Pub Date : 2025-12-01DOI: 10.1016/j.amjoto.2025.104754
Elliott M. Sina , Bryce Hambach , Eric Mastrolonardo , Sruti Tekumalla , Meghan Crippen , Richard Goldman
Objectives
Injection drug use (IDU) is a known risk factor for neck abscesses, often requiring urgent surgical intervention by acute-care Otolaryngologists. However, data on the prevalence and long-term outcomes of IDU-related neck abscesses are limited. This study investigates differences in 30-day readmission rates and 5-year all-cause mortality between patients with and without a history of IDU hospitalized for neck abscesses.
Methods
This is a retrospective cohort study utilizing the TriNetX national clinical database. Patients hospitalized for neck abscesses (ICD-10: L02.11) were categorized into two cohorts: IDU (current/previous) and non-IDU. Demographics, 30-day readmission rates, and 5-year survival were analyzed. 1:1 Propensity score matching (PSM) was used to adjust for 15 covariates known to be associated with IDU-related neck abscesses, and a two-sample t-test was applied. Kaplan-Meier analysis was performed to assess 5-year survival.
Results
In a cohort of 32,655 patients (mean age: 54.7, 58.4 % female), PSM resulted in 2410 patients per cohort. IDU patients had higher 30-day readmission rates than controls (10.2 % vs 7.81 %; OR: 1.32; 95 % CI: 1.10–1.62; p = 0.0061) and lower 5-year survival (77.2 % vs 81.8 %; HR: 1.21).
Conclusion
Patients admitted for IDU-related neck abscesses have significantly higher 30-day readmission rates and decreased 5-year survival compared to non-IDU patients. These findings underscore the critical need for early detection and intervention by Otolaryngologists in this vulnerable population.
目的：注射药物使用（IDU）是已知的颈部脓肿的危险因素，通常需要急诊耳鼻喉科医生的紧急手术干预。然而，关于静脉注射相关颈部脓肿的患病率和长期预后的数据有限。本研究调查了有和没有IDU史的颈部脓肿住院患者30天再入院率和5年全因死亡率的差异。方法：这是一项利用TriNetX国家临床数据库的回顾性队列研究。因颈部脓肿住院的患者（ICD-10: L02.11）分为两组：IDU（当前/既往）和非IDU。分析人口统计学、30天再入院率和5年生存率。使用1:1倾向评分匹配（PSM）来调整已知与idu相关的颈部脓肿相关的15个协变量，并采用双样本t检验。Kaplan-Meier分析评估5年生存率。结果：在32,655例患者（平均年龄：54.7岁，58.4%为女性）的队列中，PSM导致每个队列2410例患者。IDU患者的30天再入院率高于对照组（10.2% vs 7.81%; OR: 1.32; 95% CI: 1.10-1.62; p = 0.0061）， 5年生存率较低（77.2% vs 81.8%; HR: 1.21）。结论：与非idu患者相比，因idu相关颈部脓肿入院的患者30天再入院率明显高于非idu患者，5年生存率明显降低。这些发现强调了耳鼻喉科医生对这一弱势群体进行早期发现和干预的迫切需要。
{"title":"Impact of intravenous drug use on neck abscess outcomes: 30-day readmission & 5-year survival rates","authors":"Elliott M. Sina , Bryce Hambach , Eric Mastrolonardo , Sruti Tekumalla , Meghan Crippen , Richard Goldman","doi":"10.1016/j.amjoto.2025.104754","DOIUrl":"10.1016/j.amjoto.2025.104754","url":null,"abstract":"<div><h3>Objectives</h3><div>Injection drug use (IDU) is a known risk factor for neck abscesses, often requiring urgent surgical intervention by acute-care Otolaryngologists. However, data on the prevalence and long-term outcomes of IDU-related neck abscesses are limited. This study investigates differences in 30-day readmission rates and 5-year all-cause mortality between patients with and without a history of IDU hospitalized for neck abscesses.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study utilizing the TriNetX national clinical database. Patients hospitalized for neck abscesses (ICD-10: L02.11) were categorized into two cohorts: IDU (current/previous) and non-IDU. Demographics, 30-day readmission rates, and 5-year survival were analyzed. 1:1 Propensity score matching (PSM) was used to adjust for 15 covariates known to be associated with IDU-related neck abscesses, and a two-sample <em>t</em>-test was applied. Kaplan-Meier analysis was performed to assess 5-year survival.</div></div><div><h3>Results</h3><div>In a cohort of 32,655 patients (mean age: 54.7, 58.4 % female), PSM resulted in 2410 patients per cohort. IDU patients had higher 30-day readmission rates than controls (10.2 % vs 7.81 %; OR: 1.32; 95 % CI: 1.10–1.62; <em>p</em> = 0.0061) and lower 5-year survival (77.2 % vs 81.8 %; HR: 1.21).</div></div><div><h3>Conclusion</h3><div>Patients admitted for IDU-related neck abscesses have significantly higher 30-day readmission rates and decreased 5-year survival compared to non-IDU patients. These findings underscore the critical need for early detection and intervention by Otolaryngologists in this vulnerable population.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104754"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740225","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 : 2025-12-01DOI: 10.1016/j.amjoto.2025.104764
Liliana Arida-Moody , Daniel R.S. Habib , Emma H. Neal , Amy S. Whigham
Objective
This study aims to elucidate the association between pediatric obesity and revision adenoidectomy in a cohort with longitudinal care needs.
