American Journal of Otolaryngology最新文献_第6页

Guidewire-Assisted dilation in sialendoscopy: How I use the modified Marchal's dilator 导丝辅助扩张涎镜检查：我如何使用改良的Marchal扩张器

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-21 DOI: 10.1016/j.amjoto.2025.104739

Necdet Özçelik, Elvin Alaskarov, Atila Gungor

Objective

This study aims to describe a novel and practical modification of the standard Marchal's dilator to facilitate atraumatic ductal cannulation and sialendoscope insertion in sialendoscopy. The proposed technique integrates a detachable handpiece and a guidewire, streamlining the most technically challenging steps of the procedure.

Methods

A modified version of the “000” Marchal's dilator was developed by incorporating an internal guidewire and a detachable handle. Following initial ductal cannulation, the handle is removed, leaving the guidewire in place to preserve intraductal access. A conical dilator with a central lumen is then advanced over the guidewire to achieve stepwise, controlled dilation. Subsequently, the sialendoscope is inserted using the Seldinger technique, allowing atraumatic entry into the salivary duct. This approach was applied and evaluated in a series of routine sialendoscopy procedures. No patient-identifiable data were collected, and ethics committee exemption was granted.

Results

The modified dilator enabled consistent ductal access, significantly reduced cannulation and dilation times, and minimized the need for repeated instrument exchanges. Surgeons, including those with limited experience, were able to perform the procedure efficiently and with fewer complications. The guidewire-assisted technique reduced trauma to the ductal orifice and surrounding tissues, contributing to improved visualization and procedural success.

Conclusion

The guidewire-assisted modification of the Marchal's dilator offers a safe, reproducible, and user-friendly enhancement to standard sialendoscopy techniques. By simplifying access and minimizing tissue trauma, this method may reduce operative times and improve patient outcomes. Its ease of use and compatibility with existing sialendoscopic systems make it particularly advantageous in training settings and low-resource environments.

目的本研究旨在描述一种新颖实用的改良标准马尔查尔扩张器，以方便在鼻内镜检查中进行无伤性导管插管和鼻内镜插入。该技术集成了可拆卸的机头和导丝，简化了最具技术挑战性的步骤。方法采用内导丝和可拆卸把手，研制了一种改进型“000”马尔查尔扩张器。在初始导管插管后，取下手柄，留下导丝以保留导管内通路。然后将带中心腔的锥形扩张器置于导丝上方，以实现逐步可控的扩张。随后，使用Seldinger技术插入唾液内窥镜，允许自动进入唾液管。该方法在一系列常规鼻内镜检查中得到应用和评估。未收集患者身份数据，伦理委员会给予豁免。结果改进后的扩张器使导管通路一致，显着减少了插管和扩张时间，并最大限度地减少了重复更换器械的需要。外科医生，包括那些经验有限的医生，都能有效地完成手术，并发症也更少。导丝辅助技术减少了对导管口和周围组织的创伤，有助于提高视觉效果和手术成功率。结论导丝辅助下改良Marchal扩张器是一种安全、可重复性好、用户友好的标准鼻内镜技术。通过简化通道和减少组织创伤，该方法可以减少手术时间并改善患者预后。它的易用性和与现有的鼻内窥镜系统的兼容性使其在培训环境和低资源环境中特别有利。

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引用次数: 0

Evaluating the use of advanced large language models to improve readability of head and neck cancer patient education materials 评估使用先进的大型语言模型来提高头颈癌患者教育材料的可读性。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104744

Soumil Prasad , Danielle Abdennour , Coral Levkovitz , Taylor Kring , Janice Huang , Garrett Forman , Supriya Dadi , Emeil Stewart , Elizabeth Franzmann

To evaluate whether advanced large language models (LLMs) ChatGPT-4o, ChatGPT o3, Microsoft Copilot, Claude Sonnet 4, Gemini 1.5 Flash, and DeepSeek V3-R1 can improve the readability of head and neck cancer patient education materials while maintaining accuracy.

