Pub Date : 2025-10-10DOI: 10.1016/j.amjoto.2025.104730
Marcin Marciniak , Vidit M. Talati , Sean A. Setzen , Glen D'Souza , Bobby A. Tajudeen , Pete S. Batra
Introduction
Continuous positive airway pressure (CPAP) therapy is standard of care for obstructive sleep apnea (OSA) but is often discouraged after skull base surgery due to serious potential risks. Halting CPAP can negatively impact patients' quality of life and worsen postoperative cardiopulmonary complications. Identifying appropriate timing to resume CPAP following extended skull base approaches is essential, as recent literature mainly explores early CPAP safety after transsphenoidal surgery.
Case
We report a 51-year-old male with OSA who developed a post-operative cerebrospinal fluid (CSF) leak from pre-emptive CPAP use following endoscopic anterior skull base inverted papilloma resection. Dura remained intact without an intraoperative CSF leak and bilateral nasoseptal flaps (NSF) were used for skull base coverage. Despite counseling on CPAP avoidance, the patient restarted CPAP on POD21 and developed clear rhinorrhea. Computed tomography showed mild pneumocephalus. Urgent exploration revealed a left dural tear and the NSFs had separated in the midline. This was repaired with abdominal fat and NSF repositioning. The patient recovered well and was cleared for CPAP use on day 57 after repair without further issues.
Discussion
This case highlights the complexities and potential risks of resuming CPAP early after extended skull base approaches, for which standardized guidelines are lacking. Effective postoperative care is crucial for balancing CPAP benefits with risks, underscoring the need for further research on CPAP transmission to the anterior cranial fossa to optimize perioperative patient outcomes.
{"title":"Early CPAP use after anterior skull base surgery: A cautionary tale of postoperative CSF leak case report","authors":"Marcin Marciniak , Vidit M. Talati , Sean A. Setzen , Glen D'Souza , Bobby A. Tajudeen , Pete S. Batra","doi":"10.1016/j.amjoto.2025.104730","DOIUrl":"10.1016/j.amjoto.2025.104730","url":null,"abstract":"<div><h3>Introduction</h3><div>Continuous positive airway pressure (CPAP) therapy is standard of care for obstructive sleep apnea (OSA) but is often discouraged after skull base surgery due to serious potential risks. Halting CPAP can negatively impact patients' quality of life and worsen postoperative cardiopulmonary complications. Identifying appropriate timing to resume CPAP following extended skull base approaches is essential, as recent literature mainly explores early CPAP safety after transsphenoidal surgery.</div></div><div><h3>Case</h3><div>We report a 51-year-old male with OSA who developed a post-operative cerebrospinal fluid (CSF) leak from pre-emptive CPAP use following endoscopic anterior skull base inverted papilloma resection. Dura remained intact without an intraoperative CSF leak and bilateral nasoseptal flaps (NSF) were used for skull base coverage. Despite counseling on CPAP avoidance, the patient restarted CPAP on POD21 and developed clear rhinorrhea. Computed tomography showed mild pneumocephalus. Urgent exploration revealed a left dural tear and the NSFs had separated in the midline. This was repaired with abdominal fat and NSF repositioning. The patient recovered well and was cleared for CPAP use on day 57 after repair without further issues.</div></div><div><h3>Discussion</h3><div>This case highlights the complexities and potential risks of resuming CPAP early after extended skull base approaches, for which standardized guidelines are lacking. Effective postoperative care is crucial for balancing CPAP benefits with risks, underscoring the need for further research on CPAP transmission to the anterior cranial fossa to optimize perioperative patient outcomes.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104730"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342652","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 : 2025-10-03DOI: 10.1016/j.amjoto.2025.104729
Yingxiang Xu , Shan Zhu , Jinlian Li , Siyu He , Riqing Yu , Haiyu Hong , Peng He
Objective
To evaluate the efficacy of a modified uvulopalatopharyngoplastyof “8” suture abduction-suspension of the palatopharyngeal muscle (8-ASP) in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).
