American Journal of Otolaryngology最新文献_第6页

The impact of primary immunodeficiency on the severity of chronic rhinosinusitis 原发性免疫缺陷对慢性鼻窦炎严重程度的影响。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104541

Kevin Tie , Mohamed A. Aboueisha , Madelyn Wang , David S. Caradonna , Christopher D. Brook

Background

Primary immunodeficiency has been associated with chronic rhinosinusitis (CRS). However, limited evidence exists on how primary immunodeficiencies affect the severity of CRS.

Objective

To assess how primary IgA and/or IgG immunodeficiency affects the severity of CRS.

Methods

Adult patients at the Beth Israel Deaconess Medical Center in Boston with IgA and/or IgG deficiency (group A) or normal IgA and IgG (group B) were queried between January 1, 2016 and December 31, 2022. Other immunodeficiencies were excluded. The groups were analyzed for prevalence of CRS based on ICD-10 codes. The groups were matched based on demographics and comorbidities. Patients with CRS were analyzed for ≥3 acute rhinosinusitis (ARS) episodes, mean lifetime ARS episodes, and mean ARS episodes per year (all with or without antibiotic treatment). Additional analyses included need for functional endoscopic sinus surgery (FESS) and mean lifetime FESS procedures based on CPT codes. A logistic regression analysis was then performed over the same parameters.

Results

A total of 346 patients had IgA and/or IgG deficiency (group A), and 11,438 patients had normal IgA and IgG (group B). CRS prevalence was higher in group A than group B (12 % vs. 5 %; p < 0.001). Group A had more patients with ≥3 ARS episodes, higher mean lifetime ARS episodes, and ARS episodes per year, though none of these findings were statistically significant. There was no difference in need for FESS or mean lifetime FESS procedures.

Conclusion

CRS prevalence is higher in patients with IgA and/or IgG deficiency, but IgA and/or IgG immunodeficiency does not predispose patients to ARS episodes or predict need for FESS.

背景：原发性免疫缺陷与慢性鼻窦炎（CRS）有关。然而，关于原发性免疫缺陷如何影响CRS严重程度的证据有限。目的：评估原发性IgA和/或IgG免疫缺陷对CRS严重程度的影响。方法：对2016年1月1日至2022年12月31日期间在波士顿贝斯以色列女执事医疗中心IgA和/或IgG缺乏（A组）或IgA和IgG正常（B组）的成年患者进行调查。排除其他免疫缺陷。根据ICD-10编码分析各组CRS患病率。根据人口统计学和合并症对两组进行匹配。分析CRS患者急性鼻窦炎（ARS）发作≥3次、平均终生ARS发作次数和平均每年ARS发作次数（均接受或未接受抗生素治疗）。其他分析包括功能性内窥镜鼻窦手术（FESS）的需求和基于CPT代码的平均寿命FESS程序。然后对相同的参数进行逻辑回归分析。结果：共有346例患者IgA和/或IgG缺乏（A组），11438例患者IgA和IgG正常（B组），CRS患病率A组高于B组(12% vs. 5%；结论：在IgA和/或IgG缺乏的患者中，CRS患病率较高，但IgA和/或IgG缺乏并不能使患者易发生ARS，也不能预测是否需要FESS。

{"title":"The impact of primary immunodeficiency on the severity of chronic rhinosinusitis","authors":"Kevin Tie , Mohamed A. Aboueisha , Madelyn Wang , David S. Caradonna , Christopher D. Brook","doi":"10.1016/j.amjoto.2024.104541","DOIUrl":"10.1016/j.amjoto.2024.104541","url":null,"abstract":"<div><h3>Background</h3><div>Primary immunodeficiency has been associated with chronic rhinosinusitis (CRS). However, limited evidence exists on how primary immunodeficiencies affect the severity of CRS.</div></div><div><h3>Objective</h3><div>To assess how primary IgA and/or IgG immunodeficiency affects the severity of CRS.</div></div><div><h3>Methods</h3><div>Adult patients at the Beth Israel Deaconess Medical Center in Boston with IgA and/or IgG deficiency (group A) or normal IgA and IgG (group B) were queried between January 1, 2016 and December 31, 2022. Other immunodeficiencies were excluded. The groups were analyzed for prevalence of CRS based on ICD-10 codes. The groups were matched based on demographics and comorbidities. Patients with CRS were analyzed for ≥3 acute rhinosinusitis (ARS) episodes, mean lifetime ARS episodes, and mean ARS episodes per year (all with or without antibiotic treatment). Additional analyses included need for functional endoscopic sinus surgery (FESS) and mean lifetime FESS procedures based on CPT codes. A logistic regression analysis was then performed over the same parameters.</div></div><div><h3>Results</h3><div>A total of 346 patients had IgA and/or IgG deficiency (group A), and 11,438 patients had normal IgA and IgG (group B). CRS prevalence was higher in group A than group B (12 % vs. 5 %; <em>p</em> < 0.001). Group A had more patients with ≥3 ARS episodes, higher mean lifetime ARS episodes, and ARS episodes per year, though none of these findings were statistically significant. There was no difference in need for FESS or mean lifetime FESS procedures.</div></div><div><h3>Conclusion</h3><div>CRS prevalence is higher in patients with IgA and/or IgG deficiency, but IgA and/or IgG immunodeficiency does not predispose patients to ARS episodes or predict need for FESS.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104541"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rare case of cochlear implant damaged by nearby use of monopolar electrosurgery 邻近单极电刀致人工耳蜗损伤的罕见病例。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104588

Evan J. Patel , Colleen Polite , Jeffrey D. Sharon

Objectives

To present a rare case of a cochlear implant (CI) damaged by nearby use of monopolar electrosurgery.

Patient

A 38-year-old man with a right-sided CI reported that his implant had stopped producing sound immediately after his meningioma resection.