Eleven publicly available articles were assessed for baseline readability using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Each article was rewritten by six LLMs using a standardized prompt to simplify text to a sixth-grade level. Readability was reassessed post-intervention, and paired t-tests with repeated-measures ANOVA and Bonferroni correction compared performance across models. Baseline readability was poor, with a mean FKGL of 10.1 and FRES of 51.5, exceeding national recommendations. Gemini, Copilot, ChatGPT o3, and DeepSeek significantly reduced FKGL compared to originals, while ChatGPT-4o showed minimal change and Claude increased difficulty. Gemini performed best, achieving FKGL ≤7 in 81.8 % of cases, followed by Copilot and DeepSeek at 72.7 %. ChatGPT-4o met this threshold in 18.2 % of articles, and Claude met it in none. LLMs can improve the readability of head and neck cancer patient education materials, but effectiveness varies substantially among models. Gemini, Copilot, and DeepSeek were most successful in meeting clinical readability thresholds, whereas ChatGPT-4o and Claude underperformed. Careful model selection and clinical oversight are essential when applying AI to patient education, as rewritten materials must still be reviewed for accuracy before public use.

评估先进的大型语言模型（llm） ChatGPT- 40、ChatGPT o3、Microsoft Copilot、Claude Sonnet 4、Gemini 1.5 Flash和DeepSeek V3-R1是否可以在保持准确性的同时提高头颈癌患者教育材料的可读性。使用Flesch- kincaid Grade Level （FKGL）和Flesch Reading Ease Score （FRES）评估11篇公开文章的基线可读性。每篇文章都由六位法学硕士使用标准化的提示重写，以简化文本到六年级的水平。干预后重新评估可读性，并使用重复测量方差分析和Bonferroni校正配对t检验比较各模型的性能。基线可读性较差，平均FKGL为10.1，FRES为51.5，超过了国家推荐值。与原版相比，Gemini、Copilot、ChatGPT o3和DeepSeek显著降低了FKGL，而ChatGPT- 40变化很小，Claude增加了难度。Gemini表现最好，在81.8%的情况下达到FKGL≤7，其次是Copilot和DeepSeek，为72.7%。chatgpt - 40在18.2%的文章中达到了这个阈值，Claude没有达到。llm可以提高头颈癌患者教育材料的可读性，但不同模型的有效性差异很大。Gemini、Copilot和DeepSeek最成功地满足了临床可读性阈值，而chatgpt - 40和Claude表现不佳。在将人工智能应用于患者教育时，仔细的模型选择和临床监督是必不可少的，因为在公开使用之前，必须对重写的材料进行准确性审查。

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引用次数: 0

Nasal septal hematoma is a rare and self-recognizable complication of nasal bone fracture: A retrospective study 鼻中隔血肿是鼻骨骨折的一种罕见且可自我识别的并发症：一项回顾性研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104748

Leon Guchlerner , Benjamin Philipp Ernst , Christian Issing , Iris Burck , Timo Stöver , Maximilian Gröger

Purpose

Nasal septal hematoma (NSH) is a rare but potentially severe complication which can occur after nasal bone fracture (NBF). A subperichondrial accumulation of blood in the nasal septum can lead to breathing difficulties, infections and nasal deformities. To prevent such complications our department's standard operating procedure requires clinical exclusion of NSH both on the day after NBF and the day after nasal bone repositioning. These repeated appointments create a high organizational effort in the outpatient department. The aim of this study was to assess the incidence of NSH after NBF and nasal bone repositioning in our patient population and thus to evaluate the necessity of repeated follow-up examinations.

Methods

In this retrospective study patients diagnosed with NBF over a nine-year period (January 2015 – June 2024) were included (n = 675). We assessed the presence of NSH, nature of trauma, pre-existing conditions (especially coagulopathies) and the clinical course.

Results

NSH was diagnosed in 0.6 % of cases (n = 4). The NSH-incidence after nasal bone repositioning was n = 0. There was no significant correlation between coagulopathy or anticoagulant therapy and the incidence of NSH (p = 1). Painful septal swelling combined with nasal obstruction was exclusively observed in NSH-patients (n = 4, 100 %).

Conclusion

The incidence of post-traumatic and post-interventional NSH in our population is negligible. Affected patients showed specific clinical features. Therefore, routine follow-ups appear not be justified given the organizational effort. Instead, emphasis should be placed on counseling patients to recognize signs of NSH that require immediate reevaluation.