Methods
Data were collected via chart review from a tertiary pediatric hospital for patients who underwent adenoidectomy from January 2015 to January 2016 and had 2 years of post-operative follow-up. Demographic, surgical, and clinical data were analyzed using logistic and Cox regression models to identify factors affecting the likelihood and timing of revision adenoidectomy.
Results
Of 461 patients, 115 (24.9 %) were obese at primary intervention. Secondary intervention was performed for 136 patients (29.5 %), with a median interval of 29 months between procedures. In the logistic regression, predictors of revision included younger age at primary intervention (OR = 0.844, p = 0.002), adenoidectomy over adenotonsillectomy as the initial surgery (OR = 0.3, p < 0.001), higher BMI percentile (OR = 1.008, p = 0.048), and allergic rhinitis (OR = 1.722, p = 0.039). In the Cox regression, hazard was lower with adenotonsillectomy (HR = 0.358, p < 0.001), older age at initial surgery (HR = 0.858, p = 0.001), and GERD (HR = 0.595, p = 0.05), but higher with laryngomalacia/tracheomalacia (HR = 1.909, p = 0.034). BMI percentile was not associated with revision timing in the Cox model. Model concordance was 0.694.
Conclusion
Odds of revision adenoidectomy in this population are increased with higher BMI percentile, younger age at primary intervention, undergoing initial adenoidectomy rather than adenotonsillectomy, and various comorbidities, with differing time-dependent effects. These findings support the potential role of obesity-related inflammation in adenoid hypertrophy and individualized surgical decision-making in pediatric patients with sleep disordered breathing.
目的：本研究旨在阐明具有纵向护理需求的队列中儿童肥胖与翻修腺样体切除术之间的关系。方法：采用图表复习法收集某三级儿科医院2015年1月至2016年1月行腺样体切除术患者的资料，术后随访2年。使用logistic和Cox回归模型分析人口统计学、外科和临床数据，以确定影响翻修腺样体切除术可能性和时机的因素。结果：在461例患者中，115例（24.9%）在初次干预时为肥胖。136例患者（29.5%）接受了二次干预，中间间隔为29个月。在logistic回归中，修正的预测因素包括初次干预时年龄更小（OR = 0.844, p = 0.002），腺样体切除术优于腺扁桃体切除术作为初始手术（OR = 0.3, p）。结论：在该人群中，修正腺样体切除术的几率随着BMI百分比的升高、初次干预时年龄更小、首次接受腺样体切除术而非腺扁桃体切除术以及各种合共病的增加而增加，这些合共病具有不同的时间依赖性。这些发现支持肥胖相关炎症在儿童睡眠呼吸障碍患者腺样体肥大和个体化手术决策中的潜在作用。
{"title":"Adenoid regrowth and obesity in a longitudinal pediatric cohort","authors":"Liliana Arida-Moody , Daniel R.S. Habib , Emma H. Neal , Amy S. Whigham","doi":"10.1016/j.amjoto.2025.104764","DOIUrl":"10.1016/j.amjoto.2025.104764","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to elucidate the association between pediatric obesity and revision adenoidectomy in a cohort with longitudinal care needs.</div></div><div><h3>Methods</h3><div>Data were collected via chart review from a tertiary pediatric hospital for patients who underwent adenoidectomy from January 2015 to January 2016 and had 2 years of post-operative follow-up. Demographic, surgical, and clinical data were analyzed using logistic and Cox regression models to identify factors affecting the likelihood and timing of revision adenoidectomy.</div></div><div><h3>Results</h3><div>Of 461 patients, 115 (24.9 %) were obese at primary intervention. Secondary intervention was performed for 136 patients (29.5 %), with a median interval of 29 months between procedures. In the logistic regression, predictors of revision included younger age at primary intervention (OR = 0.844, <em>p</em> = 0.002), adenoidectomy over adenotonsillectomy as the initial surgery (OR = 0.3, <em>p</em> < 0.001), higher BMI percentile (OR = 1.008, <em>p</em> = 0.048), and allergic rhinitis (OR = 1.722, <em>p</em> = 0.039). In the Cox regression, hazard was lower with adenotonsillectomy (HR = 0.358, <em>p</em> < 0.001), older age at initial surgery (HR = 0.858, <em>p</em> = 0.001), and GERD (HR = 0.595, <em>p</em> = 0.05), but higher with laryngomalacia/tracheomalacia (HR = 1.909, <em>p</em> = 0.034). BMI percentile was not associated with revision timing in the Cox model. Model concordance was 0.694.</div></div><div><h3>Conclusion</h3><div>Odds of revision adenoidectomy in this population are increased with higher BMI percentile, younger age at primary intervention, undergoing initial adenoidectomy rather than adenotonsillectomy, and various comorbidities, with differing time-dependent effects. These findings support the potential role of obesity-related inflammation in adenoid hypertrophy and individualized surgical decision-making in pediatric patients with sleep disordered breathing.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104764"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713052","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 : 2025-12-01DOI: 10.1016/j.amjoto.2025.104761
