American Journal of Otolaryngology最新文献_第5页

Predicting sinonasal inverted papilloma attachment using machine learning: Current lessons and future directions 使用机器学习预测鼻窦内翻性乳头状瘤附着：目前的经验教训和未来的方向。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104549

Sean P. McKee , Xiaomin Liang , William C. Yao , Brady Anderson , Jumah G. Ahmad , David Z. Allen , Salman Hasan , Andy J. Chua , Chinmay Mokashi , Samia Islam , Amber U. Luong , Martin J. Citardi , Luca Giancardo

Background

Hyperostosis is a common radiographic feature of inverted papilloma (IP) tumor origin on computed tomography (CT). Herein, we developed a machine learning (ML) model capable of analyzing CT images and identifying IP attachment sites.

Methods

A retrospective review of patients treated for IP at our institution was performed. The tumor attachment site was manually segmented on CT scans by the operating surgeon. We used a nnU-Net model, a state-of-the-art deep learning-based segmentation algorithm that automatically configures image preprocessing, network architecture, training, and post-processing to identify the IP attachment site. The model was trained and evaluated using a 5-fold cross validation, where each iteration split the data into train/validation/test to avoid chances of overfitting. The attachment site was classified as either ‘identified or ‘not identified’ using the nnU-Net model output and the Sørensen–Dice coefficient (Dice) was used to further evaluate the segmentation performance of each subject.

Results

A total of 58 subjects met enrollment criteria. The algorithm identified the attachment site in 55.2 % (n = 32) of patients with an average dice score (+/-SD) of 0.34 (+/− 0.24). In the univariate analysis, the algorithm performed better for attachment sites within the maxillary sinus (OR 4.0; p < 0.05) and performed worse during revision surgery (OR 0.13; p < 0.05). Multivariate logistic regression analysis confirmed these associations for maxillary attachment site (OR 4.6; p < 0.05) and revision surgery (OR 0.11; p < 0.05).

Conclusion

A state-of-the-art ML model successfully identified the attachment site of IP with a high degree of fidelity in select cases, but requires larger sample sizes and more diverse datasets to become reliably integrated into clinical practice.

背景：骨质增生是内翻性乳头状瘤（IP）肿瘤来源的常见影像学特征。在此，我们开发了一个机器学习（ML）模型，能够分析CT图像并识别IP附着位点。方法：对我院收治的IP患者进行回顾性分析。手术医生在CT扫描上手动分割肿瘤附着部位。我们使用了nnU-Net模型，这是一种最先进的基于深度学习的分割算法，可以自动配置图像预处理、网络架构、训练和后处理来识别IP附件站点。该模型使用5倍交叉验证进行训练和评估，其中每次迭代将数据分为训练/验证/测试，以避免过度拟合的机会。使用nnU-Net模型输出将依恋位点分为“已识别”和“未识别”，并使用Sørensen-Dice系数（Dice）进一步评估每个受试者的分割性能。结果：共有58名受试者符合入组标准。该算法在55.2% （n = 32）的患者中识别出附着位点，平均dice评分（+/- sd）为0.34（+/- 0.24）。在单变量分析中，该算法在上颌窦内附着部位表现较好(OR 4.0；结论：最先进的ML模型在某些情况下成功地识别了IP的附着部位，并具有高度的保真度，但需要更大的样本量和更多样化的数据集才能可靠地整合到临床实践中。

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引用次数: 0

Evaluation of postoperative intracranial pressure in patients with radiological diagnosis of idiopathic intracranial hypertension 影像学诊断特发性颅内高压患者术后颅内压的评价。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104542

Valeria Barcia Castilla , Pedro Mino Vianna , Rodrigo Aragão Torres , Fabiolla Maria Martins Costa , Luziana de Lima Ramalho , Débora de Carvalho Garcez , Rogerio Pezato , Beatriz Sarno Ramos , José Marcelo Ferreira Bezerra , Miguel Soares Tepedino

Objective

This study aimed to assess postoperative intracranial pressure in patients with clinical and/or radiological features of idiopathic intracranial hypertension (IIH) undergoing endoscopic endonasal surgery for primary cerebrospinal fluid (CSF) leak repair.

Methods

Data was prospectively collected from 9 patients diagnosed with CSF nasal leaks who underwent corrective endonasal surgery between January 1, 2021, and October 31, 2022. Postoperative intracranial pressure was measured via lumbar puncture at least one month after surgery. Preoperative and postoperative MRI scans were compared to evaluate changes.

