American Journal of Otolaryngology最新文献_第3页

Warthin's tumor of the parotid gland: A 14-year retrospective review of surgical outcomes, diagnostic accuracy and patient-reported aesthetic satisfaction 腮腺Warthin肿瘤：对手术结果、诊断准确性和患者报告的审美满意度的14年回顾性回顾。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-04 DOI: 10.1016/j.amjoto.2025.104775

Ethem İlhan , Melek Uyar , Sibel Bektaş , Çağla Arukan

Objective

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.

目的：评估在一个三级中心接受手术治疗的Warthin肿瘤（WT）患者的发病率、诊断准确性、手术结果、并发症和患者报告的审美满意度。方法：回顾性分析2009-2022年接受腮腺切除术的150例患者。54例经组织病理学证实的WT患者组成了主要分析组。记录人口统计学、吸烟史、术前诊断[细针穿刺细胞学（FNAC）、超声检查（US）、磁共振成像（MRI）]、手术技术和结果。审美满意度在前瞻性亚组（n = 37）中使用5点李克特量表进行评估。结果：良性腮腺肿瘤WT占41.2%，与多形性腺瘤（42.0%）接近。平均年龄59.5±8.9岁；75.9%为男性。平均吸烟暴露为42±12.5包年，所有异时性对侧肿瘤患者均继续吸烟。FNAC的总体灵敏度为77.8%，充足样品为91.3% （PPV为94.4%）。美国在报告的检查中有5/43（11.6%）提示WT；MRI显示有34/39（87.2%）的US/MRI报告显示WT。腮腺浅表切除术占70.4%，部分腮腺浅表切除术占29.6%。最常见的并发症是严重耳神经感觉缺损（35.2%）；永久性面神经麻痹发生率为1.9%。在美学亚组中，8.1%的人认为轮廓畸形“差/非常差”，10.8%的人对疤痕表示类似的不满。结论：我们14年的分析证实，WT现在在良性腮腺肿瘤中占相当大的比例，接近多形性腺瘤的发病率，并且与吸烟有很强的相关性。FNAC和MRI显示出较高的诊断准确性，支持其在可靠的术前评估中的作用。虽然手术治疗仍然是安全的，但术后感觉缺陷和审美问题并不罕见，甚至在有限的手术后也可能影响患者的满意度。个体化治疗——特别是对老年患者或合并症患者的小的、无症状的肿瘤进行主动监测——可能有助于平衡肿瘤安全和生活质量。

{"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}

引用次数: 0

Risk factors for dysphagia following total laryngectomy 全喉切除术后吞咽困难的危险因素

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-04 DOI: 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}

引用次数: 0

Patient-reported quality-of-life outcomes following parotidectomy for benign parotid disease 良性腮腺病行腮腺切除术后患者报告的生活质量结果。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-02 DOI: 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.

目的：评价良性腮腺病行腮腺囊外剥离或部分浅表切除术患者的生活质量（QoL）。方法：在2015年7月至2020年6月期间，对155例通过囊外切除术或部分腮腺浅表性切除术行有限腮腺切除术的患者进行回顾性队列研究。恶性肿瘤患者和在其他机构进行翻修手术的患者被排除在外。通过电话访谈对生活质量进行前瞻性评价。一般生活质量、健康相关生活质量和患者满意度采用经过验证的患者报告结果工具进行评估。结果：62例符合纳入标准的患者纳入术后评估。总体生活质量评估显示腮腺手术对整体健康和生活质量的影响最小。感觉障碍是患者报告的最常见症状。特别是麻木是最常见和最严重的不良反应，并与更大的耳神经牺牲相关（p = 0.038）。患者组的美容效果和患者满意度都很高。刺痛、瘙痒、不适和疤痕压痛与整体健康呈负相关，但与总体生活质量无关。术后并发症与总体健康、总体生活质量或患者满意度的降低无关。结论：腮腺良性病变的囊外剥离和部分腮腺浅表切除术可获得较高的患者满意度、美观效果和生活质量。结果评估应纳入评估工具与更广泛的角度对患者满意度，包括美容结果。

{"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}

引用次数: 0

Evaluating safety of observation after resection of low- and intermediate-grade major salivary cancers with isolated perineural invasion with or without facial nerve sacrifice 评价中低级别涎腺癌伴孤立性周围神经侵犯伴或不伴面神经牺牲术后观察的安全性。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-02 DOI: 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.