Giulia Gramellini , Marco Borin , Matteo Lazzeroni , Alberto Giulio Dragonetti , Pasquale Capaccio , Niccolò Mevio , Jan Walter Volk Schroeder
Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophilic vasculitis frequently involving both upper and lower airways, commonly associated with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Although anti-IL-5/IL-5R biologics such as mepolizumab and benralizumab are established therapies for maintaining systemic remission, a subset of patients continues to experience refractory sinonasal symptoms. We report two EGPA cases with well-controlled systemic disease under anti-IL-5/IL-5R therapy but persistent uncontrolled CRSwNP, who were treated with add-on dupilumab. Both patients demonstrated substantial improvement in sinonasal outcomes, as reflected by reductions in SNOT-22 and nasal polyp scores, alongside maintenance of systemic remission (BVAS = 0). These findings highlight the potential role of dual biologic therapy targeting distinct inflammatory pathways in selected EGPA patients with refractory CRSwNP. Careful patient selection and close multidisciplinary monitoring are essential to ensure safety and optimize efficacy. Further studies are warranted to confirm long-term effectiveness and safety profiles.
{"title":"Adjunctive dual biologic therapy for persistent nasal symptoms in eosinophilic granulomatosis with polyangiitis (EGPA)","authors":"Giulia Gramellini , Marco Borin , Matteo Lazzeroni , Alberto Giulio Dragonetti , Pasquale Capaccio , Niccolò Mevio , Jan Walter Volk Schroeder","doi":"10.1016/j.amjoto.2025.104761","DOIUrl":"10.1016/j.amjoto.2025.104761","url":null,"abstract":"<div><div>Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophilic vasculitis frequently involving both upper and lower airways, commonly associated with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Although anti-IL-5/IL-5R biologics such as mepolizumab and benralizumab are established therapies for maintaining systemic remission, a subset of patients continues to experience refractory sinonasal symptoms. We report two EGPA cases with well-controlled systemic disease under anti-IL-5/IL-5R therapy but persistent uncontrolled CRSwNP, who were treated with add-on dupilumab. Both patients demonstrated substantial improvement in sinonasal outcomes, as reflected by reductions in SNOT-22 and nasal polyp scores, alongside maintenance of systemic remission (BVAS = 0). These findings highlight the potential role of dual biologic therapy targeting distinct inflammatory pathways in selected EGPA patients with refractory CRSwNP. Careful patient selection and close multidisciplinary monitoring are essential to ensure safety and optimize efficacy. Further studies are warranted to confirm long-term effectiveness and safety profiles.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104761"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676146","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 : 2025-11-30DOI: 10.1016/j.amjoto.2025.104752
Layla Ali , Adam Ali , Samuel Salib , Niloufar S. Tehrani , Hong-Ho Yang , Khashayar Mozaffari , Quinton Gopen
Objective
To investigate predictors of headache resolution following surgical intervention for superior semicircular canal dehiscence (SSCD) syndrome.
Method
We conducted a retrospective chart review on 344 surgical repairs of SSCD via the middle cranial fossa (MCF) approach conducted at an institution. The primary outcome measure was the resolution of headaches after SSCD repair. Analyses explored the predictive potential of several comorbidities and lifestyle factors pre-operatively.
Results
Among a total of 344 repairs, 193 (56 %) reported headaches preoperatively. Among which, 114 (59 %) experienced headache resolution following surgery. Compared to patients without a history of general anxiety disorder (GAD), patients with GAD reported a 65 % lower odds of headache resolution following surgery (aOR 0.35, 95 % CI [0.14, 0.91]). Compared to patients without hypertension (HTN), patients with HTN were significantly more likely to experience headache resolution following surgery (aOR 4.65, [1.19, 18.22]).
Conclusion
A substantial portion of patients with headaches experienced resolution following SSCD repair (∼60 %). Patients with GAD were less likely to experience headache resolution following SSCD repair, whereas patients with HTN were more likely to experience headache resolution.