Interventions

Right pterional craniotomy with use of monopolar electrosurgery.

Main outcome measures

Cochlear implant device performance, post-operative word recognition score (WRS).

Results

Formal evaluation revealed a defective cochlear implant. During revision surgery no gross defect was noted to the device suggesting that malfunction was due to electrical damage from nearby electrosurgery. The patient's hearing on the right subjectively returned to baseline after replacement of the CI and his WRS dropped to 46 % from 60 % prior to his craniotomy.

Conclusions

Monopolar electrosurgery in the immediate proximity to a CI can result in device malfunction.

目的：报告一例罕见的人工耳蜗（CI）附近单极电手术损伤病例。患者：一名38岁的男性右侧脑梗死患者报告说，他的植入物在脑膜瘤切除术后立即停止发出声音。干预措施：使用单极电手术进行右侧翼点开颅。主要观察指标：人工耳蜗设备性能、术后单词识别评分（WRS）。结果：正式评估显示一个有缺陷的人工耳蜗。在翻修手术期间，没有注意到设备的严重缺陷，这表明故障是由于附近的电手术造成的电损伤。患者的右侧听力在更换CI后主观上恢复到基线，其WRS从开颅前的60%下降到46%。结论：靠近CI的单极电手术可导致设备故障。

引用次数: 0

Assessing adult sinusitis guidelines: A comparative analysis of AAO-HNS and AI Chatbots

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104563

Shaun Edalati, Shiven Sharma, Rahul Guda, Vikram Vasan, Shahed Mohamed, Sunder Gidumal, Satish Govindaraj, Alfred Marc Iloreta

Objective

To compare the guidelines offered by the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNS) on adult sinusitis to chatbots.

Methods

ChatGPT-3.5, ChatGPT-4.0, Bard, and Llama 2 represent openly accessible large language model-based chatbots. Accuracy, over-conclusiveness, supplemental, and incompleteness of chatbot responses were compared to the AAO-HNS Adult sinusitis clinical guidelines.

Results

12 guidelines consisting of 30 questions from the AAO-HNS were compared to 4 different chatbots. Adherence to AAO-HNS guidelines varied, with Llama 2 providing 80 % accurate responses, BARD 83.3 %, ChatGPT-4.0 80 %, and ChatGPT-3.5 73.3 %. Over-conclusive responses were minimal, with only one instance each from Llama 2 and ChatGPT-4.0. However, rates of incomplete responses varied, with Llama 2 exhibiting the highest at 40 %, followed by ChatGPT-4.0 at 33.3 %, BARD at 23.3 %, and ChatGPT-3.5 at 36.7 %. Fisher's Exact Test analysis revealed significant deviations from the guideline standard, with less accuracy (p = 0.012 for Llama 2, p = 0.026 for BARD, p = 0.012 for ChatGPT-4.0, p = 0.002 for ChatGPT-3.5), inclusion of supplemental data (p < 0.001 for all), and less completeness (p < 0.01 for all) across all chatbots, indicating potential areas for enhancement in their performance.

Conclusion

Although AI chatbots like Llama 2, Bard, and ChatGPT exhibit potential in sharing health-related information, their present performance in responding to clinical concerns concerning adult rhinosinusitis is not up to par with recognized clinical criteria. Future revisions should focus on addressing these shortcomings and placing an emphasis on accuracy, completeness, and conformity with evidence-based practices.

{"title":"Assessing adult sinusitis guidelines: A comparative analysis of AAO-HNS and AI Chatbots","authors":"Shaun Edalati, Shiven Sharma, Rahul Guda, Vikram Vasan, Shahed Mohamed, Sunder Gidumal, Satish Govindaraj, Alfred Marc Iloreta","doi":"10.1016/j.amjoto.2024.104563","DOIUrl":"10.1016/j.amjoto.2024.104563","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the guidelines offered by the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNS) on adult sinusitis to chatbots.</div></div><div><h3>Methods</h3><div>ChatGPT-3.5, ChatGPT-4.0, Bard, and Llama 2 represent openly accessible large language model-based chatbots. Accuracy, over-conclusiveness, supplemental, and incompleteness of chatbot responses were compared to the AAO-HNS Adult sinusitis clinical guidelines.</div></div><div><h3>Results</h3><div>12 guidelines consisting of 30 questions from the AAO-HNS were compared to 4 different chatbots. Adherence to AAO-HNS guidelines varied, with Llama 2 providing 80 % accurate responses, BARD 83.3 %, ChatGPT-4.0 80 %, and ChatGPT-3.5 73.3 %. Over-conclusive responses were minimal, with only one instance each from Llama 2 and ChatGPT-4.0. However, rates of incomplete responses varied, with Llama 2 exhibiting the highest at 40 %, followed by ChatGPT-4.0 at 33.3 %, BARD at 23.3 %, and ChatGPT-3.5 at 36.7 %. Fisher's Exact Test analysis revealed significant deviations from the guideline standard, with less accuracy (<em>p</em> = 0.012 for Llama 2, <em>p</em> = 0.026 for BARD, p = 0.012 for ChatGPT-4.0, <em>p</em> = 0.002 for ChatGPT-3.5), inclusion of supplemental data (<em>p</em> < 0.001 for all), and less completeness (<em>p</em> < 0.01 for all) across all chatbots, indicating potential areas for enhancement in their performance.</div></div><div><h3>Conclusion</h3><div>Although AI chatbots like Llama 2, Bard, and ChatGPT exhibit potential in sharing health-related information, their present performance in responding to clinical concerns concerning adult rhinosinusitis is not up to par with recognized clinical criteria. Future revisions should focus on addressing these shortcomings and placing an emphasis on accuracy, completeness, and conformity with evidence-based practices.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104563"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gargantuan carcinoma ex-pleomorphic adenoma of the submandibular gland: Case report and review of literature 颌下腺巨癌前多形性腺瘤一例报告及文献复习。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104539

Milena Fabry , Jamie Shehan , Jacob Markovicz , Mohamedkazim Alwani MD , Sameep Kadakia

Introduction

Pleomorphic adenoma is the most common neoplasm of the major salivary glands, and can undergo malignant transformation to carcinoma ex-pleomorphic adenoma (CXPA) in untreated patients.