Material and methods
Twenty-eight consecutive patients with OSAHS with AHI > 15 with tonsillar hypertrophy, Friedman stage ≤3 and palatal collapse or obstruction were included, and all patients underwent modified uvulopalatopharyngoplasty that consisted of bilateral tonsillectomy, dissection and removal of submucosal adipose tissue of the soft palate and supratonsillar area; partial incision (0.4–0.6 cm) of the dorsal mucosa and muscle; and 8-ASP to the pterygomandibular ligament. Variables of polysomnography included the apnoea-hypo pnoea index (AHI), minimum oxygen saturation (MSAT), Stage N3 sleep, and Epworth sleepiness scale (ESS) score was also used to evaluate surgical results. Surgical success was defined as a greater than 50 % reduction in pre-operative AHI and a post-operative AHI of less than 20 per hour.
Results
Six months after operation, 24 patients (85.71 %) responded successfully. The mean apnoea-hypo pnoea index decreased from 51.72 ± 26.45 to 12.97 ± 8.49 (P < 0.001), and the mean MSAT, Stage N3 sleep and ESS score improved significantly (P < 0.001). The postoperative sequelae were mild with 3.57 % of occasional nasal regurgitation.
Conclusions
8-ASP is a novel, simplified and effective surgical treatment for OSAHS patients with a high success rate (85.71 %) and minimal adverse effect in selected patients, and this technique suggests a role of abduction-suspension of the palatopharyngeal muscle in the palatal surgery for OSAHS.
{"title":"Modified uvulopalatopharyngoplasty: “8” suture abduction-suspension of the palatopharyngeal muscle","authors":"Yingxiang Xu , Shan Zhu , Jinlian Li , Siyu He , Riqing Yu , Haiyu Hong , Peng He","doi":"10.1016/j.amjoto.2025.104729","DOIUrl":"10.1016/j.amjoto.2025.104729","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy of a modified uvulopalatopharyngoplastyof “8” suture abduction-suspension of the palatopharyngeal muscle (8-ASP) in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS).</div></div><div><h3>Material and methods</h3><div>Twenty-eight consecutive patients with OSAHS with AHI > 15 with tonsillar hypertrophy, Friedman stage ≤3 and palatal collapse or obstruction were included, and all patients underwent modified uvulopalatopharyngoplasty that consisted of bilateral tonsillectomy, dissection and removal of submucosal adipose tissue of the soft palate and supratonsillar area; partial incision (0.4–0.6 cm) of the dorsal mucosa and muscle; and 8-ASP to the pterygomandibular ligament. Variables of polysomnography included the apnoea-hypo pnoea index (AHI), minimum oxygen saturation (MSAT), Stage N3 sleep, and Epworth sleepiness scale (ESS) score was also used to evaluate surgical results. Surgical success was defined as a greater than 50 % reduction in pre-operative AHI and a post-operative AHI of less than 20 per hour.</div></div><div><h3>Results</h3><div>Six months after operation, 24 patients (85.71 %) responded successfully. The mean apnoea-hypo pnoea index decreased from 51.72 ± 26.45 to 12.97 ± 8.49 (<em>P</em> < 0.001), and the mean MSAT, Stage N3 sleep and ESS score improved significantly (P < 0.001). The postoperative sequelae were mild with 3.57 % of occasional nasal regurgitation.</div></div><div><h3>Conclusions</h3><div>8-ASP is a novel, simplified and effective surgical treatment for OSAHS patients with a high success rate (85.71 %) and minimal adverse effect in selected patients, and this technique suggests a role of abduction-suspension of the palatopharyngeal muscle in the palatal surgery for OSAHS.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104729"},"PeriodicalIF":1.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249350","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 : 2025-10-03DOI: 10.1016/j.amjoto.2025.104725
Kavya K. Pai , Kenneth W. Altman , Rupali N. Shah , Anthony Del Signore , Elizabeth G. Demicco , Tu-Anh Ha , Peak Woo
Objective
Our study aimed to characterize the presenting features, interventions, and outcomes observed in patients with laryngeal manifestations of sarcoid (LS) managed at a tertiary care center.
Study design
Retrospective case series.
Setting
Icahn School of Medicine at Mount Sinai.
Methods
Chart review including patients with LS treated between 1998 and 2012.