Results

Postoperative lumbar puncture revealed elevated intracranial pressure in 67 % of patients, and 100 % showed persistent signs of intracranial hypertension on MRI.

Conclusion

Managing elevated intracranial pressure in patients with CSF nasal leaks should be prioritized alongside surgical correction. Consideration of permanent peritoneal shunt or pharmacological treatment may be necessary for patients with classic IIH phenotype. Longitudinal studies are essential for further understanding long-term outcomes.

目的：本研究旨在评估具有临床和/或影像学特征的特发性颅内高压（IIH）患者接受内镜下鼻内手术进行原发性脑脊液（CSF）泄漏修复的术后颅内压。方法：前瞻性收集2021年1月1日至2022年10月31日期间接受鼻内矫正手术的9例诊断为脑脊液鼻漏的患者的数据。术后至少一个月通过腰椎穿刺测量颅内压。比较术前和术后MRI扫描来评估变化。结果：术后腰穿刺显示67%的患者颅内压升高，100%的患者在MRI上显示持续的颅内高压征象。结论：处理脑脊液鼻漏患者颅内压升高应优先于手术矫正。对于典型IIH表型的患者，可能需要考虑永久性腹膜分流或药物治疗。纵向研究对于进一步了解长期结果至关重要。

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引用次数: 0

Decoding RAS mutations in thyroid cancer: A meta-analysis unveils specific links to distant metastasis and increased mortality 解码甲状腺癌中的RAS突变：一项荟萃分析揭示了与远处转移和死亡率增加的具体联系。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104570

Isabel Riccio , Alexandra Laforteza , Madeleine B. Landau , Mohammad H. Hussein , Joshua Linhuber , Jonathan Staav , Peter P. Issa , Eman A. Toraih , Emad Kandil

Background/objectives

RAS mutations are common in thyroid cancer, but their impact on clinical outcomes remains controversial. This study aimed to evaluate the prevalence of RAS mutations in thyroid cancer and their association with various clinical and pathological features.

Methods

We conducted a systematic review and meta-analysis of studies reporting on RAS mutations in thyroid cancer. Both one-arm and pairwise meta-analyses were performed to compare outcomes between RAS-mutated (RAS+) and wild-type (RAS-) thyroid cancers.

Results

Our analysis included 2552 thyroid cancer patients from 17 studies. The overall prevalence of RAS mutations was 35.4 % (95 % CI: 22.7 %–50.7 %). NRAS mutations were most common (69.47 %, 95 % CI: 66.15 %–72.66 %), followed by HRAS (25.83 %, 95 % CI: 22.77 %–29.14 %) and KRAS (6.92 %, 95 % CI: 5.27 %–9.04 %). No statistically significant differences were found between RAS+ and RAS- cases in rates of T1/2 tumors, lymph node metastasis, extrathyroidal extension, or recurrence. The risk of distant metastasis was significantly higher in RAS+ cases (15 %, 95 % CI: 6 %–34 %) compared to RAS- cases (4 %, 95 % CI: 1 %–12 %), with a relative risk of 3.23 (95 % CI: 1.49–7.02). Notably, RAS+ cases showed a significantly higher mortality rate (8 %, 95 % CI: 3 %–18 %) compared to RAS- cases (2 %, 95 % CI: 1 %–5 %), with a relative risk of 4.36 (95 % CI: 1.23–15.50, p = 0.03).

Conclusion

While RAS mutations are prevalent in thyroid cancer, they do not significantly impact most clinical and pathological features. However, the presence of RAS mutations is associated with a significantly higher risk of distant metastasis and mortality, suggesting their potential role as a prognostic marker in thyroid cancer. These findings underscore the importance of RAS mutation testing in risk stratification and treatment planning for thyroid cancer patients.

背景/目的：RAS突变在甲状腺癌中很常见，但其对临床结果的影响仍存在争议。本研究旨在评估RAS突变在甲状腺癌中的患病率及其与各种临床和病理特征的关系。方法：我们对报道甲状腺癌中RAS突变的研究进行了系统回顾和荟萃分析。进行单臂和两两荟萃分析，比较RAS突变型（RAS+）和野生型（RAS-）甲状腺癌的结局。结果：我们的分析包括来自17项研究的2552名甲状腺癌患者。RAS突变的总患病率为35.4% （95% CI: 22.7% - 50.7%）。国家管制当局方面突变最常见(69.47%,95%置信区间CI: 66.15% -72.66%),其次是极品(25.83%,95%置信区间CI: 22.77% -29.14%)和喀斯特(6.92%,95%置信区间CI: 5.27% -9.04%)。RAS+组与RAS-组在T1/2肿瘤、淋巴结转移、甲状腺外展及复发率方面无统计学差异。RAS+患者发生远处转移的风险（15%,95% CI: 6% - 34%）明显高于RAS-患者（4%,95% CI: 1% - 12%），相对风险为3.23 （95% CI: 1.49-7.02）。值得注意的是，RAS+病例的死亡率（8%,95% CI: 3% - 18%）明显高于RAS-病例（2%,95% CI: 1% - 5%），相对危险度为4.36 （95% CI: 1.23-15.50, p = 0.03）。结论：RAS突变在甲状腺癌中普遍存在，但对大多数临床和病理特征没有显著影响。然而，RAS突变的存在与远端转移和死亡率的风险显著升高相关，表明它们在甲状腺癌中可能作为预后标志物。这些发现强调了RAS突变检测在甲状腺癌患者风险分层和治疗计划中的重要性。

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引用次数: 0

The relationship of nasal mucus properties and symptoms in allergic and acute non-allergic rhinitis 变应性和急性非变应性鼻炎鼻黏液性质与症状的关系。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104569

Melissa A. Yopp , Erika Tokita , Kelley Dodson , Bruce K. Rubin

Background

Allergic rhinitis (AR) and acute non-allergic rhinosinusitis (ARS) often present with similar symptoms. While these are generally differentiated by history and occasionally by secretion cell counts, there are few data temporally comparing these conditions.

Methods

A prospective, observational study was conducted to assess nasal mucus properties, nasal obstruction, nasal secretion cells, and health related QOL during the acute phase (Day 5) and during a later phase of illness (Day 14/28). We screened 280 patients and enrolled 42 subjects (ARS, n = 34; and AR, n = 8) who were otherwise healthy and met eligibility criteria. Nasal secretions for cell count and rheology, and acoustic rhinometry were measured on days 5 and 14 of symptoms. SNOT-20 was administered on Day 5, 14, 10 and 28.

Results

In subjects with ARS, there was significantly improved SNOT-20 and major symptom score at day 28 in association with increased nasal cavity volume by acoustic rhinometry and decreased mast cells; all consistent with improvement. However, in subjects with AR there was no symptomatic improvement or change in nasal volume and although there were fewer mast cells and epithelial cells, there was no decrease in the number of eosinophils, neutrophils, or goblet cells in secretions. There was no change in in vitro secretion mucociliary clearability in either group, although values were normal at baseline.

Conclusions

These results suggest that nasal symptoms in ARS are improved over 14–28 days with the reduction of mast cells, and increased nasal volume, while in AR, symptoms persist.

背景：变应性鼻炎（AR）和急性非变应性鼻窦炎（ARS）通常表现出相似的症状。虽然这些通常通过病史和偶尔通过分泌细胞计数来区分，但很少有数据对这些条件进行临时比较。方法：进行前瞻性观察性研究，评估急性期（第5天）和疾病后期（第14/28天）的鼻粘液特性、鼻塞、鼻分泌细胞和健康相关的生活质量。我们筛选了280名患者，纳入了42名受试者(ARS, n = 34；和AR， n = 8)，其他方面均健康且符合入选标准。在出现症状的第5天和第14天分别测量鼻腔分泌物细胞计数和流变学，以及声学鼻测量。在第5、14、10和28天给予SNOT-20。结果：ARS患者在第28天SNOT-20和主要症状评分显著改善，听鼻测量结果显示鼻腔体积增加，肥大细胞减少；一切都与改进相一致。然而，在AR患者中，没有症状改善或鼻体积改变，尽管肥大细胞和上皮细胞减少，但分泌物中嗜酸性粒细胞、中性粒细胞或杯状细胞的数量没有减少。两组体外分泌粘液纤毛清除率均无变化，但基线值正常。结论：这些结果表明，随着肥大细胞的减少和鼻体积的增加，ARS的鼻症状在14-28天内得到改善，而AR的症状持续存在。

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引用次数: 0

Revisiting the closed stapler laryngectomy: Technique and review of recent evidence 重新审视闭合订书机喉切除术：技术和最新证据回顾。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104512

Ryan T. Judd , Jeremy Godsell , Hannah Kuhar , Hilary McCrary , Janice Farlow , Amit Agrawal , Enver Ozer

Objective

To review the current literature regarding stapler-assisted closed total laryngectomy (TL), present a case series, and provide details on operative technique.

Finding

Several meta-analyses and randomized controlled trials have demonstrated lower rates of pharyngocutaneous fistula (PCF) with closed stapler-assisted TL compared to traditional manual closure. Operative time, hospital stay, and time to oral feeding also appear to be lower. We present a five-patient case series of stapler-assisted closed TL with successful outcomes, including the first reported salvage case with free flap reconstruction, and provide technical detail including intraoperative photographs.

Conclusion

Stapler-assisted closed TL appears to be a safe alternative to traditional manual closure in select patients with endolaryngeal tumors with potential for lower rates of PCF and shorter operative time, hospital stay, and time to oral feeding.

摘要回顾有关订书机辅助全喉闭合术（TL）的现有文献，介绍一个病例系列，并提供有关手术技巧的详细信息：几项荟萃分析和随机对照试验表明，与传统的人工闭合相比，闭合式订书机辅助全喉切除术的咽峡瘘 (PCF) 发生率较低。手术时间、住院时间和口服喂养时间似乎也更短。我们介绍了五例成功实施订书机辅助闭合式 TL 的病例系列，包括首次报道的使用游离皮瓣重建的抢救病例，并提供了包括术中照片在内的技术细节：结论：对于特定的喉内膜肿瘤患者，订书机辅助闭合 TL 似乎是传统人工闭合的一种安全替代方法，有可能降低 PCF 发生率，缩短手术时间、住院时间和口服时间。

引用次数: 0

Persistent sleep apnea after adenotonsillectomy in pediatric patients with head and neck burns 小儿头颈部烧伤患者腺扁桃体切除术后持续性睡眠呼吸暂停。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104546

Robert E. Africa , Amber M. Dunmire , Austin L. Johnson , Nadia Z. Quadri , Harold S. Pine , Charles A. Hughes , Brian J. McKinnon , Yusif Hajiyev

Background

To determine if face, head, or neck burns increases risk of persistent sleep disordered breathing (SDB) or obstructive sleep apnea (OSA) after adenotonsillectomy.

Methods

The TriNetX database was used to gather data for patients who had face, head, or neck burn including mouth and pharynx and history of sleep study with adenotonsillectomy. A comparison of persistent SDB or OSA was done between cohort 1, a group with sleep study and adenotonsillectomy after burn injury, and cohort 2, a group with treatment before a burn. Risk of persistence was evaluated as relative risk (RR) with 95 % confidence interval (CI).

Results

Eighty-three pediatric patients were included. Fifty-one patients were in cohort 1, and 32 in cohort 2. Forty-three patients in cohort 1 had persistent SDB or OSA as compared to 11 in cohort 2, which was statistically significant (RR: 2.45; 95 % CI: 1.50–4.02; p-value <0.0001). After propensity score matching, both groups had 23 patients, and 19 had persistent SDB or OSA in cohort 2, while cohort 1 had 10 patients. The difference in persistence was significant (RR 1.9; 95 % CI: 1.15–3.14; p-value equals 0.006).

Conclusions

Pediatric patients with a face, head, or neck burn had a higher rate of persistent SDB or OSA after adenotonsillectomy compared to patients who had surgery prior to thermal injury.

背景：确定面部、头部或颈部烧伤是否会增加腺扁桃体切除术后持续性睡眠呼吸障碍（SDB）或阻塞性睡眠呼吸暂停（OSA）的风险。方法：使用TriNetX数据库收集面部、头部或颈部烧伤（包括口腔和咽）患者的数据以及腺扁桃体切除术后的睡眠研究史。在队列1（在烧伤后进行睡眠研究和腺扁桃体切除术的组）和队列2（在烧伤前进行治疗的组）之间进行了持续性SDB或OSA的比较。持续风险评估为相对风险（RR）， 95%置信区间（CI）。结果：纳入83例儿科患者。51名患者在队列1,32名患者在队列2。队列1中有43例患者存在持续性SDB或OSA，而队列2中有11例，差异有统计学意义(RR: 2.45；95% ci: 1.50-4.02；p值结论：与热损伤前接受过手术的患者相比，面部、头部或颈部烧伤的儿科患者在腺扁桃体切除术后发生持续性SDB或OSA的比例更高。

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引用次数: 0

Feasibility and efficacy of home-based lymphedema exercises for head and neck cancer patients at a safety net hospital 为一家安全网医院的头颈部癌症患者提供家庭淋巴水肿锻炼的可行性和有效性。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104560

Kelsey Wood, Samuel Hopper, M. Caroline Murray, Josephine Alston, Oishika Paul, Gina D. Jefferson, Lana L. Jackson, Anne C. Kane

Purpose

Lymphedema therapy is an effective tool in mitigating head and neck lymphedema morbidity and long-term fibrosis. Studies have shown the efficacy of facility-based therapy; however, access can be limited by sociodemographic factors, including socioeconomic status and transportation. This study evaluates the feasibility and effectiveness of home-based lymphedema therapy in a socially vulnerable patient population.

Materials and methods

A retrospective chart review analyzed patients who underwent home-based lymphedema exercise regimen after training with a lymphedema-trained speech language pathologist between 2019 and 2022 at a tertiary academic medical center. Patient and cancer demographics were collected. Primary outcomes measured were quality of life surveys and diet status.

Results

Of the 27 patients included, 85.1 % were in the two highest quintiles of neighborhood deprivation based on national Area Deprivation Index (ADI). Treatment breakdown included 78 % who were treated with surgery, 96 % completed radiation and 59.3 % chemotherapy. Six months after initiating lymphedema therapy, most patients (59.3 %) were compliant with exercises. Quality of life scores showed trends toward improvement, but only a decrease in condition-related anxiety at 3 months (p = 0.004) reached statistical significance. Improvement in diet was significant at 6 and 9 months after initiation of treatment (p = 0.020).

Conclusions

Patient compliance rate demonstrates feasibility of home exercises for lymphedema treatment in a tertiary care setting with a socially vulnerable patient population. Home-based head and neck lymphedema treatment showed improvements in patient diet over time.

目的：淋巴水肿治疗是减轻头颈部淋巴水肿发病率和长期纤维化的有效手段。研究表明，以设施为基础的治疗是有效的；然而，获取可能受到社会人口因素的限制，包括社会经济地位和交通。本研究评估了家庭淋巴水肿治疗在社会弱势患者群体中的可行性和有效性。材料和方法：回顾性图表回顾分析了2019年至2022年在三级学术医疗中心接受淋巴水肿训练的语言病理学家培训后接受家庭淋巴水肿运动方案的患者。收集患者和癌症人口统计数据。测量的主要结果是生活质量调查和饮食状况。结果：纳入的27例患者中，85.1%的患者处于全国区域剥夺指数（ADI）中邻里剥夺最高的两个五分位数。其中78%的患者接受手术治疗，96%的患者接受放疗，59.3%的患者接受化疗。在开始淋巴水肿治疗6个月后，大多数患者（59.3%）能坚持运动。生活质量得分有改善的趋势，但只有在3个月时病情相关焦虑的下降（p = 0.004）达到统计学意义。治疗开始后6个月和9个月饮食改善显著（p = 0.020）。结论：患者的依从率证明了家庭运动治疗淋巴水肿的可行性，在三级医疗机构与社会弱势患者群体。以家庭为基础的头颈部淋巴水肿治疗显示，随着时间的推移，患者的饮食有所改善。

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引用次数: 0

Chemoradiation for human papillomavirus positive oropharyngeal cancer in smokers: A single-institutional experience 吸烟者人乳头瘤病毒阳性口咽癌的放化疗：单一机构的经验。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104591

Allen M. Chen , Rupali Nabar , Tjoson Tjoa , Yarah Haidar , William B. Armstrong

Purpose

To determine how smoking intensity impacts the prognosis of patients with human papillomavirus (HPV)-positive oropharyngeal cancer treated by chemoradiation.

Methods and materials

The medical records of 32 patients with histologically proven squamous cell carcinoma of the oropharynx and a prior smoking history were retrospectively reviewed. All patients were treated with intensity-modulated radiotherapy to a median dose of 70 Gy (range 63 to 72 Gy) with concurrent cisplatin. Seventeen patients (53 %) had stage II disease; and 15 patients (47 %) had stage III disease. Distribution of T-classification was: T1 8 (25 %); T2 4 (13 %); T3 10 (31 %); and T4 10 (31 %). Smoking history was categorized as follows: ≤10 pack-years (10 patients); 10–20 pack-years (6 patients); 20–30 pack-years (7 patients); >30 pack-years (9 patients).

Results

With a median follow-up of 40 months (range, 6 to 121 months), the 3-year overall survival for the entire population was 79 %. Significant differences in 3-year overall survival (83 % vs 54 %, p = 0.01), local-regional control (86 % vs 62 %, p < 0.001), and progression-free survival (75 % vs 52 %, p = 0.02) were observed when comparing patients with ≤30 pack-year versus those with >30 pack-year smoking histories.

Conclusion

The deleterious effect of smoking seemed to be most impactful in those with heavy consumption (i.e., >30 pack-year history).

目的：探讨吸烟强度对人乳头瘤病毒（HPV）阳性口咽癌放化疗患者预后的影响。方法与材料：回顾性分析32例经组织学证实有吸烟史的口咽部鳞状细胞癌患者的病历。所有患者均接受调强放疗，中位剂量为70 Gy（范围63 - 72 Gy），同时接受顺铂治疗。17例患者（53%）为II期疾病；15例（47%）为III期疾病。t分类分布为：T1 8 (25%)；T2 4 (13%)；T3 10例（31%）；T4 10（31%）。吸烟史分类如下：≤10包年（10例）；10-20包年（6例）；20-30包年（7例）；30包年（9例）。结果：中位随访时间为40个月（6至121个月），整个人群的3年总生存率为79%。3年总生存率（83%对54%，p = 0.01）、局部-区域对照（86%对62%，p 30包年吸烟史）差异显著。结论：吸烟的有害影响似乎对那些重度吸烟者（即50 - 30包年的吸烟史）影响最大。

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引用次数: 0

Technique and outcomes of endoscopic supraglottic laryngectomy type IIIa using CO2 laser 使用二氧化碳激光的内窥镜声门上喉切除术 IIIa 型的技术和效果。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104515

Sara Bassani , Erica Zampieri , Gabriele Molteni

引用次数: 0

Unmet educational needs and expectations among tracheostomy recipients 气管造口术受术者未得到满足的教育需求和期望。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104510

Tyler J. Gallagher , Oluwatobiloba Ayo-Ajibola , Michelle Koh , Catherine Julien , Kevin Herrera , Jonathan D. West , Niels C. Kokot

Objective

This study seeks to better understand unmet educational needs and treatment expectations in individuals with a tracheostomy.

Study design

Retrospective, cross-sectional survey.

Methods

A survey was distributed to individuals who received a tracheostomy at a tertiary care center in the last five years as well as in Facebook support groups for tracheostomy and head and neck cancer patients. The survey focused on tracheostomy education, satisfaction with care, and gaps in treatment plan understanding. Primary outcome was rate of tracheostomy peri-operative experience being on-par with expectations.

Results

Among 83 respondents, only report of pre-operative speech (p = 0.024) and swallow (p = 0.019) discussions were associated with peri-operative experience being on-par with expectations. Respondents were more likely to report importance of counseling regarding psychological well-being (p < 0.001) and post-operative social integration/interaction (p < 0.001) than they were to report receiving focused counseling about these topics. Qualitative analysis demonstrated the most frequently missing components of understanding of treatment plans included post-operative care and the post-operative experience (n = 19, 40.4 % each). Reasons for treatment not meeting expectations included lack of communication/education (n = 15, 39.5 %) and experience being worse than expected (n = 8, 21.1 %). Individuals frequently wanted more details of the experience of living with a tracheostomy (n = 25, 42.6 %) and details about tracheostomy care (n = 10, 16.4 %).

Conclusion

This study demonstrates significant gaps in informational needs for individuals receiving a tracheostomy, emphasizing the importance of guideline-directed tracheostomy counseling. Specifically, more information is needed regarding expected post-surgical experience, tracheostomy care and maintenance, psychosocial wellbeing, and communication support.

研究目的本研究旨在更好地了解气管造口术患者未得到满足的教育需求和治疗期望：研究设计：回顾性横断面调查：向过去五年中在一家三级医疗中心接受过气管造口术的患者以及气管造口术和头颈部癌症患者 Facebook 支持小组的成员发放了一份调查问卷。调查的重点是气管切开术教育、护理满意度以及治疗计划理解方面的差距。主要结果是气管造口术围手术期体验与预期相符的比率：在 83 位受访者中，只有术前言语（p = 0.024）和吞咽（p = 0.019）讨论报告与围手术期体验与预期相符相关。受访者更倾向于报告有关心理健康咨询的重要性（p 结论：受访者更倾向于报告有关心理健康咨询的重要性（p 结论：受访者更倾向于报告有关心理健康咨询的重要性（p 结论）：本研究表明，接受气管造口术的患者在信息需求方面存在很大差距，这强调了以指南为指导的气管造口术咨询的重要性。具体而言，需要更多有关预期手术后体验、气管造口护理和维护、社会心理健康和沟通支持的信息。

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引用次数: 0