Case presentation

Our case describes a 56-year-old male with a 15-year history of slowly growing expansive right-sided neck. He underwent excision of the neck mass, neck dissection, and pectoralis flap reconstruction. Final pathology revealed a 22 cm CXPA with myoepithelial and salivary duct carcinoma components. The patient was recommended radiation therapy to receive 66 Gy in 33 fractions.

Discussion

CXPA is rare, typically aggressive, and carries a poor prognosis. This case is unique given the location of the tumor arising from the submandibular gland and delayed presentation leading to its massive size. Surgical planning for a lesion of this nature is complex due to structures in the vicinity and additional needs for reconstruction. Another important consideration highlighted by this case includes the need to assess patient reliability and provide resources to reduce the odds of being lost to follow up and enhance patient care.

简介：多形性腺瘤是主要唾液腺最常见的肿瘤，未经治疗的患者可恶性转化为癌前多形性腺瘤（CXPA）。病例介绍：我们的病例描述了一个56岁的男性，15年的历史缓慢增长扩张的右侧颈部。他接受了颈部肿块切除、颈部剥离和胸肌瓣重建。最终病理显示一个22厘米的CXPA，含有肌上皮和唾液管癌成分。建议患者接受33次66 Gy的放射治疗。讨论：肺外炎罕见，典型侵袭性，预后较差。这个病例是独特的，因为肿瘤起源于下颌骨腺和延迟的表现导致其巨大的大小。由于附近的结构和重建的额外需求，这种性质的病变的手术计划是复杂的。本病例强调的另一个重要考虑因素包括需要评估患者的可靠性，并提供资源以减少失去随访和加强患者护理的可能性。

{"title":"Gargantuan carcinoma ex-pleomorphic adenoma of the submandibular gland: Case report and review of literature","authors":"Milena Fabry , Jamie Shehan , Jacob Markovicz , Mohamedkazim Alwani MD , Sameep Kadakia","doi":"10.1016/j.amjoto.2024.104539","DOIUrl":"10.1016/j.amjoto.2024.104539","url":null,"abstract":"<div><h3>Introduction</h3><div>Pleomorphic adenoma is the most common neoplasm of the major salivary glands, and can undergo malignant transformation to carcinoma ex-pleomorphic adenoma (CXPA) in untreated patients.</div></div><div><h3>Case presentation</h3><div>Our case describes a 56-year-old male with a 15-year history of slowly growing expansive right-sided neck. He underwent excision of the neck mass, neck dissection, and pectoralis flap reconstruction. Final pathology revealed a 22 cm CXPA with myoepithelial and salivary duct carcinoma components. The patient was recommended radiation therapy to receive 66 Gy in 33 fractions.</div></div><div><h3>Discussion</h3><div>CXPA is rare, typically aggressive, and carries a poor prognosis. This case is unique given the location of the tumor arising from the submandibular gland and delayed presentation leading to its massive size. Surgical planning for a lesion of this nature is complex due to structures in the vicinity and additional needs for reconstruction. Another important consideration highlighted by this case includes the need to assess patient reliability and provide resources to reduce the odds of being lost to follow up and enhance patient care.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104539"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-invasive screening for laryngeal cancer using the oral cavity as a proxy for differentiation of laryngeal cancer versus leukoplakia: A novel application of ESS technology and artificial intelligence supported statistical modeling 使用口腔作为喉癌与白斑鉴别的代理的无创喉癌筛查：ESS技术和人工智能支持的统计建模的新应用。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104581

M. Sakharkar , G. Spokas , L. Berry , K. Daniels , P. Nithagon , E. Rodriguez-Diaz , L. Tracy , J.P. Noordzij , I. Bigio , G. Grillone , G.P. Krisciunas

Objective

This preliminary study tested whether non-invasive, remote Elastic Scattering Spectroscopy (ESS) measurements obtained in the oral cavity can be used as a proxy to accurately differentiate between patients with laryngeal cancer versus laryngeal leukoplakia.

Methods

20 patients with laryngeal lesions [cancer (n = 10),leukoplakia (n = 10)] were clinically assessed and categorized by otolaryngologists per standard clinical practice. Patient demographics of age, race, sex, and smoking history were collected. A machine-learning artificial intelligence (AI) algorithm was applied to classify patients using ESS spectra of patients with benign laryngeal leukoplakia or laryngeal cancer. Specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), F1, and area-under-the-curve (AUC) were calculated. Additional algorithms stratified spectral data by sub-anatomical site and smoking status to explore diagnostic capability.

Results

Overall, the algorithm had a sensitivity = 74 %, specificity = 40 %, PPV = 51 %, NPV = 64 %, F1 = 0.61 and AUC = 0.65. When stratifying by former and active smokers, algorithm sensitivities increased to 85 % and 77 %. Analysis by sub-anatomic location yielded an AUC = 0.77 for lateral tongue, and when stratified by (former/current) smoking status, demonstrated AUC = 0.94 and 0.83, sensitivities = 98 % and 76 %, and specificities = 85 % and 86 %. Algorithm output from the mucosal lip yielded sensitivity = 89 %, specificity = 88 %, PPV = 83 %, and NPV = 92 % in former smokers.

Conclusion

This pilot study demonstrated ESS technology coupled with AI-assisted statistical modeling, could differentiate between patients with laryngeal leukoplakia versus cancer with good precision, especially with smoking status and anatomic subclassification. If ESS can be utilized in the oral cavity as a non-invasive screening tool for laryngeal cancer, it would greatly facilitate early detection in specialized/non-specialized clinics, and under-resourced regions.