Results
27 patients with LS were identified. The mean age at presentation was 47.1 years (range 23–65 years), and 12 patients (44.4 %) were male. Presenting symptoms were dyspnea (n = 16, 59.3 %), dysphonia (n = 14, 51.9 %), cough (n = 3, 11.1 %), and stridor (n = 1, 3.7 %). LS was identified in the supraglottis (n = 15, 55.6 %), glottis (n = 8, 29.6 %), isolated vocal fold paralysis (n = 5, 18.5 %), and subglottis (n = 5, 18.5 %). 23 patients (85.1 %) had extra-laryngeal manifestations. The most common systemic medications were prednisone (n = 17, 63.0 %) hydroxychloroquine (n = 4, 14.8 %), and plaquenil (n = 3, 11.1 %). Surgical interventions included office-based or operating room intralesional steroid injection in 13 (48.1 %), debulking (n = 10, 37.0 %), and tracheotomy (n = 5, 18.5 %, with 2 eventual decanulations). Median follow up was 19 months (range, 1–168 months), with 10/17 noting improvement or resolution of laryngeal findings, but only 1/14 with systemic manifestations showing improvement.
Conclusion
LS usually presents in the context of systemic sites of disease, and most commonly manifests in the supraglottis but it may occur in the glottis, subglottis and trachea. Patients may also present with isolated vocal paralysis related to mediastinal disease. While local management is often effective in the larynx, oral prednisone and other medications benefit systemic disease.
{"title":"Laryngeal sarcoid: Clinical presentation, management, and outcomes at a tertiary care center","authors":"Kavya K. Pai , Kenneth W. Altman , Rupali N. Shah , Anthony Del Signore , Elizabeth G. Demicco , Tu-Anh Ha , Peak Woo","doi":"10.1016/j.amjoto.2025.104725","DOIUrl":"10.1016/j.amjoto.2025.104725","url":null,"abstract":"<div><h3>Objective</h3><div>Our study aimed to characterize the presenting features, interventions, and outcomes observed in patients with laryngeal manifestations of sarcoid (LS) managed at a tertiary care center.</div></div><div><h3>Study design</h3><div>Retrospective case series.</div></div><div><h3>Setting</h3><div>Icahn School of Medicine at Mount Sinai.</div></div><div><h3>Methods</h3><div>Chart review including patients with LS treated between 1998 and 2012.</div></div><div><h3>Results</h3><div>27 patients with LS were identified. The mean age at presentation was 47.1 years (range 23–65 years), and 12 patients (44.4 %) were male. Presenting symptoms were dyspnea (<em>n</em> = 16, 59.3 %), dysphonia (<em>n</em> = 14, 51.9 %), cough (<em>n</em> = 3, 11.1 %), and stridor (n = 1, 3.7 %). LS was identified in the supraglottis (<em>n</em> = 15, 55.6 %), glottis (<em>n</em> = 8, 29.6 %), isolated vocal fold paralysis (<em>n</em> = 5, 18.5 %), and subglottis (n = 5, 18.5 %). 23 patients (85.1 %) had extra-laryngeal manifestations. The most common systemic medications were prednisone (<em>n</em> = 17, 63.0 %) hydroxychloroquine (<em>n</em> = 4, 14.8 %), and plaquenil (<em>n</em> = 3, 11.1 %). Surgical interventions included office-based or operating room intralesional steroid injection in 13 (48.1 %), debulking (<em>n</em> = 10, 37.0 %), and tracheotomy (<em>n</em> = 5, 18.5 %, with 2 eventual decanulations). Median follow up was 19 months (range, 1–168 months), with 10/17 noting improvement or resolution of laryngeal findings, but only 1/14 with systemic manifestations showing improvement.</div></div><div><h3>Conclusion</h3><div>LS usually presents in the context of systemic sites of disease, and most commonly manifests in the supraglottis but it may occur in the glottis, subglottis and trachea. Patients may also present with isolated vocal paralysis related to mediastinal disease. While local management is often effective in the larynx, oral prednisone and other medications benefit systemic disease.</div><div><em>Level of evidence: 4</em></div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104725"},"PeriodicalIF":1.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145262850","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 : 2025-10-03DOI: 10.1016/j.amjoto.2025.104726
A.K. Semih
After post tonsillotomy patients most commonly develop chronic secondary tonsillar hypertrophy or recurrent infections because of compensatory lymphoid hyperplasia or changed oropharyngeal dynamics. Hence, a clinical dilemma exists regarding which procedure is to be chosen between tonsillotomy with coblation and conventional tonsillectomy with reference to long-term outcomes. This study made it possible to develop and provide comparative evidence regarding the safety, efficacy, and postoperative quality of life of patients who underwent either coblator-assisted tonsillotomy or traditional tonsillectomy after tonsillotomy, an area lacking longitudinal data. It is a prospective cohort study on 60 post-tonsillotomy patients with symptomatic tonsillar disease. Thirty participants underwent tonsillotomy using coblation, and thirty were assigned to conventional extra-capsular tonsillectomy. Preoperative and at 3, 6, and 12 months postoperative patients were evaluated with a visual analog scale for pain score, postoperative bleeding rates, infection recurrence, and quality of life (QoL) scores using the Pediatric Quality of Life Inventory (PedsQL). It was shown that cobllator tonsillotomy decreases significantly postoperative pain (mean difference 10.1) (p < 0.01); decreases recovery time (mean 5.2 days, range 3–14 days; mean difference 4.4 days) (p < 0.01); results in fewer complications, with comparable recurrence and QoL improvement at 1 year of followup. In the case of infection recurrence, there were no significant differences (p > 0.05).