{"title":"Headache resolution following the middle fossa repair of superior semicircular canal dehiscence","authors":"Layla Ali , Adam Ali , Samuel Salib , Niloufar S. Tehrani , Hong-Ho Yang , Khashayar Mozaffari , Quinton Gopen","doi":"10.1016/j.amjoto.2025.104752","DOIUrl":"10.1016/j.amjoto.2025.104752","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate predictors of headache resolution following surgical intervention for superior semicircular canal dehiscence (SSCD) syndrome.</div></div><div><h3>Method</h3><div>We conducted a retrospective chart review on 344 surgical repairs of SSCD via the middle cranial fossa (MCF) approach conducted at an institution. The primary outcome measure was the resolution of headaches after SSCD repair. Analyses explored the predictive potential of several comorbidities and lifestyle factors pre-operatively.</div></div><div><h3>Results</h3><div>Among a total of 344 repairs, 193 (56 %) reported headaches preoperatively. Among which, 114 (59 %) experienced headache resolution following surgery. Compared to patients without a history of general anxiety disorder (GAD), patients with GAD reported a 65 % lower odds of headache resolution following surgery (aOR 0.35, 95 % CI [0.14, 0.91]). Compared to patients without hypertension (HTN), patients with HTN were significantly more likely to experience headache resolution following surgery (aOR 4.65, [1.19, 18.22]).</div></div><div><h3>Conclusion</h3><div>A substantial portion of patients with headaches experienced resolution following SSCD repair (∼60 %). Patients with GAD were less likely to experience headache resolution following SSCD repair, whereas patients with HTN were more likely to experience headache resolution.</div><div>Level of Evidence: Level IV</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104752"},"PeriodicalIF":1.7,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754740","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 : 2025-11-30DOI: 10.1016/j.amjoto.2025.104756
Ross Rosen , Jamil Hayden , Jenna Rock , Alexandra Welschmeyer , Chelsea Cleveland , Todd Otteson
Introduction
Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of immunosuppression in solid organ transplant patients. Tonsillar hypertrophy commonly results from PTLD, and tonsillectomy is usually performed when PTLD is the suspected cause. Risk factors for PTLD-mediated tonsillar hypertrophy remain poorly defined. This study aimed to identify clinical and therapeutic factors associated with tonsillar hypertrophy following PTLD diagnosis.
Methods
We conducted a retrospective cohort study using the TriNetX Database. Pediatric solid organ transplant recipients were queried for tonsil disease, tonsillectomy, PTLD diagnosis, transplant history, and immunosuppressants using the associated Current Procedural Terminology, International Classification of Diseases, and RxNorm codes.
Results
We identified 21,582 children with a history of solid organ transplant. Tonsil disease was found in 1833 (8.49 %), and of these patients, 193 (10.53 %) were diagnosed with PTLD within six months. Immunosuppressants associated with higher rates of tonsil disease were tacrolimus (OR 2.74, 95 % CI 2.29–3.28), mycophenolate mofetil (OR 2.72, 95 % CI 2.29–3.24), and cyclosporine (OR 1.50, 95 % CI 1.08–2.10). Sirolimus was associated with lower rates (OR 0.66, 95 % CI 0.52–0.83). EBV diagnosis was associated with both higher rates of tonsil disease (OR 1.45, 95 % CI 1.21–1.72) and PTLD diagnosis (OR 3.52, 95 % CI 2.14–5.77).
Discussion
This is the largest study on tonsillar hypertrophy in PTLD and the first to identify tacrolimus, mycophenolate mofetil, and cyclosporine as significant risk factors for tonsil disease amongst pediatric transplant patients. Understanding risk factors that may predispose a patient to PTLD-mediated tonsil disease can guide decision making to help avoid this complication of immunosuppression.
移植后淋巴细胞增生性疾病（PTLD）是实体器官移植患者免疫抑制的罕见并发症。扁桃体肥大通常是由PTLD引起的，当怀疑是PTLD的原因时，通常进行扁桃体切除术。ptld介导的扁桃体肥大的危险因素仍不明确。本研究旨在确定PTLD诊断后扁桃体肥大的临床和治疗因素。方法：我们使用TriNetX数据库进行回顾性队列研究。使用相关的现行程序术语、国际疾病分类和RxNorm代码查询儿童实体器官移植受者的扁桃体疾病、扁桃体切除术、PTLD诊断、移植史和免疫抑制剂。结果：我们确定了21,582例有实体器官移植史的儿童。扁桃体病变1833例（8.49%），其中193例（10.53%）在6个月内被诊断为PTLD。与扁桃体疾病发生率较高相关的免疫抑制剂有他克莫司（OR 2.74, 95% CI 2.29-3.28）、霉酚酸酯（OR 2.72, 95% CI 2.29-3.24）和环孢素（OR 1.50, 95% CI 1.08-2.10）。西罗莫司与较低的发生率相关（OR 0.66, 95% CI 0.52-0.83）。EBV诊断与扁桃体疾病（OR 1.45, 95% CI 1.21-1.72）和PTLD诊断（OR 3.52, 95% CI 2.14-5.77）的高发率相关。讨论：这是最大的关于PTLD扁桃体肥大的研究，也是首次确定他克莫司、霉酚酸酯和环孢素是儿童移植患者扁桃体疾病的重要危险因素。了解可能使患者易患ptld介导的扁桃体疾病的危险因素可以指导决策，帮助避免这种免疫抑制并发症。
{"title":"Risk factors for tonsillar hypertrophy and post-transplant lymphoproliferative disorder","authors":"Ross Rosen , Jamil Hayden , Jenna Rock , Alexandra Welschmeyer , Chelsea Cleveland , Todd Otteson","doi":"10.1016/j.amjoto.2025.104756","DOIUrl":"10.1016/j.amjoto.2025.104756","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of immunosuppression in solid organ transplant patients. Tonsillar hypertrophy commonly results from PTLD, and tonsillectomy is usually performed when PTLD is the suspected cause. Risk factors for PTLD-mediated tonsillar hypertrophy remain poorly defined. This study aimed to identify clinical and therapeutic factors associated with tonsillar hypertrophy following PTLD diagnosis.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX Database. Pediatric solid organ transplant recipients were queried for tonsil disease, tonsillectomy, PTLD diagnosis, transplant history, and immunosuppressants using the associated Current Procedural Terminology, International Classification of Diseases, and RxNorm codes.</div></div><div><h3>Results</h3><div>We identified 21,582 children with a history of solid organ transplant. Tonsil disease was found in 1833 (8.49 %), and of these patients, 193 (10.53 %) were diagnosed with PTLD within six months. Immunosuppressants associated with higher rates of tonsil disease were tacrolimus (OR 2.74, 95 % CI 2.29–3.28), mycophenolate mofetil (OR 2.72, 95 % CI 2.29–3.24), and cyclosporine (OR 1.50, 95 % CI 1.08–2.10). Sirolimus was associated with lower rates (OR 0.66, 95 % CI 0.52–0.83). EBV diagnosis was associated with both higher rates of tonsil disease (OR 1.45, 95 % CI 1.21–1.72) and PTLD diagnosis (OR 3.52, 95 % CI 2.14–5.77).</div></div><div><h3>Discussion</h3><div>This is the largest study on tonsillar hypertrophy in PTLD and the first to identify tacrolimus, mycophenolate mofetil, and cyclosporine as significant risk factors for tonsil disease amongst pediatric transplant patients. Understanding risk factors that may predispose a patient to PTLD-mediated tonsil disease can guide decision making to help avoid this complication of immunosuppression.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104756"},"PeriodicalIF":1.7,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676153","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 : 2025-11-11DOI: 10.1016/j.amjoto.2025.104740
Giannicola Iannella , Sergio Terranova , Marco Brunori , Claudio Vicini , Alberto Caranti , Ruggero Campisi , Vincenzo De Ceglie , Manuele Casale , Antonio Moffa , Fabrizio Salamanca , Federico Leone , Andrea De Vito , Giovanni Cammaroto , Salvatore Cocuzza , Antonino Maniaci , Armando De Virgilio , Jerome R. Lechien , Carlos-Miguel Chiesa-Estomba , Luigi A. Vaira , Paolo Boscolo-Rizzo , Annalisa Pace
Purpose
To evaluate, in Obstructive sleep apnea (OSA) patients, the use of pre-treatment drug-induced sleep endoscopy (DISE) as a patient selection tool, that could improve the outcomes of mandibular advancement device (MAD) therapy. A multicenter retrospective case-control study has been performed.
Methods
A multicenter case-control study with two parallel arms was conducted to compare functional outcomes in patients undergoing MAD therapy. Group A (n = 118) received MAD therapy based solely on static clinical assessments, including dentoskeletal features, oropharyngeal anatomy, and upper airway endoscopy. Group B (n = 87) underwent pre-treatment DISE to dynamically evaluate the site, type, and pattern of upper airway collapse, thereby guiding patient selection for MAD therapy.
Results
In Group A, the mean pre-treatment apnea-hypopnea index (AHI) was 28.1, decreasing significantly to 12.4 post-treatment (p = 0.0001). In Group B, the mean AHI decreased from 31.3 to 9.5 (p = 0.0001). The Delta apnea-hypopnea index (ΔAHI) was significantly greater in Group B (−21.7) than in Group A (−16.6; p = 0.04). Similarly, the Delta Oxigen desaturation index (ΔODI) was −18.6 in Group B versus −14.1 in Group A (p = 0.04). The therapeutic success rate was significantly higher in Group B (82.7 %) compared to Group A (60.1 %) (p = 0.001).
Conclusion
In OSA patients, a pre-treatment DISE evaluation, improves the selection of appropriate candidates for MAD therapy by enabling dynamic assessment of upper airway collapsibility during a pharmacologically induced sleep. This targeted selection results in significantly better therapeutic outcomes for MAD therapy for the OSA treatment.