目的：本初步研究测试了在口腔中获得的无创、远程弹性散射光谱（ESS）测量是否可以作为准确区分喉癌和喉白斑患者的代理。方法：对20例喉部病变患者[癌（n = 10）、白斑（n = 10）]进行临床评估，由耳鼻喉科医师按标准临床操作进行分类。收集患者的年龄、种族、性别和吸烟史。采用机器学习人工智能（AI）算法对良性喉白斑或喉癌患者的ESS谱进行分类。计算特异性、敏感性、阳性预测值（PPV）、阴性预测值（NPV）、F1和曲线下面积（AUC）。另外的算法分层光谱数据按亚解剖部位和吸烟状况来探索诊断能力。结果：总体而言，该算法的敏感性为74%，特异性为40%，PPV = 51%, NPV = 64%, F1 = 0.61, AUC = 0.65。当按戒烟者和活跃吸烟者进行分层时，算法灵敏度分别提高到85%和77%。亚解剖位置分析显示，侧舌的AUC = 0.77，当按（以前/现在）吸烟状况分层时，AUC = 0.94和0.83，敏感性= 98%和76%，特异性= 85%和86%。在前吸烟者中，粘膜唇的算法输出的灵敏度= 89%，特异性= 88%,PPV = 83%, NPV = 92%。结论：本初步研究表明，ESS技术与人工智能辅助统计建模相结合，可以很好地区分喉白斑与癌患者，特别是吸烟状况和解剖亚分类。如果ESS可以作为一种无创的口腔喉癌筛查工具，将极大地促进专科/非专科诊所和资源不足地区的早期发现。

{"title":"Non-invasive screening for laryngeal cancer using the oral cavity as a proxy for differentiation of laryngeal cancer versus leukoplakia: A novel application of ESS technology and artificial intelligence supported statistical modeling","authors":"M. Sakharkar , G. Spokas , L. Berry , K. Daniels , P. Nithagon , E. Rodriguez-Diaz , L. Tracy , J.P. Noordzij , I. Bigio , G. Grillone , G.P. Krisciunas","doi":"10.1016/j.amjoto.2024.104581","DOIUrl":"10.1016/j.amjoto.2024.104581","url":null,"abstract":"<div><h3>Objective</h3><div>This preliminary study tested whether non-invasive, remote Elastic Scattering Spectroscopy (ESS) measurements obtained in the oral cavity can be used as a proxy to accurately differentiate between patients with laryngeal cancer versus laryngeal leukoplakia.</div></div><div><h3>Methods</h3><div>20 patients with laryngeal lesions [cancer (<em>n</em> = 10),leukoplakia (n = 10)] were clinically assessed and categorized by otolaryngologists per standard clinical practice. Patient demographics of age, race, sex, and smoking history were collected. A machine-learning artificial intelligence (AI) algorithm was applied to classify patients using ESS spectra of patients with benign laryngeal leukoplakia or laryngeal cancer. Specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), F1, and area-under-the-curve (AUC) were calculated. Additional algorithms stratified spectral data by sub-anatomical site and smoking status to explore diagnostic capability.</div></div><div><h3>Results</h3><div>Overall, the algorithm had a sensitivity = 74 %, specificity = 40 %, PPV = 51 %, NPV = 64 %, F1 = 0.61 and AUC = 0.65. When stratifying by former and active smokers, algorithm sensitivities increased to 85 % and 77 %. Analysis by sub-anatomic location yielded an AUC = 0.77 for lateral tongue, and when stratified by (former/current) smoking status, demonstrated AUC = 0.94 and 0.83, sensitivities = 98 % and 76 %, and specificities = 85 % and 86 %. Algorithm output from the mucosal lip yielded sensitivity = 89 %, specificity = 88 %, PPV = 83 %, and NPV = 92 % in former smokers.</div></div><div><h3>Conclusion</h3><div>This pilot study demonstrated ESS technology coupled with AI-assisted statistical modeling, could differentiate between patients with laryngeal leukoplakia versus cancer with good precision, especially with smoking status and anatomic subclassification. If ESS can be utilized in the oral cavity as a non-invasive screening tool for laryngeal cancer, it would greatly facilitate early detection in specialized/non-specialized clinics, and under-resourced regions.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104581"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predictive factors for drainage in pediatric cervical lymphadenitis: A study of clinical indicators and recovery outcomes 儿童宫颈淋巴结炎引流的预测因素：临床指标和恢复结果的研究。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104586

Hatice Merve Savran , Fatih Savran , Naciye Gönül Tanır

Background

The purpose of this study was to investigate the predictive factors for drainage in patients hospitalized with cervical lymphadenitis in the Pediatrics Infectious Diseases Department and to differentiate the recovery time between patients who received antibiotic treatment only and those who received drainage for their lymphadenitis.

Materials and methods

We retrospectively analyzed 169 patients selected for this study, aged 1 month to 18 years, who were followed up with a diagnosis of cervical lymphadenitis between January 2011 and December 2019. Clinical features such as sex, age, physical examination findings, laboratory findings, imaging findings, and antibiotic treatments were retrospectively reviewed. Patients with lymphadenopathy larger than 2.5 cm, whose initial complaints lasted <28 days, and whose clinical and follow-up data were complete were included in the study.

Results

Of the 169 patients in our study, 137 recovered without drainage and 32 with drainage. In these patients, findings such as an erythrocyte sedimentation rate >53.5 mm/h, platelet count >436,000/mm³, unilaterality, outpatient antibiotic use, and the lymph node ratio of short axis to long axis >0.5 were found to be predictive factors for lymph node drainage.

Conclusions

Evaluation of patients with cervical lymphadenitis with physical examination, laboratory and imaging findings, and consideration of the factors predicting drainage with fine needle aspiration as soon as possible will shorten the length of hospital stay.