{"title":"Tonsillotomy with Coblator or Tonsillectomy? One-Year Postoperative Follow-up Results","authors":"A.K. Semih","doi":"10.1016/j.amjoto.2025.104726","DOIUrl":"10.1016/j.amjoto.2025.104726","url":null,"abstract":"<div><div>After post tonsillotomy patients most commonly develop chronic secondary tonsillar hypertrophy or recurrent infections because of compensatory lymphoid hyperplasia or changed oropharyngeal dynamics. Hence, a clinical dilemma exists regarding which procedure is to be chosen between tonsillotomy with coblation and conventional tonsillectomy with reference to long-term outcomes. This study made it possible to develop and provide comparative evidence regarding the safety, efficacy, and postoperative quality of life of patients who underwent either coblator-assisted tonsillotomy or traditional tonsillectomy after tonsillotomy, an area lacking longitudinal data. It is a prospective cohort study on 60 post-tonsillotomy patients with symptomatic tonsillar disease. Thirty participants underwent tonsillotomy using coblation, and thirty were assigned to conventional extra-capsular tonsillectomy. Preoperative and at 3, 6, and 12 months postoperative patients were evaluated with a visual analog scale for pain score, postoperative bleeding rates, infection recurrence, and quality of life (QoL) scores using the Pediatric Quality of Life Inventory (PedsQL). It was shown that cobllator tonsillotomy decreases significantly postoperative pain (mean difference 10.1) (<em>p</em> < 0.01); decreases recovery time (mean 5.2 days, range 3–14 days; mean difference 4.4 days) (<em>p</em> < 0.01); results in fewer complications, with comparable recurrence and QoL improvement at 1 year of followup. In the case of infection recurrence, there were no significant differences (<em>p</em> > 0.05).</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104726"},"PeriodicalIF":1.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145262851","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 : 2025-10-03DOI: 10.1016/j.amjoto.2025.104728
Bang-Yan Zhang , Chen-Chi Wu , Tien-Chen Liu , Ting-Hua Yang
Objective(s)
To clarify the clinical characteristics, management, and prognosis of nontuberculous mycobacteria (NTM) otomastoiditis, a rare and intractable disease with high relapse risk. This study presents the largest case series to date, analyzing 30 patients with NTM otomastoiditis.
Methods
This retrospective case series was conducted at a single tertiary referral center. Clinical data including causative pathogens, imaging findings, antibiotic regimens, surgical interventions, complications, and audiometric outcomes were reviewed and analyzed.
Results
Among the 30 patients (14 males; mean age 55 ± 20 years), Mycobacterium abscessus was identified in 26 (87 %) cases. Skull base osteomyelitis or intracranial involvement was present in 7 (23 %) patients. All patients received anti-NTM antibiotics, with macrolides being the most frequently prescribed. The median antibiotic duration was 13 months. Twenty-three (77 %) patients underwent surgery, and 12 (40 %) had additional operations. Among 23 patients with complete audiometric data, mean air-conduction hearing thresholds improved from 64.1 to 55.6 dB HL (p = 0.04); however, irreversible total deafness developed in 3 patients.