目的：对于孤立性神经周围浸润（PNI）且无其他不良特征的早期中低级别唾液腺癌（ligg - sgcs），辅助放疗（aRT）的肿瘤学益处和面神经牺牲的影响尚未得到研究。方法：使用由美国头颈学会（AHNS）唾液腺组建立的多机构国际队列，我们检查了T1-2N0 ligg - sgcs，排除肿瘤溢出，阳性边缘，阳性淋巴血管侵袭和未报告的PNI。我们比较了孤立的PNI和对照组之间的局部复发率。采用多因素风险回归评估PNI、辅助放射治疗（aRT）和面神经牺牲的局部复发风险。结果：在35个中心的336例患者中，24例（7%）患者将分离性PNI作为唯一的高危特征。aRT在孤立性PNI患者中（n = 10/24或42%，RR: 2.32, 95% CI: 1.37-3.94）明显高于对照组（n = 56/312或18%）。aRT与局部控制无显著相关性，即使在控制PNI和面神经牺牲后也是如此（HR: 0.34, 95% CI: 0.04-3.06）。在孤立的PNI队列中，aRT组有一例复发（n = 1/ 10,10 %），未aRT组有一例复发（n = 1/14或7 %）。30例（91%）接受面神经牺牲的患者在最终组织病理学上没有PNI，所有30例患者术前面神经功能完全。结论：aRT不一定能减少早期伴孤立性PNI的ligg - sgcs的局部复发。术前面神经功能正常的患者，可能不需要牺牲面神经。

{"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}

引用次数: 0

Stapokibart (CM310): A review in seasonal allergic rhinitis Stapokibart (CM310)：季节性变应性鼻炎的研究进展。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-02 DOI: 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}

引用次数: 0

Development and validation of a clinical prediction model to diagnose Warthin tumor based on non-contrast computed tomography features and clinical characteristics 基于非对比ct特征和临床特征诊断Warthin瘤的临床预测模型的开发和验证。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-02 DOI: 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.

目的：本研究旨在建立并验证一种结合临床特征和非对比CT成像特征的临床预测模型，以识别腮腺Warthin瘤（WT）。方法：将2018年6月至2024年12月在江南大学附属医院行腮腺肿瘤手术切除的289例患者按7:3的比例连续随机分为训练组（n = 202）和验证组（n = 87）。收集人口统计学和非对比CT成像变量。逻辑回归识别了预测因子，并构建了模态图。为了进一步验证该模型，使用了一个由来自第二家医院的84名患者组成的独立数据集。通过受试者工作特征（ROC）曲线、校正曲线、Hosmer-Lemeshow检验和决策曲线分析（DCA）对模型的性能进行评价。结果：年龄、吸烟史、肿瘤分布、耳垂位置和纵横比（LTR）被确定为区分WT与其他腮腺肿瘤的独立预测因素。nomogram诊断准确率较高，其曲线下面积（AUC）值分别为0.942（训练）、0.937（验证）和0.953（外部验证）。校正曲线与理想预测结果吻合良好，并得到Hosmer-Lemeshow检验的支持（P < 0.05）。DCA进一步证明了nomogram模型在临床中的优越性。结论：结合临床和非对比CT特征的nomogram模型在临床上对WT与其他腮腺肿瘤的鉴别具有较高的准确性。

{"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}

引用次数: 0

Endoscopic transnasal repair of choanal atresia: clinical characteristics and outcomes from a main tertiary hospital in Syria 经鼻内镜修复后肛门闭锁：叙利亚一家主要三级医院的临床特点和结果。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-01 DOI: 10.1016/j.amjoto.2025.104757

Diab Alkhouri , Dima Alhomsi , Mhd Nabil Dandachli

Introduction

Congenital choanal atresia (CA) is a rare malformation that can present as a neonatal emergency or with delayed symptoms in older children. Despite advances in endoscopic transnasal repair, recurrence and restenosis remain major challenges, and evidence from resource-limited countries is scarce. This study reports a 12-year experience managing CA in Syria, highlighting clinical characteristics, surgical outcomes, and prognostic factors for recurrence.

Methods

This retrospective cohort study included 33 pediatric patients with choanal atresia who underwent endoscopic transnasal repair between 2012 and 2024. Patients were categorized by laterality (unilateral vs. bilateral) and by recurrence status (recurrence vs. non-recurrence) to identify prognostic factors. Demographics, clinical features, surgical details, and outcomes were extracted from medical records.