背景：本研究的目的是探讨儿科感染性科宫颈淋巴结炎住院患者引流的预测因素，并区分单纯接受抗生素治疗和接受引流治疗的淋巴结炎患者的恢复时间。材料和方法：我们回顾性分析了入选本研究的169例患者，年龄在1个月至18岁之间，他们在2011年1月至2019年12月期间被诊断为宫颈淋巴结炎。临床特征，如性别、年龄、体格检查结果、实验室检查结果、影像学检查结果和抗生素治疗回顾性回顾。结果：本组169例患者中，137例不引流恢复，32例引流恢复。在这些患者中，发现红细胞沉降率bbb53.5 mm/h，血小板计数>436,000/mm3，单侧，门诊抗生素使用，淋巴结短轴与长轴比值>0.5是淋巴结引流的预测因素。结论：对颈淋巴炎患者进行体格检查、实验室检查和影像学检查，并考虑预测尽早细针抽吸引流的因素，可缩短住院时间。

{"title":"Predictive factors for drainage in pediatric cervical lymphadenitis: A study of clinical indicators and recovery outcomes","authors":"Hatice Merve Savran , Fatih Savran , Naciye Gönül Tanır","doi":"10.1016/j.amjoto.2024.104586","DOIUrl":"10.1016/j.amjoto.2024.104586","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to investigate the predictive factors for drainage in patients hospitalized with cervical lymphadenitis in the Pediatrics Infectious Diseases Department and to differentiate the recovery time between patients who received antibiotic treatment only and those who received drainage for their lymphadenitis.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 169 patients selected for this study, aged 1 month to 18 years, who were followed up with a diagnosis of cervical lymphadenitis between January 2011 and December 2019. Clinical features such as sex, age, physical examination findings, laboratory findings, imaging findings, and antibiotic treatments were retrospectively reviewed. Patients with lymphadenopathy larger than 2.5 cm, whose initial complaints lasted <28 days, and whose clinical and follow-up data were complete were included in the study.</div></div><div><h3>Results</h3><div>Of the 169 patients in our study, 137 recovered without drainage and 32 with drainage. In these patients, findings such as an erythrocyte sedimentation rate >53.5 mm/h, platelet count >436,000/mm<sup>3</sup>, unilaterality, outpatient antibiotic use, and the lymph node ratio of short axis to long axis >0.5 were found to be predictive factors for lymph node drainage.</div></div><div><h3>Conclusions</h3><div>Evaluation of patients with cervical lymphadenitis with physical examination, laboratory and imaging findings, and consideration of the factors predicting drainage with fine needle aspiration as soon as possible will shorten the length of hospital stay.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104586"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes with transcutaneous bone conduction implants in patients with mixed hearing loss 混合性听力损失患者经皮骨传导植入体的疗效。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104513

Ghazal S. Daher, Emily S. Thompson, Meredith Thomason, George B. Sankar, Cynthia A. Hogan, Matthew L. Carlson

Objective

To evaluate audiological outcomes of transcutaneous devices among individuals with mixed hearing loss (MHL) who underwent implantation with the Cochlear™ Osia® and Med-El Bonebridge™ devices.

Methods

Adults with MHL in at least one ear, including a best bone conduction (BBC) threshold of 30 dB HL or poorer, and air-bone gaps of 15 dB HL or more at one or more frequencies were implanted with the Cochlear™ Osia® or Med-El Bonebridge™ devices for MHL. Four-frequency pure tone average (PTA) was calculated for aided thresholds and compared to preoperative PTAs for BBC thresholds.

Results

Among the study participants, 11 were implanted with Osia, and 11 were implanted with Bonebridge. In the Osia group, the BBC PTA averaged 23.6 dB, which was not significantly different from the aided PTA of 27.0 dB (P = 0.2). In the Bonebridge group, the BBC PTA averaged 23.3 dB while the aided PTA was significantly poorer at 32.9 dB (P = 0.03). In both groups, aided sound field thresholds were worse than BBC thresholds overall except for a 7 dB improvement at 2000 Hz in the Osia group (P < 0.05).

Conclusion

We highlight important limitations of current transcutaneous bone conduction systems for rehabilitation of MHL. Sound field outcomes for Osia and Bonebridge devices are limited by the BBC thresholds of either ear; these devices do not provide significant gain or “overclosure” beyond BBC thresholds. While both groups generally experienced declines in aided thresholds compared to best conduction thresholds, the Osia implant exhibited an exception of a 7 dB improvement at 2000 Hz.

目的：评估经皮设备对混合性听力损失（MHL）患者的听力效果：评估科利耳™ Osia® 和 Med-El Bonebridge™ 经皮设备对混合性听力损失（MHL）患者的听力效果：成年患者至少有一只耳朵患有 MHL，包括最佳骨传导（BBC）阈值为 30 dB HL 或更低，且在一个或多个频率上的气骨间隙为 15 dB HL 或更高，他们都植入了科利耳™ Osia® 或 Med-El Bonebridge™ 设备来治疗 MHL。计算了辅助阈值的四频纯音平均值（PTA），并与 BBC 阈值的术前 PTA 进行了比较：研究参与者中，11 人植入了 Osia，11 人植入了 Bonebridge。在 Osia 组，BBC PTA 平均值为 23.6 dB，与辅助 PTA 27.0 dB 相比差异不大（P = 0.2）。在 Bonebridge 组，BBC PTA 平均为 23.3 分贝，而辅助 PTA 则明显较差，为 32.9 分贝（P = 0.03）。在这两组中，除了 Osia 组在 2000 Hz 时提高了 7 dB 之外，辅助声场阈值总体上都比 BBC 的阈值差（P 结论：Bonebridge 和 Osia 组的辅助声场阈值都比 BBC 的阈值差）：我们强调了目前经皮骨传导系统在多发性硬化症康复方面的重要局限性。Osia 和 Bonebridge 设备的声场效果受限于任一耳朵的 BBC 阈值；这些设备不能在 BBC 阈值之外提供显著的增益或 "过度封闭"。虽然与最佳传导阈值相比，两组患者的辅助阈值都普遍下降，但 Osia 植入体在 2000 Hz 时的改善幅度达到了 7 dB。

{"title":"Outcomes with transcutaneous bone conduction implants in patients with mixed hearing loss","authors":"Ghazal S. Daher, Emily S. Thompson, Meredith Thomason, George B. Sankar, Cynthia A. Hogan, Matthew L. Carlson","doi":"10.1016/j.amjoto.2024.104513","DOIUrl":"10.1016/j.amjoto.2024.104513","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate audiological outcomes of transcutaneous devices among individuals with mixed hearing loss (MHL) who underwent implantation with the Cochlear™ Osia® and Med-El Bonebridge™ devices.</div></div><div><h3>Methods</h3><div>Adults with MHL in at least one ear, including a best bone conduction (BBC) threshold of 30 dB HL or poorer, and air-bone gaps of 15 dB HL or more at one or more frequencies were implanted with the Cochlear™ Osia® or Med-El Bonebridge™ devices for MHL. Four-frequency pure tone average (PTA) was calculated for aided thresholds and compared to preoperative PTAs for BBC thresholds.</div></div><div><h3>Results</h3><div>Among the study participants, 11 were implanted with Osia, and 11 were implanted with Bonebridge. In the Osia group, the BBC PTA averaged 23.6 dB, which was not significantly different from the aided PTA of 27.0 dB (<em>P</em> = 0.2). In the Bonebridge group, the BBC PTA averaged 23.3 dB while the aided PTA was significantly poorer at 32.9 dB (<em>P</em> = 0.03). In both groups, aided sound field thresholds were worse than BBC thresholds overall except for a 7 dB improvement at 2000 Hz in the Osia group (<em>P</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>We highlight important limitations of current transcutaneous bone conduction systems for rehabilitation of MHL. Sound field outcomes for Osia and Bonebridge devices are limited by the BBC thresholds of either ear; these devices do not provide significant gain or “overclosure” beyond BBC thresholds. While both groups generally experienced declines in aided thresholds compared to best conduction thresholds, the Osia implant exhibited an exception of a 7 dB improvement at 2000 Hz.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104513"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sudden sensorineural hearing loss in diabetes mellitus patients receiving intra-tympanic steroid injections 鼓室内注射类固醇的糖尿病患者突发性感音神经性听力损失。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104576

Shih-Lung Chen , Chia-Ying Ho , Shy-Chyi Chin , Kai-Chieh Chan , Yu-Chien Wang

Background

Sudden sensorineural hearing loss is an acute hearing disorder typically managed using steroids. However, prognostic factors of diabetes mellitus (DM) patients undergoing intra-tympanic steroid injections (ITSIs) are unclear. We explored the prognostic factors for ITSI in DM patients with unilateral SSNHL.

Methods

This retrospective study enrolled 89 DM patients with unilateral SSNHL from July 2016 to June 2022. All patients received ITSIs, and their clinical and audiological data were analyzed.

Results

The patients' mean age was 49.31 ± 16.26 years. After ITSI, the mean hearing level gain was 14.91 ± 20.28 dB, the mean speech reception threshold (SRT) gain was 15.78 ± 32.16 dB, and the mean speech discrimination score (SDS) gain was 16.94 ± 35.06 %. Based on Siegel's criteria, 8 patients (8.98 %) had complete recovery, 14 (15.73 %) had partial recovery, 16 (17.98 %) had slight recovery, and 51 (57.31 %) had no improvement. Older age (odds ratio [OR] = 0.970, 95 % confidence interval [CI]: 0.941–0.999, p = 0.043) and profound hearing loss on pure-tone audiometry (PTA; OR = 0.058, 95 % CI: 0.007–0.462, p < 0.001) were adverse prognostic factors in univariate analyses. Older age (OR = 0.963, 95 % CI: 0.932–0.994, p = 0.023) and profound hearing loss (OR = 0.048, 95 % CI: 0.005–0.395, p = 0.004) were independent negative prognostic factors in a multivariate analysis.

Conclusions

ITSI is effective and avoids side effects of high-dose steroids in patients with SSNHL and DM. Among 89 DM SSNHL patients who underwent ITSI, older age and profound hearing loss were negative prognostic factors. Prompt and active management is necessary for DM patients with these risk factors.

背景：突发性感音神经性听力损失是一种急性听力障碍，通常使用类固醇治疗。然而，糖尿病（DM）患者接受鼓室内类固醇注射（ITSIs）的预后因素尚不清楚。我们探讨糖尿病合并单侧SSNHL患者ITSI的预后因素。方法：本回顾性研究纳入2016年7月至2022年6月89例单侧SSNHL DM患者。所有患者均接受itsi治疗，并对其临床和听力学资料进行分析。结果：患者平均年龄49.31±16.26岁。ITSI后，平均听力水平增益为14.91±20.28 dB，平均语音接收阈值（SRT）增益为15.78±32.16 dB，平均语音识别评分（SDS）增益为16.94±35.06%。根据Siegel标准，完全恢复8例（8.98%），部分恢复14例（15.73%），轻微恢复16例（17.98%），无好转51例（57.31%）。高龄（优势比[OR] = 0.970, 95%可信区间[CI]: 0.941 ~ 0.999, p = 0.043）和重度听力损失(PTA；OR = 0.058, 95% CI: 0.007-0.462， p结论：ITSI对SSNHL合并DM患者有效，避免了大剂量类固醇的副作用，89例接受ITSI治疗的DM SSNHL患者中，年龄和重度听力损失是不良预后因素。对于有这些危险因素的糖尿病患者，及时和积极的管理是必要的。

{"title":"Sudden sensorineural hearing loss in diabetes mellitus patients receiving intra-tympanic steroid injections","authors":"Shih-Lung Chen , Chia-Ying Ho , Shy-Chyi Chin , Kai-Chieh Chan , Yu-Chien Wang","doi":"10.1016/j.amjoto.2024.104576","DOIUrl":"10.1016/j.amjoto.2024.104576","url":null,"abstract":"<div><h3>Background</h3><div>Sudden sensorineural hearing loss is an acute hearing disorder typically managed using steroids. However, prognostic factors of diabetes mellitus (DM) patients undergoing intra-tympanic steroid injections (ITSIs) are unclear. We explored the prognostic factors for ITSI in DM patients with unilateral SSNHL.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled 89 DM patients with unilateral SSNHL from July 2016 to June 2022. All patients received ITSIs, and their clinical and audiological data were analyzed.</div></div><div><h3>Results</h3><div>The patients' mean age was 49.31 ± 16.26 years. After ITSI, the mean hearing level gain was 14.91 ± 20.28 dB, the mean speech reception threshold (SRT) gain was 15.78 ± 32.16 dB, and the mean speech discrimination score (SDS) gain was 16.94 ± 35.06 %. Based on Siegel's criteria, 8 patients (8.98 %) had complete recovery, 14 (15.73 %) had partial recovery, 16 (17.98 %) had slight recovery, and 51 (57.31 %) had no improvement. Older age (odds ratio [OR] = 0.970, 95 % confidence interval [CI]: 0.941–0.999, <em>p</em> = 0.043) and profound hearing loss on pure-tone audiometry (PTA; OR = 0.058, 95 % CI: 0.007–0.462, <em>p</em> < 0.001) were adverse prognostic factors in univariate analyses. Older age (OR = 0.963, 95 % CI: 0.932–0.994, <em>p</em> = 0.023) and profound hearing loss (OR = 0.048, 95 % CI: 0.005–0.395, <em>p</em> = 0.004) were independent negative prognostic factors in a multivariate analysis.</div></div><div><h3>Conclusions</h3><div>ITSI is effective and avoids side effects of high-dose steroids in patients with SSNHL and DM. Among 89 DM SSNHL patients who underwent ITSI, older age and profound hearing loss were negative prognostic factors. Prompt and active management is necessary for DM patients with these risk factors.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104576"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Navigating a challenging airway: An ultrasound-guided approach to urgent tracheostomy 导航具有挑战性的气道：超声引导下的紧急气管切开术。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104572

Soraya Abdul-Hadi Martinez , Edgar F. Del Toro-Diez , Jose Sanchez-Perez , Coral Ruiz-Mojica , Luis Martinez-Nater , Ana L. Melero-Pardo , Yamil E. Castillo Beauchamp

Objectives

Airway compromise in neck cancer patients with distorted anatomy has been a challenge for head and neck surgeons. To the best of our knowledge, the use of ultrasound has not been reported as an adjunct prior to an awake urgent tracheostomy in these types of patients. Our main objective is to provide an additional tool for identification of vital neck structures in preparation for an awake tracheostomy.

Data sources

Literature review

Review methods

This literature review was performed through the following data sources: PubMed and Cochrane Library.

Conclusions

Ultrasound is a cost-effective method to provide safe identification of vital structures in patients with distorted neck anatomy who requires an urgent awake tracheostomy.

Implications for practice

This article highlights the importance of ultrasound-guided tracheostomy for identification of anatomical landmarks in patients with distorted neck anatomy. We also propose a safe, reliable, and logarithmic approach for successful awake tracheostomy in these patients' using ultrasonography. We firmly believe that the ultrasound should be part of the armamentarium of all head and neck surgeon. By taking advantage of the advances in technology, the morbidity and mortality of establishing a secure airway in the distorted neck anatomy can be decreased.

目的：解剖结构扭曲的颈癌患者气道受损一直是头颈外科医生面临的挑战。据我们所知，在这些类型的患者中，在清醒的紧急气管切开术之前，还没有使用超声作为辅助手段的报道。我们的主要目的是提供一种额外的工具来识别重要的颈部结构，为清醒气管切开术做准备。资料来源：文献综述综述方法：本文献综述通过以下数据源进行：PubMed和Cochrane图书馆。结论：超声是一种经济有效的方法，为需要紧急清醒气管切开术的颈部畸形患者提供安全的重要结构识别。实践意义：本文强调超声引导气管切开术对颈部解剖畸形患者解剖标志识别的重要性。我们还提出了一种安全、可靠和对数的方法，可以在这些患者的清醒气管切开术中使用超声检查。我们坚信超声应该成为所有头颈外科医生设备的一部分。利用先进的技术，在扭曲的颈部解剖结构中建立安全气道的发病率和死亡率可以降低。

{"title":"Navigating a challenging airway: An ultrasound-guided approach to urgent tracheostomy","authors":"Soraya Abdul-Hadi Martinez , Edgar F. Del Toro-Diez , Jose Sanchez-Perez , Coral Ruiz-Mojica , Luis Martinez-Nater , Ana L. Melero-Pardo , Yamil E. Castillo Beauchamp","doi":"10.1016/j.amjoto.2024.104572","DOIUrl":"10.1016/j.amjoto.2024.104572","url":null,"abstract":"<div><h3>Objectives</h3><div>Airway compromise in neck cancer patients with distorted anatomy has been a challenge for head and neck surgeons. To the best of our knowledge, the use of ultrasound has not been reported as an adjunct prior to an awake urgent tracheostomy in these types of patients. Our main objective is to provide an additional tool for identification of vital neck structures in preparation for an awake tracheostomy.</div></div><div><h3>Data sources</h3><div>Literature review</div></div><div><h3>Review methods</h3><div>This literature review was performed through the following data sources: PubMed and Cochrane Library.</div></div><div><h3>Conclusions</h3><div>Ultrasound is a cost-effective method to provide safe identification of vital structures in patients with distorted neck anatomy who requires an urgent awake tracheostomy.</div></div><div><h3>Implications for practice</h3><div>This article highlights the importance of ultrasound-guided tracheostomy for identification of anatomical landmarks in patients with distorted neck anatomy. We also propose a safe, reliable, and logarithmic approach for successful awake tracheostomy in these patients' using ultrasonography. We firmly believe that the ultrasound should be part of the armamentarium of all head and neck surgeon. By taking advantage of the advances in technology, the morbidity and mortality of establishing a secure airway in the distorted neck anatomy can be decreased.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104572"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What is the robustness of randomized controlled trials supporting rhinosinusitis guidelines? 支持鼻窦炎指南的随机对照试验的稳健性是什么？

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-01-01 DOI: 10.1016/j.amjoto.2024.104575

Najm S. Khan , Aatin K. Dhanda , Masayoshi Takashima , Richard Liu , Yuki Yoshiyasu , Wenbo Wu , Whitney Jin , Edward D. McCoul , Murugappan Ramanathan Jr. , Omar G. Ahmed

Purpose

To determine the robustness of randomized controlled trials (RCTs) supporting the current rhinosinusitis guideline; International Consensus Statement on Allergy and Rhinology: rhinosinusitis (ICAR-RS).

Materials & methods

RCTs referenced by ICAR-RS with primary dichotomous outcomes were analyzed. The Fragility Index (FI) was calculated for trials with statistically significant findings. Trial characteristics, the FI, and FI minus number lost to follow-up (LTF) were assessed for associations.

Results

A total of 317 RCTs were identified, with 38 trials possessing a primary dichotomous outcome. Thirty-one percent evaluated surgical interventions and 24 % were industry-sponsored. The mean sample size was 116 with 9 patients, on average, LTF. Sixty-three percent were eligible for FI calculation and had a median FI of 2.5 (IQR 1, 4.25). Sixty-seven percent of trials had an FI ≤ 3, indicating low robustness. No difference in FI was observed between trials with and without industry support (p = 0.577). The FI was less than or equal to the number of patients LTF in 33 % of trials (n = 8). Higher FI was strongly correlated with higher sample size, total number of events, p-value, and grade of recommendation (p < 0.001). After adjusting for covariates, higher sample size and total number of events were associated with higher FI.

Conclusion

The RCTs used to support the ICAR-RS have an overall low robustness and future rhinosinusitis trials should report FI measures to provide improved context of their results.

目的：确定支持当前鼻窦炎指南的随机对照试验（rct）的稳健性；过敏和鼻科学国际共识声明：鼻窦炎（ICAR-RS）。材料与方法：采用ICAR-RS参考的随机对照试验（rct）进行主要二分类结果分析。脆弱性指数（FI）计算具有统计学显著结果的试验。评估试验特征、FI和FI减去随访损失数（LTF）的相关性。结果：共有317项随机对照试验被确定，其中38项试验具有主要的二分类结果。31%的人评估手术干预，24%的人是行业赞助的。平均样本量为116例，9例患者，平均为LTF。63%的患者符合FI计算条件，FI中位数为2.5 （IQR 1,4.25）。67%的试验FI≤3，表明稳健性较低。在有和没有行业支持的试验中，FI没有差异（p = 0.577）。在33%的试验中，FI小于或等于LTF患者的数量（n = 8）。较高的FI与较高的样本量、事件总数、p值和推荐等级密切相关(p结论：用于支持ICAR-RS的随机对照试验总体上具有较低的鲁棒性，未来的鼻窦炎试验应报告FI措施，以提供更好的结果背景。

{"title":"What is the robustness of randomized controlled trials supporting rhinosinusitis guidelines?","authors":"Najm S. Khan , Aatin K. Dhanda , Masayoshi Takashima , Richard Liu , Yuki Yoshiyasu , Wenbo Wu , Whitney Jin , Edward D. McCoul , Murugappan Ramanathan Jr. , Omar G. Ahmed","doi":"10.1016/j.amjoto.2024.104575","DOIUrl":"10.1016/j.amjoto.2024.104575","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the robustness of randomized controlled trials (RCTs) supporting the current rhinosinusitis guideline; International Consensus Statement on Allergy and Rhinology: rhinosinusitis (ICAR-RS).</div></div><div><h3>Materials & methods</h3><div>RCTs referenced by ICAR-RS with primary dichotomous outcomes were analyzed. The Fragility Index (FI) was calculated for trials with statistically significant findings. Trial characteristics, the FI, and FI minus number lost to follow-up (LTF) were assessed for associations.</div></div><div><h3>Results</h3><div>A total of 317 RCTs were identified, with 38 trials possessing a primary dichotomous outcome. Thirty-one percent evaluated surgical interventions and 24 % were industry-sponsored. The mean sample size was 116 with 9 patients, on average, LTF. Sixty-three percent were eligible for FI calculation and had a median FI of 2.5 (IQR 1, 4.25). Sixty-seven percent of trials had an FI ≤ 3, indicating low robustness. No difference in FI was observed between trials with and without industry support (<em>p = 0.</em>577). The FI was less than or equal to the number of patients LTF in 33 % of trials (<em>n</em> = 8). Higher FI was strongly correlated with higher sample size, total number of events, <em>p</em>-value, and grade of recommendation (<em>p < 0.001)</em>. After adjusting for covariates, higher sample size and total number of events were associated with higher FI.</div></div><div><h3>Conclusion</h3><div>The RCTs used to support the ICAR-RS have an overall low robustness and future rhinosinusitis trials should report FI measures to provide improved context of their results.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104575"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0