Conclusion
Nontuberculous mycobacterial otomastoiditis requires early recognition and comprehensive management. Combined surgical debridement and prolonged antibiotic therapy are often necessary, and all patients can achieve disease control. Hearing outcomes vary, but functional preservation is possible in appropriately managed cases.
目的探讨非结核分枝杆菌（NTM）耳乳突炎这一罕见难治性疾病的临床特点、治疗及预后。这项研究提出了迄今为止最大的病例系列，分析了30例NTM耳乳突炎患者。方法本回顾性病例系列在单一三级转诊中心进行。临床资料包括致病病原体、影像学发现、抗生素治疗方案、手术干预、并发症和听力学结果进行了回顾和分析。结果30例患者中，男性14例，平均年龄55±20岁，检出脓肿分枝杆菌26例（87%）。颅底骨髓炎或颅内受累7例（23%）。所有患者均接受抗ntm抗生素治疗，大环内酯类药物是最常用的处方。抗生素的中位持续时间为13个月。23例（77%）患者接受了手术，12例（40%）患者接受了额外的手术。在23例听力数据完整的患者中，平均空气传导听力阈值从64.1提高到55.6 dB HL (p = 0.04)；3例发生不可逆全聋。结论非结核性分枝杆菌性耳乳突炎需要早期识别和综合治疗。手术清创和长期抗生素治疗往往是必要的，所有患者都能达到疾病控制。听力结果各不相同，但在适当管理的情况下，功能保留是可能的。
{"title":"Characteristics and prognosis of intractable otomastoiditis caused by nontuberculous mycobacteria","authors":"Bang-Yan Zhang , Chen-Chi Wu , Tien-Chen Liu , Ting-Hua Yang","doi":"10.1016/j.amjoto.2025.104728","DOIUrl":"10.1016/j.amjoto.2025.104728","url":null,"abstract":"<div><h3>Objective(s)</h3><div>To clarify the clinical characteristics, management, and prognosis of nontuberculous mycobacteria (NTM) otomastoiditis, a rare and intractable disease with high relapse risk. This study presents the largest case series to date, analyzing 30 patients with NTM otomastoiditis.</div></div><div><h3>Methods</h3><div>This retrospective case series was conducted at a single tertiary referral center. Clinical data including causative pathogens, imaging findings, antibiotic regimens, surgical interventions, complications, and audiometric outcomes were reviewed and analyzed.</div></div><div><h3>Results</h3><div>Among the 30 patients (14 males; mean age 55 ± 20 years), <em>Mycobacterium abscessus</em> was identified in 26 (87 %) cases. Skull base osteomyelitis or intracranial involvement was present in 7 (23 %) patients. All patients received anti-NTM antibiotics, with macrolides being the most frequently prescribed. The median antibiotic duration was 13 months. Twenty-three (77 %) patients underwent surgery, and 12 (40 %) had additional operations. Among 23 patients with complete audiometric data, mean air-conduction hearing thresholds improved from 64.1 to 55.6 dB HL (<em>p</em> = 0.04); however, irreversible total deafness developed in 3 patients.</div></div><div><h3>Conclusion</h3><div>Nontuberculous mycobacterial otomastoiditis requires early recognition and comprehensive management. Combined surgical debridement and prolonged antibiotic therapy are often necessary, and all patients can achieve disease control. Hearing outcomes vary, but functional preservation is possible in appropriately managed cases.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104728"},"PeriodicalIF":1.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145262852","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 : 2025-09-17DOI: 10.1016/j.amjoto.2025.104723
C. Hajema , I.J. Kruyt , M.K.S. Hol
{"title":"Comment on “Assessment of TISA ‘Transcutaneous Implant Skin Anomalies’ scale for cutaneous complications related to bone conduction hearing implants” by Hernández et al. American Journal of Otolaryngology-Head and Neck Medicine and Surgery 46 (2025) 104554","authors":"C. Hajema , I.J. Kruyt , M.K.S. Hol","doi":"10.1016/j.amjoto.2025.104723","DOIUrl":"10.1016/j.amjoto.2025.104723","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104723"},"PeriodicalIF":1.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154726","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 : 2025-09-13DOI: 10.1016/j.amjoto.2025.104722
Tejaswi Gupta , Jyoti Kumar Verma , Sanjeev Yadav
{"title":"Critical appraisal of “diagnosis and treatment of CSF rhinorrhea with intracranial hypertension”","authors":"Tejaswi Gupta , Jyoti Kumar Verma , Sanjeev Yadav","doi":"10.1016/j.amjoto.2025.104722","DOIUrl":"10.1016/j.amjoto.2025.104722","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 6","pages":"Article 104722"},"PeriodicalIF":1.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079498","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 : 2025-09-01Epub Date: 2025-08-05DOI: 10.1016/j.amjoto.2025.104718
Courtney B Shires, Roger Bui, Brooke Bocklud, Karuna Dewan
Objective: There is currently a paucity of literature detailing the socioeconomic implications on management and outcomes of pediatric subglottic stenosis. Through this study, we sought to ascertain whether disparities of social determinants of health did have a discernible impact on management of subglottic stenosis through endoscopic versus open procedures and whether there would be a difference in outcomes.