目的鼻中隔血肿（NSH）是鼻骨骨折（NBF）后发生的一种罕见但潜在的严重并发症。鼻中隔的骨膜下积血可导致呼吸困难、感染和鼻畸形。为了防止此类并发症的发生，我科的标准操作程序要求在鼻骨复位后和鼻骨复位后的第二天均排除NSH。这些重复的预约在门诊部门创造了高度的组织性努力。本研究的目的是评估NBF和鼻骨复位后NSH的发生率，从而评估反复随访检查的必要性。方法本回顾性研究纳入了9年（2015年1月- 2024年6月）诊断为NBF的患者（n = 675）。我们评估了NSH的存在、创伤的性质、先前存在的疾病（尤其是凝血功能障碍）和临床病程。结果诊断为snsh的病例为0.6% （n = 4）。鼻骨复位后nsh发生率n = 0。凝血功能障碍或抗凝治疗与NSH发生率无显著相关性（p = 1）。疼痛性鼻中隔肿胀合并鼻塞仅在nsh患者中观察到（n = 4,100%）。结论创伤后和介入后NSH在我国人群中的发生率可以忽略不计。患者表现出特殊的临床特征。因此，考虑到组织的努力，例行的随访似乎是不合理的。相反，重点应放在咨询患者认识到NSH的迹象，需要立即重新评估。

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引用次数: 0

Prevalence of alcohol use over time in survivors of head and neck cancer 头颈癌幸存者长期饮酒的流行程度

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104743

M. Bryant Howren , Alan J. Christensen , Nitin A. Pagedar

Objectives

Alcohol use is a risk factor for the development of head and neck cancer (HNC) and continued use after diagnosis is associated with recurrence, comorbidities, and poor psychosocial outcomes. This retrospective observational descriptive study sought to report the prevalence of alcohol use in survivors of HNC from diagnosis through 10 years postdiagnosis.

Methods

Adult patients with upper aerodigestive tract carcinomas from the head and neck oncology clinic at a large Midwestern healthcare system were eligible to participate. Between 1998 and 2014, 2095 patients reported alcohol use status at diagnosis. By 10 years postdiagnosis, this number was 187. Self-reported alcohol use was classified as current/previous/never.

Results

At diagnosis, 48.8 % reported currently using alcohol, 36.6 % reported previous use, and 14.7 % reported never using; 24.5 % of those with a history of alcohol use were likely problem users. At 1 year postdiagnosis, 44.7 % reported currently using alcohol, 40.2 % reported previous use, and 15.1 % reported never using. At 5 years postdiagnosis, 48.9 % reported currently using alcohol, 38.3 % reported previous use, and 12.8 % reported never using. At 10 years postdiagnosis, 42.2 % reported currently using alcohol, 44.9 % reported previous use, and 12.8 % reported never using alcohol.

Conclusions

Continued alcohol use remains an issue over time in HNC survivors. Screening protocols should be incorporated into clinical workflow and more research is needed to understand correlates and degree of use in long-term HNC survivors to facilitate optimal recovery and adjustment during the survivorship period.

目的：饮酒是头颈癌（HNC）发生的一个危险因素，诊断后继续饮酒与复发、合并症和不良的社会心理结局相关。本回顾性观察性描述性研究旨在报告HNC幸存者从诊断到诊断后10年的酒精使用情况。方法选取美国中西部某大型医疗保健系统头颈部肿瘤门诊的成年上气消化道癌患者为研究对象。1998年至2014年间，2095名患者在诊断时报告了酒精使用状况。到确诊后10年，这一数字为187。自我报告的酒精使用情况分为目前/以前/从未。结果在诊断中，48.8%的患者报告目前有酒精使用，36.6%的患者报告曾经有过酒精使用，14.7%的患者报告从未有过酒精使用；24.5%有酒精使用史的人可能是问题使用者。在诊断后1年，44.7%报告目前使用酒精，40.2%报告以前使用过，15.1%报告从未使用过。在诊断后5年，48.9%报告目前使用酒精，38.3%报告以前使用过酒精，12.8%报告从未使用过酒精。在诊断后10年，42.2%报告目前使用酒精，44.9%报告以前使用过酒精，12.8%报告从未使用过酒精。结论：在HNC幸存者中，长期持续饮酒仍然是一个问题。筛查方案应纳入临床工作流程，需要更多的研究来了解长期HNC幸存者的相关性和使用程度，以促进生存期间的最佳恢复和调整。

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引用次数: 0

Sinus and palatal Rosai-Dorfman Disease: Case report and review of the literature 窦及腭罗塞-多尔夫曼病：病例报告及文献复习。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104736

Clare Moffatt , Hanna K. Mandl , Jessa E. Miller , Jonathan W. Said , Elliot Abemayor , Daniel M. Beswick

Rosai-Dorfman Disease (RDD) is a rare non-Langerhans cell histiocytosis. We present a unique case of RDD with sinus and palatal involvement managed with surgical biopsy, debulking and radiation, and review the literature on this topic. A 69-year-old female presented with a two-year history of nasal obstruction and left-sided epiphora. CT imaging demonstrated a large soft tissue mass with extension into and bony destruction of the left maxillary sinus and hard palate. An initial biopsy obtained at an outside center reported an inflammatory myofibroblastic tumor. MRI and PET-CT were obtained and identified no additional lesions or lymphadenopathy. A repeat biopsy was performed in clinic but was non-diagnostic. The patient was taken to the operating room for biopsy and debulking of the sinonasal mass, and final pathology demonstrated proliferation of large histiocytic cells with clear cytoplasm and emperipolesis on a background of fibrosis. The tumor stained positive for S100, BCL1 and OCT2, consistent with RDD. The patient then underwent targeted radiation therapy. At 15-month follow-up, MRI showed no evidence of disease recurrence.

While RDD is classically described as “sinus histiocytosis with massive lymphadenopathy”, this case features extranodal sinus and palatal involvement with no lymphadenopathy. RDD is notoriously challenging to diagnose, and we highlight that our pathology is positive for OCT2, which has recently been found to be a novel and specific marker associated with the monocyte-macrophage phenotype of RDD. We demonstrate that symptomatic extranodal sinus and palatal RDD can be diagnosed and treated with a combination of surgical biopsy, debulking and radiation.

Rosai-Dorfman病（RDD）是一种罕见的非朗格汉斯细胞组织细胞增多症。我们提出一个独特的RDD与窦和腭累及手术活检，减积和放射治疗的病例，并回顾了有关该主题的文献。一名69岁女性，有鼻塞和左侧泪显两年的病史。CT影像显示一大块软组织肿块，并延伸至左侧上颌窦及硬腭骨破坏。在外部中心获得的初步活检报告为炎症性肌纤维母细胞瘤。MRI和PET-CT均未发现其他病变或淋巴结病变。临床复查活检，但无诊断意义。患者被带到手术室进行活检和鼻窦肿块减积，最终病理显示大的组织细胞增生，细胞质清晰，纤维化背景下的细胞增多。肿瘤S100、BCL1、OCT2染色阳性，与RDD一致。患者随后接受了靶向放射治疗。随访15个月，MRI未见疾病复发。虽然RDD通常被描述为“窦性组织细胞增生伴大量淋巴结病”，但本病例以结外窦和腭受累为特征，无淋巴结病。众所周知，RDD的诊断具有挑战性，我们强调我们的病理是OCT2阳性，最近发现OCT2是与RDD的单核巨噬细胞表型相关的一种新的特异性标记物。我们证明，有症状的结外窦和腭RDD可以通过手术活检、减积和放疗的结合来诊断和治疗。

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引用次数: 0

Objective diagnosis of Patulous Eustachian Tube following bariatric surgery using dynamic tympanometry 目的应用动态鼓室测量法诊断减肥手术后咽鼓管扩张。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-20 DOI: 10.1016/j.amjoto.2025.104742

Servet Erdemes , Hasan Elkan , Mehmet Çiftçi

Objective

The aim of this study is to evaluate Patulous Eustachian Tube (PET) dysfunction developing after bariatric surgery using objective audiological tests, and to investigate the effect of rapid weight loss on the development of PET.

