American Journal of Otolaryngology最新文献_第6页

Risk of lymph node metastasis in T1 tonsil squamous cell carcinomas patients according to age stratification at diagnosis 根据诊断时的年龄分层确定T1扁桃体鳞状细胞癌患者淋巴结转移的风险。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-31 DOI: 10.1016/j.amjoto.2024.104452

Yujiao Li, Chaosu Hu

Background

The objective of this study is to assess the association between age and lymph nodes metastasis (LNM) in T1 tonsil squamous cell carcinomas (TSCC) patients.

Methods

Patients with T1 TSCC were extracted from the SEER database between 2005 and 2014. Univariate and multivariate logistic regression models were produced to recognize the association between age and risk factors of LNM.

Results

A total of 2430 patients were analyzed. Younger patients more frequently presented with LNM compared to their older peers (P < 0.01, respectively.). In multivariate analyses, older age was associated with a significantly lower risk of LNM. Compared to patients aged 29–39-years-old, the hazard ratios for patients aged 40–49, 50–59, 60–69, and 70–88 years old were 0.911 (95 % confidence interval [CI] 0.370–2.245), 0.641 (95 % CI 0.268–1.535), 0.511 (95 % CI 0.212–1.231), and 0.236 (95 % CI 0.095–0.584), respectively. Subgroups analysis shows that the effect of older age was significantly associated with a lower risk of LNM in all groups except for Asian patients (P < 0.05, respectively).

Conclusion

Our study demonstrates that younger patients with T1 TSCC had a higher risk of LNM than their old peers and the effect of older age was significantly associated with a lower risk of LNM in all groups except for Asian patients. More accurate assessments of LNM and prophylactic neck dissection or prophylactic adjuvant radiation therapy to neck will be imperative for reducing recurrence in younger T1 TSCC.

背景：本研究旨在评估T1扁桃体鳞状细胞癌（TSCC）患者年龄与淋巴结转移（LNM）之间的关系：本研究旨在评估T1扁桃体鳞状细胞癌（TSCC）患者的年龄与淋巴结转移（LNM）之间的关系：2005年至2014年期间的T1 TSCC患者均来自SEER数据库。结果：共分析了2430名T1 TSCC患者：结果：共分析了2430名患者。与年龄较大的患者相比，年轻患者更常出现 LNM（P 结论：我们的研究表明，年轻的 T1、T2 和 T3 患者更容易出现 LNM：我们的研究表明，T1 TSCC 的年轻患者比年长者有更高的 LNM 风险，除亚洲患者外，年龄越大，LNM 风险越低。要降低年轻 T1 TSCC 患者的复发率，必须对 LNM 进行更准确的评估，并进行预防性颈部切除术或颈部预防性辅助放疗。

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引用次数: 0

Manometric Abnormalities in Patients With and Without Chronic Cough 慢性咳嗽和非慢性咳嗽患者的气压异常

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-31 DOI: 10.1016/j.amjoto.2024.104445

WayAnne Watson , Ethan Simmons , Adebimpe Adebowale , Charles Banda , Roy Qu , Benjamin Becerra , Brianna Crawley , Thomas Murry , Priya Krishna

Purpose

This study examines the relationship between chronic cough and vagal hypersensitivity by measuring baseline esophageal motility, with interest in the upper esophageal sphincter (UES).

Materials and methods

Patients undergoing workup for dysphagia were assigned to a chronic cough or control group based on self-reported symptoms. Differences in demographics, medical comorbidities, and high resolution esophageal manometry findings were obtained retrospectively.

Results

62.5% of our cohort had chronic cough (30/48). There were no significant differences between the two groups with respect to sex, age, and race/ethnicity. Laryngopharyngeal reflux (LPR) was the only statistically significant predictor of CC (OR 74.04, p = 0.010). Cough patients had upper esophageal sphincter relaxation duration (734 ms) significantly longer than the non-cough patients (582 ms; p = 0.03), though both groups had similar upper esophageal mean basal pressure, mean residual pressure, relaxation time-to-nadir, and recovery time. No significant difference was found in the median intrabolus pressure and UES motility mean peak pressure between groups.

Conclusion

Subtle differences in high-resolution manometry between patients with and without cough suggest, in line with previous studies, baseline alterations of upper esophageal function may manifest in patients with chronic cough through an undetermined mechanism that may include underlying vagal hypersensitivity. These findings encourage further manometric study examining the relationship between UES dysfunction and chronic cough.

