American Journal of Otolaryngology最新文献_第8页

Preliminary study on classification and treatment of type I variant preauricular fistula 变异型耳前瘘分型及治疗的初步探讨

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-25 DOI: 10.1016/j.amjoto.2025.104709

Liang Liu , Haigang Zhang , Xunwu Dou , Xinghe Zhao , Mingyue Fan

Objective

To classify and manage Type I Variant Preauricular Fistulas (Type I VPFs) based on clinical manifestations, evaluate the efficacy of individualized surgical approaches, and provide a reference for their treatment.

Methods

From January 2016 to December 2023, our department treated 34 cases of Type I VPFs, including 19 males and 15 females, aged 11 months to 12 years (mean age: 5 years and 5 months). Sixteen cases involved the left ear, and 18 involved the right ear, with 4 cases presenting double fistulas. All cases had recurrent infections, and 7 cases had a history of incision and drainage. