Pub Date : 2025-11-01DOI: 10.1016/j.amjoto.2025.104749
Mina A. Beshy , Fayssal Alqudrah , Isago Jerrett , Andrew M. Parrott , Taha A. Mur
Introduction
Oncocytic lipoadenomas represent a rare, benign variant of salivary gland tumors (SGT). The parotid gland is the most common location for these tumors, accounting for 85 % of cases, followed by the submandibular gland. There have only been 7 reported cases of submandibular gland oncocytic lipoadenomas documented to date.
Main concerns
Herein, we present a case of an asymptomatic 47-year-old female with no significant past medical history who was incidentally diagnosed with a mass of the submandibular gland. We proceeded with complete surgical excision of the left submandibular gland, along with a neck dissection to ensure the removal of any potentially neoplastic tissue.
Primary diagnosis and outcomes
Histopathologic analysis of the excised mass revealed lobulated adipocytic tissue intermixed with small, scattered foci of salivary gland tissue, and several areas of oncocytic glandular tissue surrounded by patchy chronic inflammation, consistent with previously reported findings of oncocytic lipoadenomas.
Conclusions
This case underscores the rarity of this benign entity and highlights its inclusion in the differential diagnosis of salivary gland masses. Furthermore, it emphasizes the importance of diagnostic imaging and histopathologic analysis following core needle biopsy, as biopsy alone may not provide sufficient diagnostic clarity.
{"title":"Oncocytic lipoadenoma of the submandibular gland case report","authors":"Mina A. Beshy , Fayssal Alqudrah , Isago Jerrett , Andrew M. Parrott , Taha A. Mur","doi":"10.1016/j.amjoto.2025.104749","DOIUrl":"10.1016/j.amjoto.2025.104749","url":null,"abstract":"<div><h3>Introduction</h3><div>Oncocytic lipoadenomas represent a rare, benign variant of salivary gland tumors (SGT). The parotid gland is the most common location for these tumors, accounting for 85 % of cases, followed by the submandibular gland. There have only been 7 reported cases of submandibular gland oncocytic lipoadenomas documented to date.</div></div><div><h3>Main concerns</h3><div>Herein, we present a case of an asymptomatic 47-year-old female with no significant past medical history who was incidentally diagnosed with a mass of the submandibular gland. We proceeded with complete surgical excision of the left submandibular gland, along with a neck dissection to ensure the removal of any potentially neoplastic tissue.</div></div><div><h3>Primary diagnosis and outcomes</h3><div>Histopathologic analysis of the excised mass revealed lobulated adipocytic tissue intermixed with small, scattered foci of salivary gland tissue, and several areas of oncocytic glandular tissue surrounded by patchy chronic inflammation, consistent with previously reported findings of oncocytic lipoadenomas.</div></div><div><h3>Conclusions</h3><div>This case underscores the rarity of this benign entity and highlights its inclusion in the differential diagnosis of salivary gland masses. Furthermore, it emphasizes the importance of diagnostic imaging and histopathologic analysis following core needle biopsy, as biopsy alone may not provide sufficient diagnostic clarity.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104749"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407766","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.2025.104731
Mei Wei , Xiu Zhang , Lei Geng , Wei Wang , Zhitao Xiao , Yanbei Liu
Objective
To design and implement a deep learning-based multimodal data fusion classification model that integrates laryngoscope images and voice signals to improve the diagnostic accuracy of laryngeal diseases, enabling rapid and precise identification for clinical support.
Results
The model demonstrated high classification accuracy and robustness, achieving an overall accuracy of 87.92 % on the independent test set. Precision, recall, specificity, and F1-score were 0.879, 0.887, 0.966, and 0.883, respectively. The model outperformed single-modal approaches and existing multimodal frameworks.
Conclusion
The proposed HSNet effectively integrates hierarchical features from laryngoscope images and voice modalities, enabling accurate classification of six laryngeal diseases. This method holds significant potential for clinical applications.
{"title":"HSNet: An adaptive fusion network based on laryngoscope–speech multimodal data for laryngeal disease classification","authors":"Mei Wei , Xiu Zhang , Lei Geng , Wei Wang , Zhitao Xiao , Yanbei Liu","doi":"10.1016/j.amjoto.2025.104731","DOIUrl":"10.1016/j.amjoto.2025.104731","url":null,"abstract":"<div><h3>Objective</h3><div>To design and implement a deep learning-based multimodal data fusion classification model that integrates laryngoscope images and voice signals to improve the diagnostic accuracy of laryngeal diseases, enabling rapid and precise identification for clinical support.</div></div><div><h3>Results</h3><div>The model demonstrated high classification accuracy and robustness, achieving an overall accuracy of 87.92 % on the independent test set. Precision, recall, specificity, and F1-score were 0.879, 0.887, 0.966, and 0.883, respectively. The model outperformed single-modal approaches and existing multimodal frameworks.</div></div><div><h3>Conclusion</h3><div>The proposed HSNet effectively integrates hierarchical features from laryngoscope images and voice modalities, enabling accurate classification of six laryngeal diseases. This method holds significant potential for clinical applications.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104731"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145385277","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}
The apparent diffusion coefficient (ADC), obtained from diffusion-weighted imaging (DWI) on MRI, quantifies water diffusion within tissues and is commonly used to distinguish benign from malignant tumors. In the sinonasal region, preoperative diagnosis is often challenging due to diverse histologies and limited biopsy samples. This study aimed to assess the utility of ADCmean values in categorizing sinonasal tumors into benign tumors (excluding papillomas), papillomas, and malignant tumors, and to evaluate their potential as a supplementary diagnostic tool.
Methods
We retrospectively analyzed 74 patients with sinonasal tumors who underwent surgery between January 2011 and April 2022 and had preoperative DWI-MRI for ADC measurement. Tumors were classified into three groups based on final pathology: benign tumors excluding papillomas (12 cases), papillomas (28 cases), and malignant tumors (34 cases). Receiver operating characteristic (ROC) analysis was used to determine ADCmean cutoff values for each category. Diagnostic accuracy of ADC-based classification was compared with that of preoperative biopsy. Additionally, 8 cases without biopsy due to technical or safety concerns were assessed using ADCmean values alone.
Results
Mean ADC values significantly differed across groups: 1.89 ± 0.37 × 10−3 mm2/s for benign tumors excluding papillomas, 1.38 ± 0.33 × 10−3 mm2/s for papillomas, and 1.06 ± 0.27 × 10−3 mm2/s for malignant tumors. ROC analysis yielded optimal cutoff values: >1.57 for benign tumors excluding papillomas, 1.23–1.57 for papillomas, and < 1.23 for malignant tumors. Based on these thresholds, tumors were categorized into high (>1.57), intermediate (1.23–1.57), and low (<1.23) ADC groups. ADC-based classification achieved 68.9 % accuracy (51/74), lower than biopsy (95.4 %, 63/66), but correctly predicted tumor categories in all three cases where biopsy results were discordant with final pathology. In 8 cases without biopsy, ADC-based categorization achieved 87.5 % accuracy (7/8).
Conclusion
ADCmean values from DWI-MRI can effectively differentiate between benign tumors excluding papillomas, papillomas, and malignant tumors. Although not as accurate as biopsy, ADC-based categorization adds diagnostic value, especially in cases where biopsy is inconclusive or infeasible. Combining ADC analysis with biopsy findings may improve preoperative diagnostic accuracy and assist clinical decision-making in managing sinonasal tumors.
{"title":"Utility of apparent diffusion coefficient values in preoperative MRI for sinonasal tumors: Categorization of benign tumors excluding Papillomas, Papillomas, and malignant tumors","authors":"Mami Matsunaga , Masahiro Kikuchi , Yuji Kitada , Takayuki Nakagawa , Sho Koyasu , Yuji Nakamoto , Koichi Omori","doi":"10.1016/j.amjoto.2025.104738","DOIUrl":"10.1016/j.amjoto.2025.104738","url":null,"abstract":"<div><h3>Objective</h3><div>The apparent diffusion coefficient (ADC), obtained from diffusion-weighted imaging (DWI) on MRI, quantifies water diffusion within tissues and is commonly used to distinguish benign from malignant tumors. In the sinonasal region, preoperative diagnosis is often challenging due to diverse histologies and limited biopsy samples. This study aimed to assess the utility of ADCmean values in categorizing sinonasal tumors into benign tumors (excluding papillomas), papillomas, and malignant tumors, and to evaluate their potential as a supplementary diagnostic tool.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 74 patients with sinonasal tumors who underwent surgery between January 2011 and April 2022 and had preoperative DWI-MRI for ADC measurement. Tumors were classified into three groups based on final pathology: benign tumors excluding papillomas (12 cases), papillomas (28 cases), and malignant tumors (34 cases). Receiver operating characteristic (ROC) analysis was used to determine ADCmean cutoff values for each category. Diagnostic accuracy of ADC-based classification was compared with that of preoperative biopsy. Additionally, 8 cases without biopsy due to technical or safety concerns were assessed using ADCmean values alone.</div></div><div><h3>Results</h3><div>Mean ADC values significantly differed across groups: 1.89 ± 0.37 × 10<sup>−3</sup> mm<sup>2</sup>/s for benign tumors excluding papillomas, 1.38 ± 0.33 × 10<sup>−3</sup> mm<sup>2</sup>/s for papillomas, and 1.06 ± 0.27 × 10<sup>−3</sup> mm<sup>2</sup>/s for malignant tumors. ROC analysis yielded optimal cutoff values: >1.57 for benign tumors excluding papillomas, 1.23–1.57 for papillomas, and < 1.23 for malignant tumors. Based on these thresholds, tumors were categorized into high (>1.57), intermediate (1.23–1.57), and low (<1.23) ADC groups. ADC-based classification achieved 68.9 % accuracy (51/74), lower than biopsy (95.4 %, 63/66), but correctly predicted tumor categories in all three cases where biopsy results were discordant with final pathology. In 8 cases without biopsy, ADC-based categorization achieved 87.5 % accuracy (7/8).</div></div><div><h3>Conclusion</h3><div>ADCmean values from DWI-MRI can effectively differentiate between benign tumors excluding papillomas, papillomas, and malignant tumors. Although not as accurate as biopsy, ADC-based categorization adds diagnostic value, especially in cases where biopsy is inconclusive or infeasible. Combining ADC analysis with biopsy findings may improve preoperative diagnostic accuracy and assist clinical decision-making in managing sinonasal tumors.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104738"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412975","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}
Thyroid nodules initially classified as Bethesda categories II, III, or IV are occasionally re-aspirated due to evolving clinical or ultrasonographic features, or as part of structured protocols. This real-world study aimed to (1) determine the frequency of changes in Bethesda classification following repeat fine-needle aspiration (FNA), (2) assess the relationship between Bethesda category shifts and the clinical indication for re-aspiration, and (3) evaluate malignancy rates in nodules that demonstrated cytologic reclassification.
Methods
A retrospective analysis of thyroid nodules that underwent more than one FNA between 2018 and 2024. Only nodules initially categorized as Bethesda II, III, or IV were included. Cytological outcomes were compared between the initial and repeat aspirations.
Results
A total of 429 nodules underwent repeat FNA, with 111 nodules meeting inclusion criteria. Among nodules initially classified as Bethesda II (benign), 40.4 % were upgraded to a higher Bethesda category on repeat aspiration. For nodules initially categorized as Bethesda III or IV, 13.6 and 21.6 % were upgraded, while 40.6 and 48.6 % were downgraded to a lower-risk category, respectively.
Malignancy rates correlated with upgraded cytology classifications: 55.6–80 % of nodules reclassified as Bethesda III / IV were malignant, while 66.7–100 % of nodules upgraded to Bethesda V / VI were confirmed as malignant on final pathology.
Conclusions
Repeat FNA of thyroid nodules - particularly when prompted by clinical assessment, sonographic changes, and institutional guidelines for indeterminate cytology - can significantly refine risk stratification. These findings support the high diagnostic utility of repeated aspiration in appropriate clinical scenarios.
简介：最初被归类为Bethesda II、III或IV类的甲状腺结节，由于临床或超声特征的变化，或作为结构化方案的一部分，偶尔会再次抽吸。这项现实世界的研究旨在(1)确定重复细针抽吸（FNA）后Bethesda分类变化的频率，(2)评估Bethesda分类变化与再次抽吸的临床指征之间的关系，以及(3)评估显示细胞学再分类的结节的恶性率。方法：回顾性分析2018年至2024年间接受1次以上FNA的甲状腺结节。仅包括最初归类为Bethesda II、III或IV的结节。比较首次和重复穿刺的细胞学结果。结果：共有429例结节接受了重复FNA治疗，其中111例符合纳入标准。在最初被分类为Bethesda II（良性）的结节中，40.4%在重复抽吸后升级到更高的Bethesda类别。对于最初被归类为Bethesda III或IV的结节，分别有13.6%和21.6%的结节升级，而40.6%和48.6%的结节被降级为低风险类别。恶性率与升级的细胞学分类相关：55.6- 80%的结节重新分类为Bethesda III / IV为恶性，而66.7- 100%的结节升级为Bethesda V / VI最终病理证实为恶性。结论：甲状腺结节的重复FNA -特别是当临床评估、超声检查改变和不确定细胞学的机构指南提示时-可以显着改善风险分层。这些发现支持在适当的临床情况下反复穿刺的高诊断效用。
{"title":"The clinical effect of second needle aspiration and repeated cytological investigation for same thyroid nodule","authors":"Tzahi Neuman , Nir Zontag , Karin Atlan , Haggi Mazeh , Nir Hirshoren","doi":"10.1016/j.amjoto.2025.104737","DOIUrl":"10.1016/j.amjoto.2025.104737","url":null,"abstract":"<div><h3>Introduction</h3><div>Thyroid nodules initially classified as Bethesda categories II, III, or IV are occasionally re-aspirated due to evolving clinical or ultrasonographic features, or as part of structured protocols. This real-world study aimed to (1) determine the frequency of changes in Bethesda classification following repeat fine-needle aspiration (FNA), (2) assess the relationship between Bethesda category shifts and the clinical indication for re-aspiration, and (3) evaluate malignancy rates in nodules that demonstrated cytologic reclassification.</div></div><div><h3>Methods</h3><div>A retrospective analysis of thyroid nodules that underwent more than one FNA between 2018 and 2024. Only nodules initially categorized as Bethesda II, III, or IV were included. Cytological outcomes were compared between the initial and repeat aspirations.</div></div><div><h3>Results</h3><div>A total of 429 nodules underwent repeat FNA, with 111 nodules meeting inclusion criteria. Among nodules initially classified as Bethesda II (benign), 40.4 % were upgraded to a higher Bethesda category on repeat aspiration. For nodules initially categorized as Bethesda III or IV, 13.6 and 21.6 % were upgraded, while 40.6 and 48.6 % were downgraded to a lower-risk category, respectively.</div><div>Malignancy rates correlated with upgraded cytology classifications: 55.6–80 % of nodules reclassified as Bethesda III / IV were malignant, while 66.7–100 % of nodules upgraded to Bethesda V / VI were confirmed as malignant on final pathology.</div></div><div><h3>Conclusions</h3><div>Repeat FNA of thyroid nodules - particularly when prompted by clinical assessment, sonographic changes, and institutional guidelines for indeterminate cytology - can significantly refine risk stratification. These findings support the high diagnostic utility of repeated aspiration in appropriate clinical scenarios.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104737"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407754","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.2025.104732
Weiguo Li , Shengqi Gan , Gong Liang , Linrong Wu , Junjun Zhang , Jiangyu Yan , Dong Ye
Nasal bleeding, especially following nasal or sinus surgery, significantly impacts patient recovery. Traditional hemostatic methods no longer meet the clinical needs of patients. With the advancement of treatment options for nasal bleeding, absorbable hemostatic materials, known for their excellent biocompatibility and degradability, have garnered widespread attention in the field of nasal hemostasis. This article aims to review the recent progress in research on hemostatic materials for nasal bleeding and post-operative nasal surgery. It analyzes the mechanisms of action of various types of hemostatic materials, including collagen-based, cellulose-based, alginate-based, and platelet-rich plasma (PRP) materials, discussing their clinical applications, advantages, and limitations. Finally, the article explores the future direction of nasal hemostatic materials, particularly the innovative development of bioactive absorbable materials and their potential applications in nasal bleeding. Overall, with the continuous emergence of novel materials, nasal hemostatic materials are expected to play an increasingly vital role in improving therapeutic outcomes, reducing recurrence, and enhancing the quality of life for patients.
{"title":"Advances in absorbable hemostatic materials for nasal bleeding and post-sinus surgery","authors":"Weiguo Li , Shengqi Gan , Gong Liang , Linrong Wu , Junjun Zhang , Jiangyu Yan , Dong Ye","doi":"10.1016/j.amjoto.2025.104732","DOIUrl":"10.1016/j.amjoto.2025.104732","url":null,"abstract":"<div><div>Nasal bleeding, especially following nasal or sinus surgery, significantly impacts patient recovery. Traditional hemostatic methods no longer meet the clinical needs of patients. With the advancement of treatment options for nasal bleeding, absorbable hemostatic materials, known for their excellent biocompatibility and degradability, have garnered widespread attention in the field of nasal hemostasis. This article aims to review the recent progress in research on hemostatic materials for nasal bleeding and post-operative nasal surgery. It analyzes the mechanisms of action of various types of hemostatic materials, including collagen-based, cellulose-based, alginate-based, and platelet-rich plasma (PRP) materials, discussing their clinical applications, advantages, and limitations. Finally, the article explores the future direction of nasal hemostatic materials, particularly the innovative development of bioactive absorbable materials and their potential applications in nasal bleeding. Overall, with the continuous emergence of novel materials, nasal hemostatic materials are expected to play an increasingly vital role in improving therapeutic outcomes, reducing recurrence, and enhancing the quality of life for patients.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104732"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412977","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.2025.104735
Brandon D. Abell , Victoria Fischman , Laylaa Ramos Arriaza , Cristina Cabrera-Muffly , Anne Getz , Andrew P. Johnson
Objective
Burnout is prevalent in the medical field, including within Otolaryngology – Head and Neck Surgery. To date, no study has focused on the impact burnout plays on the future career choices of otolaryngology residents and fellows. Additionally, this study aimed to assess how perceptions of burnout among subspecialty teaching faculty impacted trainees' future career choices.
Methods
An anonymous, cross-sectional survey was distributed nationally to program directors and coordinators of all ACGME-accredited Otolaryngology—Head and Neck Surgery residency programs in the United States during the 2022 academic year, with a request to forward the survey to current residents and fellows.
Results
A total of 82 trainees (72 resident physicians and 10 fellows) responded to the survey, with an estimated resident physician response rate of 4 %. 35 of the 72 residents (49 %) were planning to or were in the process of applying for a fellowship position. Burnout was cited as a factor in whether or not to pursue fellowship training for 41.3 % of respondents, and as a factor in whether or not to pursue academic medicine in 46.9 % of respondents. Witnessed or perceived burnout among faculty members also played a role in future career decisions for 61 % of respondents. Qualitative analysis revealed themes including negotiating current and future comfort/ burnout, seeking balance, and the influence of perceived burnout.
Conclusions
Personal burnout and observed burnout among faculty impacts career decision-making in a significant percentage of otolaryngology residents and fellows. Efforts to mitigate burnout are crucial to avoid determent of career choices within otolaryngology.
{"title":"Toasted: Is burnout affecting otolaryngology trainee career decisions?","authors":"Brandon D. Abell , Victoria Fischman , Laylaa Ramos Arriaza , Cristina Cabrera-Muffly , Anne Getz , Andrew P. Johnson","doi":"10.1016/j.amjoto.2025.104735","DOIUrl":"10.1016/j.amjoto.2025.104735","url":null,"abstract":"<div><h3>Objective</h3><div>Burnout is prevalent in the medical field, including within Otolaryngology – Head and Neck Surgery. To date, no study has focused on the impact burnout plays on the future career choices of otolaryngology residents and fellows. Additionally, this study aimed to assess how perceptions of burnout among subspecialty teaching faculty impacted trainees' future career choices.</div></div><div><h3>Methods</h3><div>An anonymous, cross-sectional survey was distributed nationally to program directors and coordinators of all ACGME-accredited Otolaryngology—Head and Neck Surgery residency programs in the United States during the 2022 academic year, with a request to forward the survey to current residents and fellows.</div></div><div><h3>Results</h3><div>A total of 82 trainees (72 resident physicians and 10 fellows) responded to the survey, with an estimated resident physician response rate of 4 %. 35 of the 72 residents (49 %) were planning to or were in the process of applying for a fellowship position. Burnout was cited as a factor in whether or not to pursue fellowship training for 41.3 % of respondents, and as a factor in whether or not to pursue academic medicine in 46.9 % of respondents. Witnessed or perceived burnout among faculty members also played a role in future career decisions for 61 % of respondents. Qualitative analysis revealed themes including negotiating current and future comfort/ burnout, seeking balance, and the influence of perceived burnout.</div></div><div><h3>Conclusions</h3><div>Personal burnout and observed burnout among faculty impacts career decision-making in a significant percentage of otolaryngology residents and fellows. Efforts to mitigate burnout are crucial to avoid determent of career choices within otolaryngology.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104735"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407735","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.2025.104745
François Voruz , Rebecca Revol , Maxime Mermod , Pascal Senn , Yan Monnier , Nicolas Dulguerov
Purpose
To assess the efficacy, safety, and tolerance of drainage under local anesthesia compared to immediate tonsillectomy to treat uncomplicated unilateral peritonsillar abscess (PTA) in adults.
Methods
A randomized clinical trial was conducted in a tertiary care university hospital. Adults with PTA radiologically confirmed as ≥1 cm and uncomplicated were randomly assigned to two groups using block randomization. They immediately underwent either tonsillectomy under general anesthesia or drainage under local anesthesia. The primary outcome was treatment success at 48 h, defined as a reduction in swelling and restoration of swallowing function, allowing hospital discharge. Secondary outcomes included pain and anxiety levels, along with postoperative bleeding.
Results
A total of 41 patients were included (66 % male; age range 18—77 years). Twenty-one patients underwent tonsillectomy, while 20 underwent drainage. The success rate was higher in the tonsillectomy group (100 %) than in the drainage group (75 %, p = 0.02). Pain and anxiety levels were significantly higher in the drainage group (p < 0.01). Postoperative bleeding occurred in 33 % of the tonsillectomy group, while no bleeding was reported in the drainage group (p < 0.01).
Conclusion
Immediate tonsillectomy for treating PTA offers definitive management with high efficacy, albeit with an increased risk of postoperative bleeding. Drainage under local anesthesia is associated with a higher failure rate and increased patient discomfort but demonstrates a better safety profile. Treatment decisions should be tailored based on patient preferences, clinical presentation, and available resources.
{"title":"A randomized clinical trial of peritonsillar abscess treatment comparing drainage and tonsillectomy","authors":"François Voruz , Rebecca Revol , Maxime Mermod , Pascal Senn , Yan Monnier , Nicolas Dulguerov","doi":"10.1016/j.amjoto.2025.104745","DOIUrl":"10.1016/j.amjoto.2025.104745","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the efficacy, safety, and tolerance of drainage under local anesthesia compared to immediate tonsillectomy to treat uncomplicated unilateral peritonsillar abscess (PTA) in adults.</div></div><div><h3>Methods</h3><div>A randomized clinical trial was conducted in a tertiary care university hospital. Adults with PTA radiologically confirmed as ≥1 cm and uncomplicated were randomly assigned to two groups using block randomization. They immediately underwent either tonsillectomy under general anesthesia or drainage under local anesthesia. The primary outcome was treatment success at 48 h, defined as a reduction in swelling and restoration of swallowing function, allowing hospital discharge. Secondary outcomes included pain and anxiety levels, along with postoperative bleeding.</div></div><div><h3>Results</h3><div>A total of 41 patients were included (66 % male; age range 18—77 years). Twenty-one patients underwent tonsillectomy, while 20 underwent drainage. The success rate was higher in the tonsillectomy group (100 %) than in the drainage group (75 %, <em>p</em> = 0.02). Pain and anxiety levels were significantly higher in the drainage group (<em>p</em> < 0.01). Postoperative bleeding occurred in 33 % of the tonsillectomy group, while no bleeding was reported in the drainage group (<em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>Immediate tonsillectomy for treating PTA offers definitive management with high efficacy, albeit with an increased risk of postoperative bleeding. Drainage under local anesthesia is associated with a higher failure rate and increased patient discomfort but demonstrates a better safety profile. Treatment decisions should be tailored based on patient preferences, clinical presentation, and available resources.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrial.gov</span><svg><path></path></svg></span> protocol record <span><span>NCT04543708</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104745"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450653","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}
Nasal obstruction has been identified as a significant factor in the development and exacerbation of obstructive sleep apnea (OSA). This study aimed to explore the correlation between objective and subjective measures of nasal obstruction with polysomnographic features.
Methods
A cross-sectional study was conducted on 100 patients suspected of OSA. Participants completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire to assess subjective nasal obstruction. Objective nasal airflow was measured using peak nasal expiratory flow (PNEF). All participants underwent type I polysomnography to assess sleep-related breathing disturbances. Correlations between NOSE scores, PNEF, and various polysomnographic parameters, including the apnea-hypopnea index (AHI), mean oxygen saturation, time spent below 90 % oxygen saturation, lowest oxygen saturation, and arousal index, were calculated.
Results
The mean total NOSE scale score was 9.5 (SD = 5.6), indicating a moderate level of nasal obstruction. The mean PNEF was 0.56 L/s (SD = 0.44 L/s). A significant negative correlation was found between PNEF and the total NOSE scale score (Spearman's rho = ‐0.319, p = 0.003). Additionally, PNEF was significantly negatively correlated with the arousal index (Spearman's rho = ‐0.329, p = 0.002). However, no significant correlations were found between PNEF and other polysomnographic parameters. Furthermore, individual NOSE questions and the total NOSE score were not significantly correlated with any polysomnographic parameter.
Conclusion
This study demonstrates a link between subjective nasal obstruction and reduced nasal airflow, as indicated by PNEF, in patients with OSA. The association between lower PNEF and a higher arousal index suggests that reduced nasal airflow may contribute to a low arousal threshold phenotype in OSA. Future research should further investigate the complex interplay between nasal obstruction, nasal airflow, and other factors that influence OSA severity and treatment response.
{"title":"The relationship between subjective and objective nasal obstruction and polysomnographic parameters in obstructive sleep apnea","authors":"Reza Erfanian , Shirin Irani , Reihaneh Heidari , Maryam Keyfari Alamdari","doi":"10.1016/j.amjoto.2025.104733","DOIUrl":"10.1016/j.amjoto.2025.104733","url":null,"abstract":"<div><h3>Background</h3><div>Nasal obstruction has been identified as a significant factor in the development and exacerbation of obstructive sleep apnea (OSA). This study aimed to explore the correlation between objective and subjective measures of nasal obstruction with polysomnographic features.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted on 100 patients suspected of OSA. Participants completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire to assess subjective nasal obstruction. Objective nasal airflow was measured using peak nasal expiratory flow (PNEF). All participants underwent type I polysomnography to assess sleep-related breathing disturbances. Correlations between NOSE scores, PNEF, and various polysomnographic parameters, including the apnea-hypopnea index (AHI), mean oxygen saturation, time spent below 90 % oxygen saturation, lowest oxygen saturation, and arousal index, were calculated.</div></div><div><h3>Results</h3><div>The mean total NOSE scale score was 9.5 (SD = 5.6), indicating a moderate level of nasal obstruction. The mean PNEF was 0.56 L/s (SD = 0.44 L/s). A significant negative correlation was found between PNEF and the total NOSE scale score (Spearman's rho = ‐0.319, <em>p</em> = 0.003). Additionally, PNEF was significantly negatively correlated with the arousal index (Spearman's rho = ‐0.329, <em>p</em> = 0.002). However, no significant correlations were found between PNEF and other polysomnographic parameters. Furthermore, individual NOSE questions and the total NOSE score were not significantly correlated with any polysomnographic parameter.</div></div><div><h3>Conclusion</h3><div>This study demonstrates a link between subjective nasal obstruction and reduced nasal airflow, as indicated by PNEF, in patients with OSA. The association between lower PNEF and a higher arousal index suggests that reduced nasal airflow may contribute to a low arousal threshold phenotype in OSA. Future research should further investigate the complex interplay between nasal obstruction, nasal airflow, and other factors that influence OSA severity and treatment response.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104733"},"PeriodicalIF":1.7,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358402","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 : 2025-10-21DOI: 10.1016/j.amjoto.2025.104747
Robert E. Africa, Amber M. Dunmire, Shahrukh R. Ali, Brian J. McKinnon, Charles A. Hughes, Tyler A. Janz, Farrah Siddiqui, Scott A. Hardison
Background
To evaluate the trends in opioid and non-opioid prescribing for functional endoscopic sinus surgery (FESS) in relation to the publication of guidelines by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in April 2021.
Methods
This is a retrospective study utilizing de-identified patient data obtained from the TriNetX database including patients who were prescribed either opioid or non-opioid analgesics within 1–5 days following FESS from January 1, 2023 to December 31, 2023. To evaluate the trends of prescription before and after the new opioid prescription guidelines, interrupted time series analysis in Statistical Analysis System (SAS) 9.4 was performed with significance at p < 0.05.
Results
Opioid prescription had an immediate increase by 0.87 % after guideline publication, but it was not statistically significant (p = 0.92). Throughout the rest of the study period, the trend decreased by 0.20 %, but it was not statistically significant (p = 0.35). For non-opioid prescriptions, there was a significant sustained increase in non-opioid prescriptions after the guideline change by 0.07 % (p = 0.03).
Conclusions
No associated decrease in opioid prescription for FESS after the guideline publication was observed. Non-opioid prescription did not have an immediate increase, but the trend increased in the post-publication period.
{"title":"Examination of opioid prescribing guidelines on sinus surgery opioid prescription trends","authors":"Robert E. Africa, Amber M. Dunmire, Shahrukh R. Ali, Brian J. McKinnon, Charles A. Hughes, Tyler A. Janz, Farrah Siddiqui, Scott A. Hardison","doi":"10.1016/j.amjoto.2025.104747","DOIUrl":"10.1016/j.amjoto.2025.104747","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the trends in opioid and non-opioid prescribing for functional endoscopic sinus surgery (FESS) in relation to the publication of guidelines by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in April 2021.</div></div><div><h3>Methods</h3><div>This is a retrospective study utilizing de-identified patient data obtained from the TriNetX database including patients who were prescribed either opioid or non-opioid analgesics within 1–5 days following FESS from January 1, 2023 to December 31, 2023. To evaluate the trends of prescription before and after the new opioid prescription guidelines, interrupted time series analysis in Statistical Analysis System (SAS) 9.4 was performed with significance at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>Opioid prescription had an immediate increase by 0.87 % after guideline publication, but it was not statistically significant (<em>p</em> = 0.92). Throughout the rest of the study period, the trend decreased by 0.20 %, but it was not statistically significant (<em>p</em> = 0.35). For non-opioid prescriptions, there was a significant sustained increase in non-opioid prescriptions after the guideline change by 0.07 % (<em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>No associated decrease in opioid prescription for FESS after the guideline publication was observed. Non-opioid prescription did not have an immediate increase, but the trend increased in the post-publication period.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104747"},"PeriodicalIF":1.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358401","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 : 2025-10-21DOI: 10.1016/j.amjoto.2025.104734
Abdulhakeem Almutairi , Lina Yousef Aloraini , Bader Muzhier Alshahrani , Maan Omar Alzuhairi , Rabab Hussain Alzanadi , Khalid Fahad Alanazi , Yahya Ali Khubrani , Ahmed Y. Azzam
Introduction
Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a significant therapeutic challenge with high recurrence rates despite the current standard treatments. Several biologic therapies targeting type-2 inflammation have emerged, but detailed comparisons between these agents are lacking.
Methods
We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating biologics for CRSwNP. Literature databases were searched up to the date of 28th of April 2025. Primary outcomes included changes in nasal polyp score (NPS), nasal congestion, SNOT-22, and surgery/systemic corticosteroid reduction.
Results
Sixteen studies (with total of 3040 patients included) investigating six biologics (dupilumab, omalizumab, mepolizumab, benralizumab, tezepelumab, reslizumab) were included. For NPS reduction, dupilumab showed greatest improvement (−2.44; 95 %CI: −2.85,-2.03), followed by tezepelumab (−2.07; 95 %CI:-2.39,-1.74). Mepolizumab demonstrated superior nasal congestion improvement (−2.64; 95 %CI:-3.24,-2.04). For quality of life, preliminary findings from a single study showed tezepelumab with the greatest SNOT-22 improvement (−27.26; 95 %CI:-32.32,-22.21), however validation in additional trials is needed. Surgery/systemic corticosteroid need was most reduced with tezepelumab in this single study (HR:0.02; 95 %CI:0.00–0.09). Omalizumab had the lowest adverse event rate (49.6 %). Network meta-analysis identified omalizumab and tezepelumab as highest-ranked overall (efficacy/safety combination).
Conclusion
Our study demonstrated significant efficacy and safety profiles among biologics for CRSwNP. Treatment selection should consider specific symptom focus and comorbidity patterns, with network meta-analysis suggesting favorable overall profiles for omalizumab, with tezepelumab showing promise but requiring additional validation.
{"title":"Comparative efficacy and safety of monoclonal antibodies biologic therapies for chronic rhinosinusitis with nasal polyps: A systematic review and network meta-analysis","authors":"Abdulhakeem Almutairi , Lina Yousef Aloraini , Bader Muzhier Alshahrani , Maan Omar Alzuhairi , Rabab Hussain Alzanadi , Khalid Fahad Alanazi , Yahya Ali Khubrani , Ahmed Y. Azzam","doi":"10.1016/j.amjoto.2025.104734","DOIUrl":"10.1016/j.amjoto.2025.104734","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a significant therapeutic challenge with high recurrence rates despite the current standard treatments. Several biologic therapies targeting type-2 inflammation have emerged, but detailed comparisons between these agents are lacking.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating biologics for CRSwNP. Literature databases were searched up to the date of 28th of April 2025. Primary outcomes included changes in nasal polyp score (NPS), nasal congestion, SNOT-22, and surgery/systemic corticosteroid reduction.</div></div><div><h3>Results</h3><div>Sixteen studies (with total of 3040 patients included) investigating six biologics (dupilumab, omalizumab, mepolizumab, benralizumab, tezepelumab, reslizumab) were included. For NPS reduction, dupilumab showed greatest improvement (−2.44; 95 %CI: −2.85,-2.03), followed by tezepelumab (−2.07; 95 %CI:-2.39,-1.74). Mepolizumab demonstrated superior nasal congestion improvement (−2.64; 95 %CI:-3.24,-2.04). For quality of life, preliminary findings from a single study showed tezepelumab with the greatest SNOT-22 improvement (−27.26; 95 %CI:-32.32,-22.21), however validation in additional trials is needed. Surgery/systemic corticosteroid need was most reduced with tezepelumab in this single study (HR:0.02; 95 %CI:0.00–0.09). Omalizumab had the lowest adverse event rate (49.6 %). Network meta-analysis identified omalizumab and tezepelumab as highest-ranked overall (efficacy/safety combination).</div></div><div><h3>Conclusion</h3><div>Our study demonstrated significant efficacy and safety profiles among biologics for CRSwNP. Treatment selection should consider specific symptom focus and comorbidity patterns, with network meta-analysis suggesting favorable overall profiles for omalizumab, with tezepelumab showing promise but requiring additional validation.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104734"},"PeriodicalIF":1.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358521","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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