目的：本研究通过测量基线食管运动（尤其是上食管括约肌（UES））来研究慢性咳嗽与迷走神经超敏之间的关系：根据自我报告的症状，将接受吞咽困难检查的患者分为慢性咳嗽组和对照组。结果：62.5%的患者患有慢性咳嗽：结果：62.5%的患者患有慢性咳嗽（30/48）。两组患者在性别、年龄和种族/民族方面无明显差异。喉咽反流（LPR）是唯一具有统计学意义的慢性咳嗽预测因子（OR 74.04，P = 0.010）。咳嗽患者的食管上括约肌松弛持续时间（734 毫秒）明显长于非咳嗽患者（582 毫秒；p = 0.03），尽管两组患者的食管上括约肌平均基础压力、平均残余压力、松弛到基底的时间和恢复时间相似。两组间的中位食管内压和上食管运动平均峰值压力无明显差异：结论：咳嗽患者和非咳嗽患者在高分辨率测压方面的细微差别表明，与之前的研究一致，慢性咳嗽患者上食道功能的基线改变可能是通过一种未确定的机制表现出来的，其中可能包括潜在的迷走神经超敏反应。这些发现鼓励人们进一步开展测压研究，探讨上食道功能障碍与慢性咳嗽之间的关系。

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引用次数: 0

Association of prealbumin with complications after total laryngectomy with free flap reconstruction 前白蛋白与游离皮瓣重建全喉切除术后并发症的关系

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-31 DOI: 10.1016/j.amjoto.2024.104451

Anthony Tang , Sophia Dang , Isabella Lao , Sumaarg Pandya , Mario G. Solari , Jessica Maxwell , Kevin J. Contrera , Jose P. Zevallos , Robert Ferris , Seungwon Kim , Shaum Sridharan , Matthew E. Spector

Objective

Malnutrition is an important risk factor for patient surgical outcomes. This is especially true for head and neck cancer (HNC) patients receiving a total laryngectomy with free flap reconstruction (TLwFFR). Preoperative prealbumin and albumin values have both been used to indicate poor nutrition. This study aims to identify the prognostic value of preoperative prealbumin and albumin levels with wound healing complications in HNC patients after TLwFFR.

Methods

A retrospective review was conducted in all HNC patients who underwent TLwFFR from 2016 to 2022 at a tertiary-care institution. Patients with either preoperative (within 1 month of surgery) prealbumin or albumin lab values were included. Low preoperative prealbumin (low prealbumin) levels and low preoperative albumin (low albumin) levels were defined as ≤20 mg/dL and <3.4 g/dL, respectively. Outcomes collected included all wound healing complications (infection, wound dehiscence, pharyngocutaneous fistula). The association between prealbumin and albumin with outcomes were analyzed using multivariable logistic regression.

Results

A total of 83 patients met the inclusion criteria. The mean age at surgery was 61.6 ± 9.3. The overall wound healing complication rate was 33.7 %. There was an association between low prealbumin levels and any wound healing complication. On multivariate analysis, low prealbumin levels were associated with postoperative wound healing complications (OR, 4.7; CI 1.3–17.0. P = 0.02) after controlling for low albumin level, age, smoking, and preoperative radiation.

Conclusions

Low prealbumin levels were associated with wound healing complications in TLwFFR patients. Consideration of consistent prealbumin testing with nutritional intervention may reduce wound healing complications.

目标营养不良是影响患者手术效果的一个重要风险因素。对于接受游离皮瓣重建全喉切除术（TLwFFR）的头颈癌（HNC）患者来说尤其如此。术前白蛋白和白蛋白值都被用来表示营养不良。本研究旨在确定术前白蛋白和白蛋白水平对TLwFFR术后HNC患者伤口愈合并发症的预后价值。方法对2016年至2022年在一家三级医疗机构接受TLwFFR的所有HNC患者进行回顾性研究。术前（术后1个月内）有白蛋白或白蛋白实验室值的患者均被纳入其中。低术前白蛋白（低白蛋白）水平和低术前白蛋白（低白蛋白）水平分别定义为≤20 mg/dL 和 <3.4 g/dL。收集的结果包括所有伤口愈合并发症（感染、伤口开裂、咽瘘）。结果共有 83 名患者符合纳入标准。手术时的平均年龄为（61.6 ± 9.3）岁。总体伤口愈合并发症发生率为 33.7%。低前白蛋白水平与伤口愈合并发症之间存在关联。经多变量分析，在控制低白蛋白水平、年龄、吸烟和术前辐射后，低前白蛋白水平与术后伤口愈合并发症有关（OR，4.7；CI 1.3-17.0。考虑持续进行前白蛋白检测并进行营养干预可减少伤口愈合并发症。

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引用次数: 0

Understanding pediatric inpatient conductive hearing loss: An analysis of patient demographics 了解儿科住院患者传导性听力损失：患者人口统计学分析

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-31 DOI: 10.1016/j.amjoto.2024.104447

Dean G. Kennedy , Preetha Velu , Jonathan M. Carnino , Nicholas R. Wilson , Taylor Jamil , Kristin Hartman-Joshi , Jessica R. Levi

Objective

Hearing loss is a common sensory impairment in children that affects quality of life and development. Early intervention, such as hearing aids and communication therapies, can help children overcome these challenges and lessen the impact on their development. The objective of this study was to identify specific patient demographic factors correlated with the prevalence of pediatric conductive hearing loss.

Study design

The study utilized the Kids' Inpatient Database (KID) by the Agency for Healthcare Research and Quality which collects inpatient information from hospitals for patients under 21 years old. We included all patients discharged in 2016 diagnosed with conductive hearing loss, and excluded neonatal patients discharged within 28 days of birth.

Methods

Statistical analyses were performed using R Studio and IBM SPSS Statistics. Weighted odds ratios were calculated for conductive hearing loss in relation to race and income, and a multivariate regression analysis examined associations between demographic variables and race categories in conductive hearing loss.

Results

The prevalence of conductive hearing loss (CHL) in pediatric patients in 2016 was 51.62 cases per 100,000 patients. Non-Hispanic White patients had the highest prevalence, while Black patients had the highest likelihood of CHL compared to the overall population. Lower income levels were associated with a decreased probability of CHL diagnosis. After adjusting for age, sex, hospital region, insurance, and income on multivariate analysis, White and Black patients were less likely to be diagnosed with CHL. Furthermore, patients in specific income quartiles also had lower CHL likelihood compared to the general population.

Conclusion

While Black patients had a higher likelihood of being diagnosed with CHL than the general population, socioeconomic factors such as income greatly influenced the likelihood of CHL diagnosis. Other significant factors included income, region of the country, sex, and age. Further research is needed to better understand and address healthcare disparities related to pediatric hearing loss.

目标听力损失是儿童常见的感官障碍，会影响生活质量和发育。助听器和交流疗法等早期干预措施可以帮助儿童克服这些困难，减轻对其发育的影响。本研究旨在确定与小儿传导性听力损失患病率相关的特定患者人口学因素。研究设计本研究利用了美国医疗保健研究与质量机构（Agency for Healthcare Research and Quality）的儿童住院患者数据库（KID），该数据库从医院收集 21 岁以下患者的住院信息。我们纳入了2016年出院的所有确诊为传导性听力损失的患者，并排除了出生后28天内出院的新生儿患者。方法使用R Studio和IBM SPSS Statistics进行统计分析。计算了传导性听力损失与种族和收入的加权几率比，并进行了多变量回归分析，研究了传导性听力损失中人口统计学变量和种族类别之间的关联。结果2016年儿科患者中传导性听力损失（CHL）的患病率为每10万名患者中有51.62例。与总人口相比，非西班牙裔白人患者的发病率最高，而黑人患者发生传导性听力损失的可能性最大。收入水平越低，确诊 CHL 的概率越低。在多变量分析中对年龄、性别、医院所在地区、保险和收入进行调整后，白人和黑人患者被诊断为CHL的可能性较低。结论虽然黑人患者被诊断为CHL的可能性高于普通人群，但收入等社会经济因素对诊断为CHL的可能性有很大影响。其他重要因素包括收入、国家地区、性别和年龄。为了更好地了解和解决与小儿听力损失相关的医疗差距问题，还需要进一步的研究。

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引用次数: 0

Effectiveness of bimodal stimulation of the auditory-somatosensory system in the treatment of tonal tinnitus 双模式刺激听觉-味觉系统治疗音调性耳鸣的效果。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-31 DOI: 10.1016/j.amjoto.2024.104449

Masoud Bolandi , Mohanna Javanbakht , Moslem Shaabani , Enayatollah Bakhshi

Background and objectives

The dorsal cochlear nucleus (DCN) is the interaction site of auditory and somatosensory system inputs. According to the stochastic resonance theory, hearing loss increases the neural activity of the somatosensory system in the DCN and causes tinnitus. it is possible to modulate this neural hyperactivity by applying random noise through the auditory and somatosensory systems (bimodal stimulation). Therefore, this study aimed to investigate the effectiveness of the bimodal intervention based on the theory of stochastic resonance.

Methods

The study divided 34 participants into unimodal and bimodal groups with 17 subjects in each. The bimodal group received customized acoustic stimulation along with transcutaneous auricular vagus nerve stimulation (tAVNS) and the unimodal group received customized acoustic stimulation along with tAVNS as a sham. The treatment sessions in both groups were 6 sessions and each session lasted for 20 min. The participants were evaluated before, immediately after, and one month after the completion of the intervention sessions, using the Tinnitus Handicap Inventory (THI) questionnaire and the mismatch negativity (MMN) test.