Study design: The study is a multi- institutional, academic center, retrospective case series.
Methods: The study examines pediatric patients under the age of 18 evaluated by Ochsner-affiliated hospitals through May 2012 to May 2022 with the diagnosis of subglottic stenosis, acquired or congenital, through Epic SlicerDicer search engine. Patients were stratified into low and high socioeconomic status (SES), which served as independent variables, using principal component analysis of several social determinants. We recorded sex, age, ethnicity, and completion of college education. Interventions reviewed included endoscopic treatment, open airway surgery, and presence of tracheostomy. Outcome measurements included decannulation, time to decannulation, and death. Chi squared analysis was performed on dichotomous variables and student t-test was performed for continuous variables.
Results: The groups were similar in demographics: sex, age, ethnicity, and proportion with college degree. Cotton Meyer grade was significantly higher in low SES compared to high SES (p = 0.04). Patients of low SES were significantly more likely to die (p < 0.001). Low SES patients were more likely to have an acquired rather than a congenital subglottic stenosis as compared to their high SES counterparts (p = 0.02). Low SES patients were also more likely to undergo endoscopic intervention (p = 0.03). There was no statistically significant difference in tracheostomy status or decannulation success between the two groups.
Conclusion: There were statistically significant findings between low and high SES groups. Overall, patients of low SES appeared to have greater severity of subglottic stenosis, with greater number of endoscopic interventions, and greater mortality. This study which collected data from an area with marginalized patients with poor health literacy, demonstrates that sociodemographic factors contribute to disparate intervention and outcomes in pediatric patients with subglottic stenosis.
{"title":"The impact of socioeconomic status on management of pediatric subglottic stenosis and outcomes.","authors":"Courtney B Shires, Roger Bui, Brooke Bocklud, Karuna Dewan","doi":"10.1016/j.amjoto.2025.104718","DOIUrl":"10.1016/j.amjoto.2025.104718","url":null,"abstract":"<p><strong>Objective: </strong>There is currently a paucity of literature detailing the socioeconomic implications on management and outcomes of pediatric subglottic stenosis. Through this study, we sought to ascertain whether disparities of social determinants of health did have a discernible impact on management of subglottic stenosis through endoscopic versus open procedures and whether there would be a difference in outcomes.</p><p><strong>Study design: </strong>The study is a multi- institutional, academic center, retrospective case series.</p><p><strong>Methods: </strong>The study examines pediatric patients under the age of 18 evaluated by Ochsner-affiliated hospitals through May 2012 to May 2022 with the diagnosis of subglottic stenosis, acquired or congenital, through Epic SlicerDicer search engine. Patients were stratified into low and high socioeconomic status (SES), which served as independent variables, using principal component analysis of several social determinants. We recorded sex, age, ethnicity, and completion of college education. Interventions reviewed included endoscopic treatment, open airway surgery, and presence of tracheostomy. Outcome measurements included decannulation, time to decannulation, and death. Chi squared analysis was performed on dichotomous variables and student t-test was performed for continuous variables.</p><p><strong>Results: </strong>The groups were similar in demographics: sex, age, ethnicity, and proportion with college degree. Cotton Meyer grade was significantly higher in low SES compared to high SES (p = 0.04). Patients of low SES were significantly more likely to die (p < 0.001). Low SES patients were more likely to have an acquired rather than a congenital subglottic stenosis as compared to their high SES counterparts (p = 0.02). Low SES patients were also more likely to undergo endoscopic intervention (p = 0.03). There was no statistically significant difference in tracheostomy status or decannulation success between the two groups.</p><p><strong>Conclusion: </strong>There were statistically significant findings between low and high SES groups. Overall, patients of low SES appeared to have greater severity of subglottic stenosis, with greater number of endoscopic interventions, and greater mortality. This study which collected data from an area with marginalized patients with poor health literacy, demonstrates that sociodemographic factors contribute to disparate intervention and outcomes in pediatric patients with subglottic stenosis.</p>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"104718"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803262","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 : 2025-09-01Epub Date: 2025-08-06DOI: 10.1016/j.amjoto.2025.104717
Yossef Alsabawi, Pompeyo R Quesada, David T Rouse
Background: Low health literacy among patients hinders comprehension of care instructions and worsens outcomes, yet most otolaryngology patient materials and chatbot responses to medical inquiries exceed the recommended reading level of sixth- to eighth-grade. Whether chatbots can be pre-programmed to provide accurate, plain-language responses has yet to be studied. This study aims to compare response readability of a GPT model customized for plain language with GPT-4 when answering common otolaryngology patient questions.