Methods

This prospective study was conducted between January and December 2024. A total of 64 patients with a body mass index (BMI) ≥ 40 who underwent bariatric surgery were included. Patients underwent otorhinolaryngological examination and audiological tests preoperatively and postoperatively (six-month postoperative). The diagnosis of PET was made objectively using the Patulous Eustachian Tube program of the Interacoustics AT235 device.

Results

68.8 % of the patients included in the study were female (n = 44) and 31.3 % were male (n = 20), with a mean age of 32.47 ± 5.11 years. While PET was not detected in any of the patients in the preoperative period (0 %), it developed in 25 % (n = 16) of the patients in the postoperative period. Greater weight loss was observed in patients who developed PET; however, this difference was not statistically significant (p > 0.05). Symptoms such as autophony, ear fullness, and hearing their own breath sounds were observed in patients diagnosed with PET.

Conclusion

Rapid weight loss after bariatric surgery may trigger the development of PET. In this study, PET was reliably diagnosed through objective tympanometric tests. It is important that the diagnosis of PET be supported not only by subjective symptoms but also by objective tests. Patients with otological complaints after surgery should be carefully evaluated for PET.

目的：通过客观听力学试验评价减肥手术后扩张性咽鼓管（PET）功能障碍的发生，并探讨快速减肥对PET发育的影响。方法：本前瞻性研究于2024年1月至12月进行。共纳入64例接受减肥手术的体重指数(BMI)≥40的患者。患者术前和术后（术后6个月）均行耳鼻喉科检查和听力学检查。应用Interacoustics AT235装置的扩张性咽鼓管程序对PET进行客观诊断。结果：纳入研究的患者中女性占68.8% (n = 44)，男性占31.3% (n = 20)，平均年龄32.47±5.11岁。术前未发现PET(0%)，术后出现PET的患者占25% （n = 16）。发生PET的患者体重减轻幅度更大；但差异无统计学意义（p < 0.05）。在诊断为PET的患者中观察到自音、耳充盈和听到自己的呼吸音等症状。结论：减肥手术后体重迅速下降可能诱发PET的发生。在本研究中，PET通过客观的鼓室测量试验得到了可靠的诊断。PET的诊断不仅要有主观症状的支持，还要有客观检查的支持，这一点很重要。术后有耳科疾患的患者应仔细评估PET。

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引用次数: 0

Early CPAP use after anterior skull base surgery: A cautionary tale of postoperative CSF leak case report 前颅底手术后早期使用CPAP：一个术后脑脊液泄漏的警示案例报告。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-10 DOI: 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.

导语：持续气道正压通气（CPAP）治疗是阻塞性睡眠呼吸暂停（OSA）的标准治疗方法，但由于存在严重的潜在风险，颅底手术后通常不建议使用。停止CPAP会对患者的生活质量产生负面影响，并加重术后心肺并发症。确定扩展颅底入路后恢复CPAP的适当时机至关重要，因为最近的文献主要探讨了经蝶窦手术后早期CPAP的安全性。病例：我们报告了一名51岁的OSA男性患者，在内镜下颅底内翻性乳头状瘤切除术后，由于预防性CPAP使用而发生脑脊液（CSF）泄漏。硬脑膜保持完整，术中无脑脊液泄漏，双侧鼻中隔皮瓣（NSF）用于颅底覆盖。尽管咨询避免CPAP，但患者在POD21重新启动CPAP并出现明显的鼻漏。计算机断层扫描显示轻度脑气。紧急检查发现左侧硬脑膜撕裂，nsf在中线分离。通过腹部脂肪和NSF复位修复。患者恢复良好，修复后第57天获准使用CPAP，无其他问题。讨论：本病例强调了扩展颅底入路后早期恢复CPAP的复杂性和潜在风险，缺乏标准化的指南。有效的术后护理对于平衡CPAP的益处和风险至关重要，因此需要进一步研究CPAP向前颅窝的传播，以优化围手术期患者的预后。

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引用次数: 0

Modified uvulopalatopharyngoplasty: “8” suture abduction-suspension of the palatopharyngeal muscle 改良悬垂腭咽成形术：“8”号线外展-悬吊腭咽肌。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-03 DOI: 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.