Results

After the intervention sessions, the results indicated a statistically significant decrease in THI scores and a significant increase in the MMN amplitude in the bimodal group compared to the unimodal group. No significant changes in MMN latency were observed between the two groups. These changes were stable in the one-month follow-up visit.

Conclusions

Our study showed that bimodal stimulation is a better intervention option compared to unimodal stimulation. Bimodal stimulation may be an effective intervention method for some subjects with tinnitus, especially people with hearing loss who have tonal tinnitus.

背景和目的：耳蜗背核（DCN）是听觉和体感系统输入的交互部位。根据随机共振理论，听力损失会增加耳蜗背核体感系统的神经活动，并导致耳鸣。通过听觉和体感系统施加随机噪声（双模刺激）可以调节这种神经亢进。因此，本研究旨在探讨基于随机共振理论的双模干预的有效性：研究将 34 名参与者分为单模态组和双模态组，每组 17 人。双模态组在接受定制声波刺激的同时接受经皮耳廓迷走神经刺激（tAVNS），而单模态组在接受定制声波刺激的同时接受经皮耳廓迷走神经刺激（tAVNS）作为假刺激。两组的治疗疗程均为 6 次，每次持续 20 分钟。在干预疗程之前、之后和一个月之后，使用耳鸣障碍量表（THI）问卷和错配负性（MMN）测试对参与者进行评估：干预疗程结束后，结果表明与单模态组相比，双模态组的 THI 分数有显著下降，MMN 振幅有显著上升。两组之间的 MMN 延迟没有明显变化。这些变化在一个月的随访中保持稳定：我们的研究表明，与单模态刺激相比，双模态刺激是一种更好的干预方案。结论：我们的研究表明，与单模态刺激相比，双模态刺激是一种更好的干预方法。对于某些耳鸣患者，尤其是有听力损失并伴有音调性耳鸣的患者，双模态刺激可能是一种有效的干预方法。

{"title":"Effectiveness of bimodal stimulation of the auditory-somatosensory system in the treatment of tonal tinnitus","authors":"Masoud Bolandi , Mohanna Javanbakht , Moslem Shaabani , Enayatollah Bakhshi","doi":"10.1016/j.amjoto.2024.104449","DOIUrl":"10.1016/j.amjoto.2024.104449","url":null,"abstract":"<div><h3>Background and objectives</h3><p>The dorsal cochlear nucleus (DCN) is the interaction site of auditory and somatosensory system inputs. According to the stochastic resonance theory, hearing loss increases the neural activity of the somatosensory system in the DCN and causes tinnitus. it is possible to modulate this neural hyperactivity by applying random noise through the auditory and somatosensory systems (bimodal stimulation). Therefore, this study aimed to investigate the effectiveness of the bimodal intervention based on the theory of stochastic resonance.</p></div><div><h3>Methods</h3><p>The study divided 34 participants into unimodal and bimodal groups with 17 subjects in each. The bimodal group received customized acoustic stimulation along with transcutaneous auricular vagus nerve stimulation (tAVNS) and the unimodal group received customized acoustic stimulation along with tAVNS as a sham. The treatment sessions in both groups were 6 sessions and each session lasted for 20 min. The participants were evaluated before, immediately after, and one month after the completion of the intervention sessions, using the Tinnitus Handicap Inventory (THI) questionnaire and the mismatch negativity (MMN) test.</p></div><div><h3>Results</h3><p>After the intervention sessions, the results indicated a statistically significant decrease in THI scores and a significant increase in the MMN amplitude in the bimodal group compared to the unimodal group. No significant changes in MMN latency were observed between the two groups. These changes were stable in the one-month follow-up visit.</p></div><div><h3>Conclusions</h3><p>Our study showed that bimodal stimulation is a better intervention option compared to unimodal stimulation. Bimodal stimulation may be an effective intervention method for some subjects with tinnitus, especially people with hearing loss who have tonal tinnitus.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104449"},"PeriodicalIF":1.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905575","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}

引用次数: 0

Head and neck squamous cell carcinoma (HNSCC) in solid organ transplant recipients — Results from the scientific registry of transplant recipients (SRTR) database 实体器官移植受者中的头颈部鳞状细胞癌（HNSCC）--移植受者科学登记（SRTR）数据库的结果。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-31 DOI: 10.1016/j.amjoto.2024.104444

Amrita Mukherjee , Jinhong Cui , Pranali G. Patel , Preeti Bhagia , Susan D. McCammon , Sooryanarayana Varambally , Sadeep Shrestha

Background

Solid organ transplant recipients have an elevated risk of cancer following organ transplantation than the age-adjusted general population. We assessed incidence of head and neck squamous cell carcinoma (HNSCC) in heart, lung, and liver recipients.

Basic procedures/methods

This retrospective cohort study included 124,966 patients from the United States Scientific Registry of Transplant Recipients (SRTR) database who received heart, lung, or liver transplantation between 1991 and 2010. Follow-up data were available until 2018. Patients with prevalent HNSCC at transplantation were excluded. Incident cases of HNSCC post organ transplantation were identified, and incidence rates (per 100,000 person-years) were reported by gender, race, organ type, year and age at organ transplantation.

Main findings

The majority of patients received liver transplantation (58.64 %), followed by heart (28.64 %), and lung (12.72 %) transplantation. During follow-up, 4.14 % patients developed HNSCC. Overall incidence rate of HNSCC was 426.76 per 100,000 person-years. Male recipients had a higher HNSCC incidence rate than female recipients (571.8 and 177.0 per 100,000 person-years, respectively). Lung recipients had the highest overall HNSCC incidence rate (1273.6 per 100,000 person-years), followed by heart (644.2 per 100,000 person-years), and liver recipients (207.1 per 100,000 person-years). Overall, an increase in HNSCC incidence rate was observed with increase in age at organ transplantation. An increase in incidence rates of HNSCC over time was observed in lung recipients; however, incidence rates decreased over time in heart recipients.

Conclusion

Solid organ transplant recipients have a high incidence of HNSCC following organ transplantation, and the incidence varies by type of organ received.

背景：与年龄调整后的普通人群相比，实体器官移植受者在器官移植后罹患癌症的风险更高。我们评估了心脏、肺和肝脏受者头颈部鳞状细胞癌（HNSCC）的发病率：这项回顾性队列研究纳入了美国移植受者科学登记处（SRTR）数据库中的124966名患者，他们在1991年至2010年间接受了心脏、肺或肝脏移植手术。随访数据可提供至 2018 年。排除了移植时患有流行性 HNSCC 的患者。确定了器官移植后的HNSCC发病病例，并按性别、种族、器官类型、器官移植时的年份和年龄报告了发病率（每10万人年）：大多数患者接受了肝移植（58.64%），其次是心脏移植（28.64%）和肺移植（12.72%）。在随访期间，4.14%的患者患上了HNSCC。HNSCC的总发病率为每10万人年426.76例。男性受者的 HNSCC 发病率高于女性受者（分别为每 10 万人年 571.8 例和 177.0 例）。肺部受者的 HNSCC 总发病率最高（每 10 万人年 1273.6 例），其次是心脏受者（每 10 万人年 644.2 例）和肝脏受者（每 10 万人年 207.1 例）。总体而言，随着器官移植年龄的增加，HNSCC发病率也随之增加。肺部受者的HNSCC发病率随时间推移而增加，但心脏受者的发病率随时间推移而降低：结论：实体器官移植受者在器官移植后的 HNSCC 发生率很高，且发生率因器官类型而异。

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引用次数: 0

Tinnitus after COVID-19 vaccination: Findings from the vaccine adverse event reporting system and the vaccine safety datalink 接种 COVID-19 疫苗后出现耳鸣：疫苗不良事件报告系统和疫苗安全数据链的调查结果。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-30 DOI: 10.1016/j.amjoto.2024.104448

W. Katherine Yih , Jonathan Duffy , John R. Su , Samaneh Bazel , Bruce Fireman , Laura Hurley , Judith C. Maro , Paige Marquez , Pedro Moro , Narayan Nair , Jennifer Nelson , Ning Smith , Maria Sundaram , Gabriela Vasquez-Benitez , Eric Weintraub , Stanley Xu , Tom Shimabukuro

Purpose

To assess the occurrence of tinnitus following COVID-19 vaccination using data mining and descriptive analyses in two U.S. vaccine safety surveillance systems.

Methods

Reports of tinnitus after COVID-19 vaccination to the Vaccine Adverse Event Reporting System (VAERS) from 2020 through 2024 were examined using empirical Bayesian data mining and by calculating reporting rates. In the Vaccine Safety Datalink (VSD) population, ICD-10 coded post-vaccination medical visits were examined using tree-based data mining, and tinnitus visit incidence rates during post-vaccination days 1–140 were calculated by age group for COVID-19 vaccines and for comparison, influenza vaccine.

Results

VAERS data mining did not find disproportionate reporting of tinnitus for any COVID-19 vaccine. VAERS received up to 84.82 tinnitus reports per million COVID-19 vaccine doses administered. VSD tree-based data mining found no signals for tinnitus. VSD tinnitus visit incidence rates after COVID-19 vaccines were similar to those after influenza vaccine except for the group aged ≥65 years (Moderna COVID-19 vaccine, 165 per 10,000 person-years; Pfizer-BioNTech COVID-19 vaccine, 154; influenza vaccine, 135).

Conclusions

Overall, these findings do not support an increased risk of tinnitus following COVID-19 vaccination but cannot definitively exclude the possibility. Descriptive comparisons between COVID-19 and influenza vaccines were limited by lack of adjustment for potential confounding factors.

目的：通过对美国两个疫苗安全监控系统进行数据挖掘和描述性分析，评估接种 COVID-19 疫苗后耳鸣的发生率：采用贝叶斯经验数据挖掘法和计算报告率的方法，对 2020 年至 2024 年期间疫苗不良事件报告系统 (VAERS) 收到的接种 COVID-19 疫苗后出现耳鸣的报告进行了研究。在疫苗安全数据链接（VSD）人群中，使用基于树的数据挖掘对ICD-10编码的疫苗接种后就诊情况进行了检查，并按年龄组计算了COVID-19疫苗接种后第1-140天的耳鸣就诊率，作为比较，计算了流感疫苗的耳鸣就诊率：VAERS数据挖掘没有发现任何COVID-19疫苗的耳鸣报告比例过高。每百万剂 COVID-19 疫苗接种中，VAERS 最多收到 84.82 份耳鸣报告。VSD 树状数据挖掘未发现耳鸣信号。接种COVID-19疫苗后的VSD耳鸣就诊率与接种流感疫苗后相似，但年龄≥65岁的人群除外（Moderna COVID-19疫苗，每万人年165例；辉瑞生物COVID-19疫苗，154例；流感疫苗，135例）：总体而言，这些研究结果并不支持接种 COVID-19 疫苗后耳鸣风险增加，但不能明确排除这种可能性。由于缺乏对潜在混杂因素的调整，COVID-19和流感疫苗之间的描述性比较受到了限制。

{"title":"Tinnitus after COVID-19 vaccination: Findings from the vaccine adverse event reporting system and the vaccine safety datalink","authors":"W. Katherine Yih , Jonathan Duffy , John R. Su , Samaneh Bazel , Bruce Fireman , Laura Hurley , Judith C. Maro , Paige Marquez , Pedro Moro , Narayan Nair , Jennifer Nelson , Ning Smith , Maria Sundaram , Gabriela Vasquez-Benitez , Eric Weintraub , Stanley Xu , Tom Shimabukuro","doi":"10.1016/j.amjoto.2024.104448","DOIUrl":"10.1016/j.amjoto.2024.104448","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the occurrence of tinnitus following COVID-19 vaccination using data mining and descriptive analyses in two U.S. vaccine safety surveillance systems.</p></div><div><h3>Methods</h3><p>Reports of tinnitus after COVID-19 vaccination to the Vaccine Adverse Event Reporting System (VAERS) from 2020 through 2024 were examined using empirical Bayesian data mining and by calculating reporting rates. In the Vaccine Safety Datalink (VSD) population, ICD-10 coded post-vaccination medical visits were examined using tree-based data mining, and tinnitus visit incidence rates during post-vaccination days 1–140 were calculated by age group for COVID-19 vaccines and for comparison, influenza vaccine.</p></div><div><h3>Results</h3><p>VAERS data mining did not find disproportionate reporting of tinnitus for any COVID-19 vaccine. VAERS received up to 84.82 tinnitus reports per million COVID-19 vaccine doses administered. VSD tree-based data mining found no signals for tinnitus. VSD tinnitus visit incidence rates after COVID-19 vaccines were similar to those after influenza vaccine except for the group aged ≥65 years (Moderna COVID-19 vaccine, 165 per 10,000 person-years; Pfizer-BioNTech COVID-19 vaccine, 154; influenza vaccine, 135).</p></div><div><h3>Conclusions</h3><p>Overall, these findings do not support an increased risk of tinnitus following COVID-19 vaccination but cannot definitively exclude the possibility. Descriptive comparisons between COVID-19 and influenza vaccines were limited by lack of adjustment for potential confounding factors.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104448"},"PeriodicalIF":1.8,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888193","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}

引用次数: 0

Impact of social vulnerability index on severity of obstructive sleep apnea: Insights from drug-induced sleep endoscopy 社会脆弱性指数对阻塞性睡眠呼吸暂停严重程度的影响：药物诱导睡眠内窥镜检查的启示。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-30 DOI: 10.1016/j.amjoto.2024.104450

Andrew Franklin , Chad Nieri , Nina Gallo , M. Boyd Gillespie

Objectives

To examine the association between neighborhood-level social vulnerability on the severity of obstructive sleep apnea (OSA) in patients undergoing drug-induced sleep endoscopy (DISE).

Study design

Single center retrospective cohort study.

Methods

We conducted a retrospective chart review of patients >18 years of age that underwent DISE from July 2016 to July 2022. Patient addresses were geocoded with geographic information systems, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores in the four sub-themes: Socioeconomic (theme 1), Household Composition/Disability (theme 2), Minority Status/Language (theme 3), and Housing/Transportation (theme 4).

Results

The study included 165 patients (61.2 years ± 11.6; 31.0 BMI ± 6.1, 102 male, 63 female). Mild OSA was present in13 patients; 55 patients had moderate OSA; and 97 patients had severe OSA. A higher SVI value in minority status and language, and a higher BMI both predicted an increased Apnea Hypopnea Index (AHI) (p = 0.042, and <0.001, respectively) in the multivariate model; whereas, race, age, gender, or the other three SVI sub-theme values were not predictive.

Conclusion

Adults residing in areas of greater social vulnerability – specifically a larger minority presence or English as a second language – and patients who are obese are more likely to have more severe OSA. There was no correlation, however, between obesity and residence in an area of high SVI. These results suggest that both neighborhood conditions and obesity are associated with OSA severity. This elevated risk has potential implications for diagnostic testing, clinic follow-ups, screening, and treatment plans for adults residing in disenfranchised neighborhoods.

Level of evidence

IV.

研究目的研究设计：单中心回顾性队列研究：研究设计：单中心回顾性队列研究：我们对 2016 年 7 月至 2022 年 7 月期间接受药物诱导睡眠内窥镜检查的年龄大于 18 岁的患者进行了回顾性病历审查。使用地理信息系统对患者地址进行地理编码，并使用空间叠加法在四个子主题中分配人口普查区级社会脆弱性指数（SVI）得分：社会经济（主题 1）、家庭组成/残疾（主题 2）、少数民族地位/语言（主题 3）和住房/交通（主题 4）：研究包括 165 名患者（61.2 岁 ± 11.6；31.0 BMI ± 6.1；102 名男性，63 名女性）。13名患者患有轻度 OSA；55 名患者患有中度 OSA；97 名患者患有重度 OSA。少数民族身份和语言的 SVI 值越高，体重指数越高，预示呼吸暂停低通气指数（AHI）越高（p = 0.042，结论：居住在社会弱势地区（特别是少数民族较多或英语为第二语言的地区）的成年人和肥胖患者更有可能患有更严重的 OSA。然而，肥胖与居住在高社会脆弱性地区之间没有相关性。这些结果表明，邻里条件和肥胖都与 OSA 的严重程度有关。这种风险的升高对诊断测试、诊所随访、筛查和针对居住在被剥夺权利社区的成年人的治疗计划具有潜在的影响：证据等级：IV。

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引用次数: 0

Clinical applications of vascularized fascia lata in head and neck reconstruction: A systematic review 血管化筋膜在头颈部重建中的临床应用：系统综述

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-30 DOI: 10.1016/j.amjoto.2024.104432

Kwasi Enin , Andrew Bellas , Sidharth V. Puram , Ryan S. Jackson , Michelle Doering , Patrik Pipkorn

Background

Given limitations in the current literature, the precise indications, techniques, and outcomes relevant to vascularized fascia lata free flap reconstruction remain uncertain. The objective of this study was to perform a systematic review of published literature to evaluate indications, methods, and complications for vascularized fascia lata free flap reconstruction.

Methods

A systematic review of the literature was performed using a set of search criteria to identify patients who underwent free flap reconstruction of the head and neck region using vascularized fascia lata. Articles were reviewed based on relevance, with the primary outcome being surgical complications and surgical indications.

Results

A comprehensive search revealed 783 articles and 5 articles were ultimately found to be appropriate to this review- 55 patients undergoing free flap reconstruction were identified. Overall complication rates were 10.9 % for major complications and 18.1 % for minor complications. Follow-up spanned 1 to 95 months with a median of 48 months.

Conclusions

Microvascular reconstruction of the head and neck with vascularized fascia lata is achievable with high adaptability and reliability reported in the literature.

背景鉴于目前文献的局限性，与血管化筋膜游离皮瓣重建相关的确切适应症、技术和结果仍不确定。本研究的目的是对已发表的文献进行系统性回顾，评估血管化筋膜游离皮瓣重建的适应症、方法和并发症。方法采用一套检索标准对文献进行系统性回顾，以确定使用血管化筋膜进行头颈部游离皮瓣重建的患者。根据相关性对文章进行了综述，主要结果是手术并发症和手术适应症。结果综合检索发现了783篇文章，最终发现5篇文章适合本次综述--55名患者接受了游离皮瓣重建术。主要并发症的总发生率为10.9%，次要并发症的总发生率为18.1%。结论根据文献报道，使用血管化筋膜重建头颈部微血管具有很高的适应性和可靠性。

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引用次数: 0

Cost transparency in otolaryngology: Outpatient procedures cost information at New England hospitals 耳鼻喉科的成本透明度：新英格兰地区医院门诊程序成本信息。

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2024-07-29 DOI: 10.1016/j.amjoto.2024.104413

Samuel Ding , Alec Chang , Monica O'Brien , Grace Materne , Julianna Mastropierro , Timothy Mikulski , David O'Neil Danis III , Emily Gall , Kathryn Y. Noonan

Purpose

Healthcare costs have dramatically increased, resulting in barriers to care for many Americans. To address this, the Centers for Medicare & Medicaid Services implemented a price transparency mandate, requiring hospitals to provide cost-estimate tools. This study evaluates the accessibility and usability of these tools for common otolaryngology outpatient procedures.

