibart significantly improved rTNSS at Week 4 (LSMD -1.7, 95 % CI: −2.5, −0.8; <em>p</em> = 0.0002). Treatment-emergent adverse event rates were comparable to placebo in both trials (e.g., PHECDA: 52.0 % vs 46.6 %), mostly mild/moderate.</div></div><div><h3>Conclusion</h3><div>Add-on stapokibart is a valuable therapeutic option for adults with SoC-inadequate moderate-to-severe SAR and elevated eosinophils, providing statistically significant improvements in nasal symptoms and quality of life, with an acceptable safety profile.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104765"},"PeriodicalIF":1.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676074","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 : 2025-12-02DOI: 10.1016/j.amjoto.2025.104767
Danyang Chang , Fan Xu , Xiangming Meng , Changling Sun
Objectives
This study aims to develop and validate a clinical prediction model that integrates clinical features with non-contrast CT imaging characteristics to identify Warthin tumor (WT) in the parotid gland.
Methods
A total of 289 patients who underwent surgical resection of parotid tumors at the Affiliated hospital of Jiangnan University from June 2018 to December 2024 were consecutively and randomly divided into training (n = 202) and validation (n = 87) cohorts at a 7:3 ratio. Demographic and non-contrast CT imaging variables were collected. Logistic regression identified predictors, and a nomogram was constructed. To further validate the model, an independent dataset comprising 84 patients from a second hospital was used. The model's performance was evaluated through receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow test, and decision curve analysis (DCA).
Results
Age, smoking history, tumor distribution, earlobe position, and longitudinal-to-transverse ratio (LTR) were identified as independent predictors for differentiating WT from other parotid gland tumors. The nomogram showed high diagnostic accuracy, with the area under the curve (AUC) values of 0.942 (training), 0.937 (validation), and 0.953 (external validation). Calibration curves indicated good agreement with ideal predictions, supported by the Hosmer-Lemeshow test (P > 0.05). DCA further demonstrated the superior clinical utility of the nomogram model.
Conclusion
The nomogram model incorporating clinical and non-contrast CT features demonstrates high accuracy for differentiating WT from other parotid gland tumors in clinical practice.
{"title":"Development and validation of a clinical prediction model to diagnose Warthin tumor based on non-contrast computed tomography features and clinical characteristics","authors":"Danyang Chang , Fan Xu , Xiangming Meng , Changling Sun","doi":"10.1016/j.amjoto.2025.104767","DOIUrl":"10.1016/j.amjoto.2025.104767","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to develop and validate a clinical prediction model that integrates clinical features with non-contrast CT imaging characteristics to identify Warthin tumor (WT) in the parotid gland.</div></div><div><h3>Methods</h3><div>A total of 289 patients who underwent surgical resection of parotid tumors at the Affiliated hospital of Jiangnan University from June 2018 to December 2024 were consecutively and randomly divided into training (<em>n</em> = 202) and validation (<em>n</em> = 87) cohorts at a 7:3 ratio. Demographic and non-contrast CT imaging variables were collected. Logistic regression identified predictors, and a nomogram was constructed. To further validate the model, an independent dataset comprising 84 patients from a second hospital was used. The model's performance was evaluated through receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow test, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>Age, smoking history, tumor distribution, earlobe position, and longitudinal-to-transverse ratio (LTR) were identified as independent predictors for differentiating WT from other parotid gland tumors. The nomogram showed high diagnostic accuracy, with the area under the curve (AUC) values of 0.942 (training), 0.937 (validation), and 0.953 (external validation). Calibration curves indicated good agreement with ideal predictions, supported by the Hosmer-Lemeshow test (<em>P</em> > 0.05). DCA further demonstrated the superior clinical utility of the nomogram model.</div></div><div><h3>Conclusion</h3><div>The nomogram model incorporating clinical and non-contrast CT features demonstrates high accuracy for differentiating WT from other parotid gland tumors in clinical practice.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104767"},"PeriodicalIF":1.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713023","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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