目的：评价改良腭咽成形术（8- asp）治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效。材料和方法：纳入连续28例伴有扁桃体肥大、Friedman期≤3期、腭塌陷或梗阻的AHI bbb15型OSAHS患者，所有患者均行改良腭咽成形术，包括双侧扁桃体切除术、软腭和腭上区粘膜下脂肪组织的剥离和去除；背部黏膜和肌肉部分切口（0.4-0.6 cm）；8-ASP连接到翼状下颌韧带。多导睡眠图的变量包括呼吸暂停-呼吸不足指数（AHI）、最低血氧饱和度（MSAT）、N3期睡眠，Epworth嗜睡量表（ESS）评分也用于评估手术效果。手术成功的定义是术前AHI降低50%以上，术后AHI每小时低于20。结果：术后6个月，24例（85.71%）有效率。结论：8-ASP是一种新颖、简便、有效的OSAHS手术治疗方法，成功率高（85.71%），在部分患者中不良反应最小，提示腭咽肌外旋-悬吊术在OSAHS腭部手术中的作用。

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引用次数: 0

Laryngeal sarcoid: Clinical presentation, management, and outcomes at a tertiary care center 喉肉瘤：临床表现，管理和结果在三级保健中心

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-03 DOI: 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.

Level of evidence: 4

目的：本研究旨在描述在三级医疗中心治疗的喉部肉瘤（LS）患者的表现特征、干预措施和结果。研究设计：回顾性病例系列。西奈山的伊坎医学院。方法回顾性分析了1998年至2012年间接受LS治疗的患者。结果共鉴定出27例LS患者。平均发病年龄为47.1岁（23-65岁），男性12例（44.4%）。表现症状是呼吸困难(n = 16, 59.3%)、言语障碍(n = 14日51.9%),咳嗽(n = 3, 11.1%),和喘鸣(n = 1, 3.7%)。LS见于声门上（n = 15, 55.6%）、声门（n = 8, 29.6%）、孤立性声带麻痹（n = 5, 18.5%）和声门下（n = 5, 18.5%）。23例（85.1%）有喉外表现。最常见的全身药物是强的松（n = 17, 63.0%）、羟氯喹（n = 4, 14.8%）和吡喹尼（n = 3, 11.1%）。手术干预包括办公室或手术室内类固醇注射13例（48.1%），减压（n = 10, 37.0%）和气管切开术（n = 5, 18.5%， 2例最终脱管）。中位随访为19个月（范围1-168个月），10/17的喉部症状有所改善或缓解，但只有1/14的全身症状有所改善。结论ls多出现在全身性部位，最常见于声门上，但也可发生在声门、声门下和气管。患者也可能出现与纵隔疾病相关的孤立性声麻痹。虽然局部治疗通常对喉部有效，但口服强的松和其他药物对全身性疾病有益。证据等级：4

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引用次数: 0

Tonsillotomy with Coblator or Tonsillectomy? One-Year Postoperative Follow-up Results 扁桃体切开术还是扁桃体切除术？术后1年随访结果

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-10-03 DOI: 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).

扁桃体切除术后，由于代偿性淋巴样增生或口咽动力学改变，患者最常发生慢性继发性扁桃体肥大或复发性感染。因此，一个临床难题存在于扁桃体切除术合并消融和传统扁桃体切除术之间的长期预后选择。本研究为扁桃体切除术后接受人工辅助扁桃体切除术或传统扁桃体切除术的患者的安全性、有效性和术后生活质量提供了比较证据，这一领域缺乏纵向数据。这是一项对60例扁桃体切除术后症状性扁桃体疾病患者的前瞻性队列研究。30名参与者接受了扁桃体切开术，30名接受了传统的囊外扁桃体切除术。术前、术后3、6和12个月，使用视觉模拟量表评估患者的疼痛评分、术后出血率、感染复发和儿童生活质量量表（PedsQL）的生活质量（QoL）评分。结缔组织扁桃体切开术明显减轻术后疼痛（平均差10.1）（p < 0.01）；缩短恢复时间（平均5.2天，范围3 ~ 14天，平均差4.4天）（p < 0.01）；结果并发症较少，随访1年复发率和生活质量改善相当。在感染复发情况下，两组比较差异无统计学意义（p > 0.05）。

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引用次数: 0