Materials and methods

Cost transparency was investigated using cost-estimate tools from websites of the seven New England hospitals ranked on the US News top 50 list. Ten common current procedural terminology codes were used to collect data on availability of cost information, cost comparison, and ease-of-use by six investigators acting as “patients” for each hospital and procedure.

Results

All investigated hospitals had cost-estimate tools, with a 35.7 % mean success rate of generating an estimate. The mean times to cost-estimate tools and generated estimates were 35.69 and 34.15 s, respectively. Pre-insurance costs varied by hospital and procedure; creation of eardrum had the largest range. Seven out of ten procedures resulted in lower post-insurance costs. The mean ease-of-use rating was 5.76 out of ten.

Conclusion

All hospitals complied with the Centers for Medicare & Medicaid Services price transparency policy. The information available is sparse, difficult to access, and frequently lacks specific estimates for common otolaryngology procedures. Although hospitals are following new Centers for Medicare & Medicaid Services mandates, the estimators currently in existence are ineffective tools for financial decision-making.

目的：医疗保健成本急剧增加，导致许多美国人无法获得医疗保健服务。为解决这一问题，美国医疗保险与医疗补助服务中心（Centers for Medicare & Medicaid Services）实施了价格透明化规定，要求医院提供成本估算工具。本研究评估了这些工具对常见耳鼻喉科门诊手术的可及性和可用性：本研究使用 US News 排名前 50 位的七家新英格兰医院网站上的成本估算工具对成本透明度进行了调查。六名调查人员以 "患者 "身份对每家医院和每项手术的成本信息可用性、成本比较和易用性进行了调查：所有接受调查的医院都有成本估算工具，平均估算成功率为 35.7%。使用成本估算工具和生成估算的平均时间分别为 35.69 秒和 34.15 秒。不同医院和不同手术的保险前成本各不相同；鼓膜成形术的成本范围最大。十项手术中有七项的保险后成本较低。平均易用性评分为 5.76（满分 10 分）：所有医院都遵守了医疗保险与医疗补助服务中心的价格透明政策。现有信息稀少，难以获取，而且经常缺乏对常见耳鼻喉科手术的具体估算。尽管医院遵守了医疗保险与医疗补助服务中心的新规定，但现有的估算工具并不能有效地用于财务决策。

{"title":"Cost transparency in otolaryngology: Outpatient procedures cost information at New England hospitals","authors":"Samuel Ding , Alec Chang , Monica O'Brien , Grace Materne , Julianna Mastropierro , Timothy Mikulski , David O'Neil Danis III , Emily Gall , Kathryn Y. Noonan","doi":"10.1016/j.amjoto.2024.104413","DOIUrl":"10.1016/j.amjoto.2024.104413","url":null,"abstract":"<div><h3>Purpose</h3><p>Healthcare costs have dramatically increased, resulting in barriers to care for many Americans. To address this, the Centers for Medicare & Medicaid Services implemented a price transparency mandate, requiring hospitals to provide cost-estimate tools. This study evaluates the accessibility and usability of these tools for common otolaryngology outpatient procedures.</p></div><div><h3>Materials and methods</h3><p>Cost transparency was investigated using cost-estimate tools from websites of the seven New England hospitals ranked on the US News top 50 list. Ten common current procedural terminology codes were used to collect data on availability of cost information, cost comparison, and ease-of-use by six investigators acting as “patients” for each hospital and procedure.</p></div><div><h3>Results</h3><p>All investigated hospitals had cost-estimate tools, with a 35.7 % mean success rate of generating an estimate. The mean times to cost-estimate tools and generated estimates were 35.69 and 34.15 s, respectively. Pre-insurance costs varied by hospital and procedure; creation of eardrum had the largest range. Seven out of ten procedures resulted in lower post-insurance costs. The mean ease-of-use rating was 5.76 out of ten.</p></div><div><h3>Conclusion</h3><p>All hospitals complied with the Centers for Medicare & Medicaid Services price transparency policy. The information available is sparse, difficult to access, and frequently lacks specific estimates for common otolaryngology procedures. Although hospitals are following new Centers for Medicare & Medicaid Services mandates, the estimators currently in existence are ineffective tools for financial decision-making.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104413"},"PeriodicalIF":1.8,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896518","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}

引用次数: 0