{"title":"Effectiveness of drug-induced sleep endoscopy in improving patients selection and outcomes of mandibular advancement device therapy for obstructive sleep apnea: A multicenter case-control study","authors":"Giannicola Iannella , Sergio Terranova , Marco Brunori , Claudio Vicini , Alberto Caranti , Ruggero Campisi , Vincenzo De Ceglie , Manuele Casale , Antonio Moffa , Fabrizio Salamanca , Federico Leone , Andrea De Vito , Giovanni Cammaroto , Salvatore Cocuzza , Antonino Maniaci , Armando De Virgilio , Jerome R. Lechien , Carlos-Miguel Chiesa-Estomba , Luigi A. Vaira , Paolo Boscolo-Rizzo , Annalisa Pace","doi":"10.1016/j.amjoto.2025.104740","DOIUrl":"10.1016/j.amjoto.2025.104740","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate, in Obstructive sleep apnea (OSA) patients, the use of pre-treatment drug-induced sleep endoscopy (DISE) as a patient selection tool, that could improve the outcomes of mandibular advancement device (MAD) therapy. A multicenter retrospective case-control study has been performed.</div></div><div><h3>Methods</h3><div>A multicenter case-control study with two parallel arms was conducted to compare functional outcomes in patients undergoing MAD therapy. Group A (n = 118) received MAD therapy based solely on static clinical assessments, including dentoskeletal features, oropharyngeal anatomy, and upper airway endoscopy. Group B (n = 87) underwent pre-treatment DISE to dynamically evaluate the site, type, and pattern of upper airway collapse, thereby guiding patient selection for MAD therapy.</div></div><div><h3>Results</h3><div>In Group A, the mean pre-treatment apnea-hypopnea index (AHI) was 28.1, decreasing significantly to 12.4 post-treatment (p = 0.0001). In Group B, the mean AHI decreased from 31.3 to 9.5 (p = 0.0001). The Delta apnea-hypopnea index (ΔAHI) was significantly greater in Group B (−21.7) than in Group A (−16.6; p = 0.04). Similarly, the Delta Oxigen desaturation index (ΔODI) was −18.6 in Group B versus −14.1 in Group A (p = 0.04). The therapeutic success rate was significantly higher in Group B (82.7 %) compared to Group A (60.1 %) (p = 0.001).</div></div><div><h3>Conclusion</h3><div>In OSA patients, a pre-treatment DISE evaluation, improves the selection of appropriate candidates for MAD therapy by enabling dynamic assessment of upper airway collapsibility during a pharmacologically induced sleep. This targeted selection results in significantly better therapeutic outcomes for MAD therapy for the OSA treatment.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104740"},"PeriodicalIF":1.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145537361","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 : 2025-11-01DOI: 10.1016/j.amjoto.2025.104727
Paweł Łajczak , Emma Ann Finnegan , Enzo von Quednow , Fabio Victor Vieira Rocha , Yasmin Picanço Silva , Oguz Kagan Sahin , Walter Fagundes
Introduction
Vestibular schwannomas (VS) are benign tumors that can cause hearing loss, tinnitus and balance disorders. Radiosurgery and open surgery remain the primary treatments, but predicting hearing preservation post-surgery remains challenging due to a variety of factors. Machine learning (ML) has emerged as a promising tool for predicting hearing outcomes in VS patients. This meta-analysis aims to systematically evaluate the diagnostic accuracy of ML models in predicting hearing preservation in VS patients undergoing surgery.
Methods
We conducted a systematic review and meta-analysis following PRISMA-DTA guidelines, including studies that applied ML to predict hearing preservation in VS patients undergoing surgery. Studies were selected based on predefined inclusion criteria, and diagnostic accuracy metrics, such as sensitivity, specificity and accuracy were extracted.
Results
A total of 15 models from 3 studies were included. The overall pooled sensitivity was 0.856 (95% CI 0.758–0.919), specificity was 0.853 (95% CI 0.713–0.931), and accuracy was 0.839 (95% CI 0.748–0.902). The area under the summary ROC curve was 0.883 (95% CI 0.770–0.910), indicating high diagnostic effectiveness. Significant heterogeneity was observed.
Conclusions
ML models achieve high accuracy in predicting hearing preservation in VS patients undergoing surgery. However, significant heterogeneity exists across studies, indicating the need for further research to optimize model performance and enhance their generalizability across diverse patient populations. ML has the potential to assist clinicians in providing personalized treatment strategies and improving patient outcomes in the management of vestibular schwannomas.