Results

Of 33 patients, 21 (63.6 %) had bilateral CA and 12 (36.4 %) unilateral. Mean age at diagnosis was 34.5 months, with bilateral cases diagnosed significantly earlier (0.8 months vs. 93.4 months, p < 0.001). Mixed-type atresia predominated (93.9 %). Associated anomalies were present in 27.3 %, with cardiovascular anomalies being the most frequent. Recurrence was observed in 25 % of patients, while postoperative complications occurred in 14.3 %, mainly synechiae. Recurrence was not significantly associated with age, sex, laterality, or adjunctive measures (stents, topical steroids, mitomycin C, or laser).

Conclusion

Endoscopic transnasal repair of CA was shown to be safe and effective in a resource-limited setting, with recurrence and complication rates comparable to international reports. Routine use of stents, steroids, mitomycin C, or laser showed no clear benefit, supporting selective rather than standard application. These findings contribute regional data to the global literature and underscore the need for larger multicenter studies to refine prognostic factors and optimize long-term outcomes.

简介：先天性后肛门闭锁（CA）是一种罕见的畸形，可以作为新生儿急诊或延迟症状出现在大龄儿童。尽管内窥镜经鼻修复技术取得了进展，但复发和再狭窄仍然是主要挑战，而且来自资源有限的国家的证据很少。本研究报告了在叙利亚治疗CA的12年经验，强调了临床特征、手术结果和复发的预后因素。方法：本回顾性队列研究纳入了33例2012年至2024年间经鼻内镜修复的小儿后肛门闭锁患者。患者根据侧侧（单侧vs双侧）和复发状态（复发vs非复发）进行分类，以确定预后因素。从医疗记录中提取人口统计学、临床特征、手术细节和结果。结果：33例患者中，21例（63.6%）为双侧CA， 12例（36.4%）为单侧CA。诊断时的平均年龄为34.5个月，双侧病例的诊断时间明显提前（0.8个月对93.4个月）。结论：在资源有限的情况下，经鼻内镜修复CA是安全有效的，其复发率和并发症发生率与国际报道相当。常规使用支架、类固醇、丝裂霉素C或激光没有明显的益处，支持选择性应用而不是标准应用。这些发现为全球文献提供了区域数据，并强调需要进行更大规模的多中心研究，以细化预后因素并优化长期结果。

{"title":"Endoscopic transnasal repair of choanal atresia: clinical characteristics and outcomes from a main tertiary hospital in Syria","authors":"Diab Alkhouri , Dima Alhomsi , Mhd Nabil Dandachli","doi":"10.1016/j.amjoto.2025.104757","DOIUrl":"10.1016/j.amjoto.2025.104757","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital choanal atresia (CA) is a rare malformation that can present as a neonatal emergency or with delayed symptoms in older children. Despite advances in endoscopic transnasal repair, recurrence and restenosis remain major challenges, and evidence from resource-limited countries is scarce. This study reports a 12-year experience managing CA in Syria, highlighting clinical characteristics, surgical outcomes, and prognostic factors for recurrence.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 33 pediatric patients with choanal atresia who underwent endoscopic transnasal repair between 2012 and 2024. Patients were categorized by laterality (unilateral vs. bilateral) and by recurrence status (recurrence vs. non-recurrence) to identify prognostic factors. Demographics, clinical features, surgical details, and outcomes were extracted from medical records.</div></div><div><h3>Results</h3><div>Of 33 patients, 21 (63.6 %) had bilateral CA and 12 (36.4 %) unilateral. Mean age at diagnosis was 34.5 months, with bilateral cases diagnosed significantly earlier (0.8 months vs. 93.4 months, <em>p</em> < 0.001). Mixed-type atresia predominated (93.9 %). Associated anomalies were present in 27.3 %, with cardiovascular anomalies being the most frequent. Recurrence was observed in 25 % of patients, while postoperative complications occurred in 14.3 %, mainly synechiae. Recurrence was not significantly associated with age, sex, laterality, or adjunctive measures (stents, topical steroids, mitomycin C, or laser).</div></div><div><h3>Conclusion</h3><div>Endoscopic transnasal repair of CA was shown to be safe and effective in a resource-limited setting, with recurrence and complication rates comparable to international reports. Routine use of stents, steroids, mitomycin C, or laser showed no clear benefit, supporting selective rather than standard application. These findings contribute regional data to the global literature and underscore the need for larger multicenter studies to refine prognostic factors and optimize long-term outcomes.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104757"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666614","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

Septoplasty opioid prescription trends following the publication of opioid prescribing clinical practice guidelines 阿片类药物处方临床实践指南出版后的鼻中隔成形术阿片类药物处方趋势。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-01 DOI: 10.1016/j.amjoto.2025.104755