Methods: A custom GPT was created and provided thirty-three questions from Polat et al. (Int J Pediatr Otorhinolaryngol., 2024), and their GPT-4 answers were reused with permission. Questions were grouped by theme. Readability was calculated with Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) via online calculator. A board-certified, practicing otolaryngologist assessed content similarity and accuracy. The primary outcome was readability, measured by FKGL (0-18; equivalent to United States grade level) and FRE (0-100; higher scores indicate greater readability).
Results: The custom GPT reduced FKGL by an average of 4.2 grade levels (95 % confidence interval [CI]: 3.2, 5.1; p < 0.001) and increased FRE by an average of 17.3 points (95 % CI: 12.5, 21.7; p < 0.001). Improvements remained significant in three of four theme subgroups (p < 0.05). Readability was consistent across question types, and variances were equal between models. Expert review confirmed overall accuracy and content similarity.
Conclusion: Preprogramming a custom GPT to generate plain-language instructions yields outputs that meet Centers for Medicare & Medicaid Services readability targets without significantly compromising content quality. Tailored chatbots could enhance patient communication in otolaryngology clinics and other medical settings.
{"title":"Readability of custom chatbot vs. GPT-4 responses to otolaryngology-related patient questions.","authors":"Yossef Alsabawi, Pompeyo R Quesada, David T Rouse","doi":"10.1016/j.amjoto.2025.104717","DOIUrl":"10.1016/j.amjoto.2025.104717","url":null,"abstract":"<p><strong>Background: </strong>Low health literacy among patients hinders comprehension of care instructions and worsens outcomes, yet most otolaryngology patient materials and chatbot responses to medical inquiries exceed the recommended reading level of sixth- to eighth-grade. Whether chatbots can be pre-programmed to provide accurate, plain-language responses has yet to be studied. This study aims to compare response readability of a GPT model customized for plain language with GPT-4 when answering common otolaryngology patient questions.</p><p><strong>Methods: </strong>A custom GPT was created and provided thirty-three questions from Polat et al. (Int J Pediatr Otorhinolaryngol., 2024), and their GPT-4 answers were reused with permission. Questions were grouped by theme. Readability was calculated with Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) via online calculator. A board-certified, practicing otolaryngologist assessed content similarity and accuracy. The primary outcome was readability, measured by FKGL (0-18; equivalent to United States grade level) and FRE (0-100; higher scores indicate greater readability).</p><p><strong>Results: </strong>The custom GPT reduced FKGL by an average of 4.2 grade levels (95 % confidence interval [CI]: 3.2, 5.1; p < 0.001) and increased FRE by an average of 17.3 points (95 % CI: 12.5, 21.7; p < 0.001). Improvements remained significant in three of four theme subgroups (p < 0.05). Readability was consistent across question types, and variances were equal between models. Expert review confirmed overall accuracy and content similarity.</p><p><strong>Conclusion: </strong>Preprogramming a custom GPT to generate plain-language instructions yields outputs that meet Centers for Medicare & Medicaid Services readability targets without significantly compromising content quality. Tailored chatbots could enhance patient communication in otolaryngology clinics and other medical settings.</p>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"104717"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811554","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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