前庭神经鞘瘤（VS）是一种良性肿瘤，可引起听力损失、耳鸣和平衡障碍。放疗和开放手术仍然是主要的治疗方法，但由于各种因素，预测术后听力保留仍然具有挑战性。机器学习（ML）已成为预测VS患者听力结果的一种有前途的工具。本荟萃分析旨在系统评估ML模型在预测接受手术的VS患者听力保留方面的诊断准确性。方法：我们根据PRISMA-DTA指南进行了系统回顾和荟萃分析，包括应用ML预测接受手术的VS患者听力保留的研究。根据预定义的纳入标准选择研究，提取诊断准确性指标，如敏感性、特异性和准确性。结果：共纳入3项研究的15个模型。总体合并敏感性为0.856 (95% CI 0.758-0.919)，特异性为0.853 (95% CI 0.713-0.931)，准确性为0.839 （95% CI 0.748-0.902）。综合ROC曲线下面积为0.883 (95% CI 0.77 ~ 0.910)，诊断效能高。观察到显著的异质性。结论：ML模型在预测VS手术患者的听力保留方面具有较高的准确性。然而，各研究之间存在显著的异质性，表明需要进一步研究以优化模型性能并增强其在不同患者群体中的普遍性。ML有可能帮助临床医生提供个性化的治疗策略，并改善前庭神经鞘瘤的治疗结果。
{"title":"Machine learning model for predicting hearing preservation after vestibular schwannoma surgery: A meta-analysis","authors":"Paweł Łajczak , Emma Ann Finnegan , Enzo von Quednow , Fabio Victor Vieira Rocha , Yasmin Picanço Silva , Oguz Kagan Sahin , Walter Fagundes","doi":"10.1016/j.amjoto.2025.104727","DOIUrl":"10.1016/j.amjoto.2025.104727","url":null,"abstract":"<div><h3>Introduction</h3><div>Vestibular schwannomas (VS) are benign tumors that can cause hearing loss, tinnitus and balance disorders. Radiosurgery and open surgery remain the primary treatments, but predicting hearing preservation post-surgery remains challenging due to a variety of factors. Machine learning (ML) has emerged as a promising tool for predicting hearing outcomes in VS patients. This meta-analysis aims to systematically evaluate the diagnostic accuracy of ML models in predicting hearing preservation in VS patients undergoing surgery.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis following PRISMA-DTA guidelines, including studies that applied ML to predict hearing preservation in VS patients undergoing surgery. Studies were selected based on predefined inclusion criteria, and diagnostic accuracy metrics, such as sensitivity, specificity and accuracy were extracted.</div></div><div><h3>Results</h3><div>A total of 15 models from 3 studies were included. The overall pooled sensitivity was 0.856 (95% CI 0.758–0.919), specificity was 0.853 (95% CI 0.713–0.931), and accuracy was 0.839 (95% CI 0.748–0.902). The area under the summary ROC curve was 0.883 (95% CI 0.770–0.910), indicating high diagnostic effectiveness. Significant heterogeneity was observed.</div></div><div><h3>Conclusions</h3><div>ML models achieve high accuracy in predicting hearing preservation in VS patients undergoing surgery. However, significant heterogeneity exists across studies, indicating the need for further research to optimize model performance and enhance their generalizability across diverse patient populations. ML has the potential to assist clinicians in providing personalized treatment strategies and improving patient outcomes in the management of vestibular schwannomas.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104727"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494190","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 : 2025-11-01DOI: 10.1016/j.amjoto.2025.104746
Lauren Kwa , Ashley Bodnar , Maxwell Scher , Jacob Pieter Noordzij , Lauren Tracy
Objective
To analyze national trends in the prevalence of office-based transnasal esophagoscopy (TNE) procedures and compare with traditional operating room-based procedures utilizing transoral flexible and rigid esophagoscopy.
Methods
From 2013 to 2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 43,197/43198: diagnostic transnasal flexible esophagoscopy/with biopsy, 43200/43202: diagnostic transoral flexible esophagoscopy/with biopsy, 43191/43193: diagnostic rigid esophagoscopy/with biopsy. For each CPT code, the total number of charges billed to the Medicare database in each calendar year were recorded and analyzed using trendlines and linear regression.
Results
From 2013 to 2022, there was a significant decrease in the prevalence of transoral flexible esophagoscopy, both diagnostic (trendline slope = −1078, R2 = 0.83) and with biopsy (trendline slope = −192, R2 = 0.80). The prevalence of rigid esophagoscopy, both diagnostic and with biopsy, remained stable (trendline slope = −51, R2 = 0.14; trendline slope = −9.6, R2 = 0.26, respectively). Diagnostic TNE represented a small percentage of total diagnostic esophagoscopies performed (range: 9.37–14.94 %), and this percentage remained relatively constant over time (trendline slope = 0.0017, R2 = 0.08). TNE with biopsy was a small percentage of total esophageal biopsy procedures (range: 6.54–10.66 %), with a slight increase over time as a percentage of all esophageal biopsies performed (trendline slope = 0.0037, R2 = 0.48).
Conclusion
Benefits of office-based TNE procedures include the avoidance of general anesthesia, shorter procedure times, and cost savings. However, TNE remains a small percentage of all esophagoscopies performed, without significant trends toward increased utilization. Further investigation is needed to evaluate the lack of utilization of these office-based procedures.