Robert E. Africa , Shahrukh R. Ali , Delaney Clark , Brian J. McKinnon , Charles A. Hughes , Tyler A. Janz , Farrah Siddiqui , Scott A. Hardison

Background

To address rising opioid prescriptions, more institutions have implemented prescribing guidelines emphasizing non-opioid and other multimodal pain control. In April 2021, the AAO-HNS released guidelines for common otolaryngologic procedures to improve patient safety, reduce unnecessary opioid use, and lower the risk of postsurgical opioid dependence. The goal of this study is to evaluate the trends in opioid and non-opioid prescribing for septoplasty in relation to the publication of a major clinical practice guideline by the AAO-HNS in April 2021.

Methods

This multicenter retrospective study analyzes de-identified patient data from the TriNetX database, focusing on individuals prescribed either opioid or non-opioid analgesics within 1–5 days following septoplasty from January 1, 2013 to December 31, 2023. Interrupted time series analysis in Statistical Analysis System (SAS) 9.4 was performed with significant set at p < 0.05 to evaluate the changes in prescribing trends.

Results

Immediately, the opioid prescribing increased for septoplasty by 1.41 %, but it was not statistically significant (p = 0.08). After the initial change, there was an overall statistically significant decrease in opioid prescribing by 0.24 % every 3 months (p < 0.0001). For non-opioid prescriptions, a significant decrease occurred immediately by −0.53 % (p < 0.0001), but a long-term significant slow increase in prescribing by 0.03 % was identified every 3 months (p < 0.0001). The rate of opioid prescribing did not differ before and after guideline publication (p = 0.58), while non-opioid prescribing rate was significantly higher afterward (p = 0.03).

Conclusions

There was an associated decrease in opioid prescribing for septoplasty post-publication. However, this decrease was not observed immediately after the guideline publication, and rate of change before and after the publication was similar. Non-opioid prescription did not have an immediate increase, but the trend gradually increased in the post-publication period. This was a significant change from the pre-publication period.

背景：为了解决阿片类药物处方增加的问题，越来越多的机构实施了强调非阿片类药物和其他多模式疼痛控制的处方指南。2021年4月，AAO-HNS发布了普通耳鼻喉科手术指南，以提高患者安全性，减少不必要的阿片类药物使用，并降低术后阿片类药物依赖的风险。本研究的目的是评估与AAO-HNS于2021年4月发布的主要临床实践指南相关的阿片类药物和非阿片类药物鼻中隔成形术处方的趋势。方法：这项多中心回顾性研究分析了TriNetX数据库中未识别的患者数据，重点关注2013年1月1日至2023年12月31日鼻中隔成形术后1-5天内服用阿片类或非阿片类镇痛药的患者。在统计分析系统（SAS） 9.4中进行中断时间序列分析，显著性设置为p。结果：立即，阿片类药物处方增加了1.41%，但无统计学意义（p = 0.08）。在最初的改变后，阿片类药物处方每3个月减少0.24%，总体上具有统计学意义(p)。结论：发表后，鼻中隔成形术的阿片类药物处方减少。然而，在指南发表后并没有立即观察到这种下降，而且发表前后的变化率是相似的。非阿片类药物处方没有立即增加，但在发表后有逐渐增加的趋势。这是与出版前相比的一个重大变化。

{"title":"Septoplasty opioid prescription trends following the publication of opioid prescribing clinical practice guidelines","authors":"Robert E. Africa , Shahrukh R. Ali , Delaney Clark , Brian J. McKinnon , Charles A. Hughes , Tyler A. Janz , Farrah Siddiqui , Scott A. Hardison","doi":"10.1016/j.amjoto.2025.104755","DOIUrl":"10.1016/j.amjoto.2025.104755","url":null,"abstract":"<div><h3>Background</h3><div>To address rising opioid prescriptions, more institutions have implemented prescribing guidelines emphasizing non-opioid and other multimodal pain control. In April 2021, the AAO-HNS released guidelines for common otolaryngologic procedures to improve patient safety, reduce unnecessary opioid use, and lower the risk of postsurgical opioid dependence. The goal of this study is to evaluate the trends in opioid and non-opioid prescribing for septoplasty in relation to the publication of a major clinical practice guideline by the AAO-HNS in April 2021.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study analyzes de-identified patient data from the TriNetX database, focusing on individuals prescribed either opioid or non-opioid analgesics within 1–5 days following septoplasty from January 1, 2013 to December 31, 2023. Interrupted time series analysis in Statistical Analysis System (SAS) 9.4 was performed with significant set at <em>p</em> < 0.05 to evaluate the changes in prescribing trends.</div></div><div><h3>Results</h3><div>Immediately, the opioid prescribing increased for septoplasty by 1.41 %, but it was not statistically significant (<em>p</em> = 0.08). After the initial change, there was an overall statistically significant decrease in opioid prescribing by 0.24 % every 3 months (<em>p</em> < 0.0001). For non-opioid prescriptions, a significant decrease occurred immediately by −0.53 % (<em>p</em> < 0.0001), but a long-term significant slow increase in prescribing by 0.03 % was identified every 3 months (p < 0.0001). The rate of opioid prescribing did not differ before and after guideline publication (<em>p</em> = 0.58), while non-opioid prescribing rate was significantly higher afterward (<em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>There was an associated decrease in opioid prescribing for septoplasty post-publication. However, this decrease was not observed immediately after the guideline publication, and rate of change before and after the publication was similar. Non-opioid prescription did not have an immediate increase, but the trend gradually increased in the post-publication period. This was a significant change from the pre-publication period.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104755"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676123","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

Isolated facial pain as the sole presentation of a type I branchial cleft cyst in an adult male 孤立的面部疼痛作为唯一的表现，1型鳃裂囊肿的成年男性。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-01 DOI: 10.1016/j.amjoto.2025.104762

Darien B. Reed , Robert J. Macielak , Oliver F. Adunka , Yufan Lin , Nolan B. Seim

First branchial cleft cysts (FBCCs) are rare developmental anomalies that typically present in childhood. We report a unique case of a Type I FBCC in a 43-year-old male whose only symptom was isolated facial pain without infection or mass. Imaging and biopsies were inconclusive, prompting surgical excision for definitive diagnosis and symptomatic relief. Histopathology confirmed a branchial cleft anomaly. This case highlights the importance of including congenital anomalies in the differential diagnosis for atypical facial pain even in the adult population and underscores the value of a thorough and multi-disciplinary diagnostic workup.

第一鳃裂囊肿是一种罕见的发育异常，通常出现在儿童时期。我们报告一个独特的病例I型FBCC在一个43岁的男性，其唯一的症状是孤立的面部疼痛，没有感染或肿块。影像学和活组织检查不确定，促使手术切除以明确诊断和缓解症状。组织病理学证实为鳃裂异常。本病例强调了在非典型面部疼痛的鉴别诊断中包括先天性异常的重要性，即使在成人人群中也是如此，并强调了全面和多学科诊断工作的价值。

引用次数: 0

Prevention of hypoacusis after radiochemotherapy for head and neck squamous cell carcinoma 头颈部鳞状细胞癌放化疗后听觉减退的预防。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-01 DOI: 10.1016/j.amjoto.2025.104772

Romina Mastronicola , Maëlys Bresson , Elise Kayser , Agathe Barrat , Alexandre Aubertin , Pauline Le Roux , Illyasse El Bouziani , Hélèna Villard , Sophie Cortese , Emilie Beulque , Giacomo Gravante , Gilles Dolivet

Objective

Treatment of head and neck cancers is based on many schemes, and in the case of radiochemotherapy, the main side effect impacting a patient's quality of life is hypoacusis. Its prevention and analysis are consequently essential.

Methods

A total of 118 patients who underwent chemotherapy and/or radiotherapy received follow-up care with audiometric tests. Corticosteroid therapy began during the treatment.

Results

At the end of the radiochemotherapy cycles and after corticosteroid therapy, 58 % of patients recovered 40 dB on average, and 42 % achieved total resolution of hypoacusis.

Conclusion

Prevention of the side effects of anticancer therapies is a major issue, and our study revealed the potential ability of corticosteroids to act as otoprotective drugs.

目的：头颈癌的治疗有多种方案，在放化疗的情况下，影响患者生活质量的主要副作用是听觉减退。因此，它的预防和分析是必不可少的。方法：118例接受化疗和/或放疗的患者接受听力学测试的随访。治疗期间开始使用皮质类固醇治疗。结果：在放化疗周期结束和皮质类固醇治疗后，58%的患者平均恢复40 dB， 42%的患者完全消除了耳聋。结论：预防抗癌治疗的副作用是一个主要问题，我们的研究揭示了皮质类固醇作为耳保护药物的潜在能力。

引用次数: 0