{"title":"National trends in the utilization of office-based transnasal esophagoscopy","authors":"Lauren Kwa , Ashley Bodnar , Maxwell Scher , Jacob Pieter Noordzij , Lauren Tracy","doi":"10.1016/j.amjoto.2025.104746","DOIUrl":"10.1016/j.amjoto.2025.104746","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze national trends in the prevalence of office-based transnasal esophagoscopy (TNE) procedures and compare with traditional operating room-based procedures utilizing transoral flexible and rigid esophagoscopy.</div></div><div><h3>Methods</h3><div>From 2013 to 2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 43,197/43198: diagnostic transnasal flexible esophagoscopy/with biopsy, 43200/43202: diagnostic transoral flexible esophagoscopy/with biopsy, 43191/43193: diagnostic rigid esophagoscopy/with biopsy. For each CPT code, the total number of charges billed to the Medicare database in each calendar year were recorded and analyzed using trendlines and linear regression.</div></div><div><h3>Results</h3><div>From 2013 to 2022, there was a significant decrease in the prevalence of transoral flexible esophagoscopy, both diagnostic (trendline slope = −1078, R<sup>2</sup> = 0.83) and with biopsy (trendline slope = −192, R<sup>2</sup> = 0.80). The prevalence of rigid esophagoscopy, both diagnostic and with biopsy, remained stable (trendline slope = −51, R<sup>2</sup> = 0.14; trendline slope = −9.6, R<sup>2</sup> = 0.26, respectively). Diagnostic TNE represented a small percentage of total diagnostic esophagoscopies performed (range: 9.37–14.94 %), and this percentage remained relatively constant over time (trendline slope = 0.0017, R<sup>2</sup> = 0.08). TNE with biopsy was a small percentage of total esophageal biopsy procedures (range: 6.54–10.66 %), with a slight increase over time as a percentage of all esophageal biopsies performed (trendline slope = 0.0037, R<sup>2</sup> = 0.48).</div></div><div><h3>Conclusion</h3><div>Benefits of office-based TNE procedures include the avoidance of general anesthesia, shorter procedure times, and cost savings. However, TNE remains a small percentage of all esophagoscopies performed, without significant trends toward increased utilization. Further investigation is needed to evaluate the lack of utilization of these office-based procedures.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104746"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412976","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 : 2025-11-01DOI: 10.1016/j.amjoto.2025.104741
Wen-Ching Chuang , Chia-Chen Lin , Yu-Chien Wang , Shih-Lung Chen , Che-Ming Wu
Objective
To investigate how visual cues influence speech recognition in Mandarin-speaking cochlear implant (CI) users and examine age-related differences in audiovisual (AV) integration across varying sound intensities and noise conditions.
Design
A cross-sectional observational study comparing performance in visual-only (VO), audio-only (AO), and AV conditions using standardized Mandarin monosyllabic word and sentence tests. Study Sample: Seventy-two participants were recruited, including 40 CI users (22 children, 18 adults) and 32 normal-hearing (NH) controls (16 children, 16 adults). All CI users were unilateral recipients of Cochlear™ Nucleus® devices.
Results
AV input significantly enhanced word recognition in CI users, particularly under degraded conditions (low intensity or high noise), consistent with the principle of inverse effectiveness. CI children outperformed adults in AV word tasks, whereas adults had better sentence comprehension. VO performance was comparable between CI and NH groups, suggesting effective visual compensation among CI users. The most pronounced AV benefit was observed at 0 dB signal-to-noise ratio, where AV sentence scores approached AO performance at +5 dB.
Conclusion
AV cues play a critical role in speech perception for Mandarin-speaking CI users, especially under acoustically challenging conditions. Age-specific patterns in AV integration suggest differential reliance on visual input and linguistic strategies. These findings support the inclusion of AV and VO tasks in clinical assessments and underscore the importance of multimodal rehabilitation approaches, particularly for pediatric CI users.
{"title":"Audiovisual speech perception in Mandarin cochlear implant users across age and listening conditions","authors":"Wen-Ching Chuang , Chia-Chen Lin , Yu-Chien Wang , Shih-Lung Chen , Che-Ming Wu","doi":"10.1016/j.amjoto.2025.104741","DOIUrl":"10.1016/j.amjoto.2025.104741","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate how visual cues influence speech recognition in Mandarin-speaking cochlear implant (CI) users and examine age-related differences in audiovisual (AV) integration across varying sound intensities and noise conditions.</div></div><div><h3>Design</h3><div>A cross-sectional observational study comparing performance in visual-only (VO), audio-only (AO), and AV conditions using standardized Mandarin monosyllabic word and sentence tests. Study Sample: Seventy-two participants were recruited, including 40 CI users (22 children, 18 adults) and 32 normal-hearing (NH) controls (16 children, 16 adults). All CI users were unilateral recipients of Cochlear™ Nucleus® devices.</div></div><div><h3>Results</h3><div>AV input significantly enhanced word recognition in CI users, particularly under degraded conditions (low intensity or high noise), consistent with the principle of inverse effectiveness. CI children outperformed adults in AV word tasks, whereas adults had better sentence comprehension. VO performance was comparable between CI and NH groups, suggesting effective visual compensation among CI users. The most pronounced AV benefit was observed at 0 dB signal-to-noise ratio, where AV sentence scores approached AO performance at +5 dB.</div></div><div><h3>Conclusion</h3><div>AV cues play a critical role in speech perception for Mandarin-speaking CI users, especially under acoustically challenging conditions. Age-specific patterns in AV integration suggest differential reliance on visual input and linguistic strategies. These findings support the inclusion of AV and VO tasks in clinical assessments and underscore the importance of multimodal rehabilitation approaches, particularly for pediatric CI users.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104741"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407910","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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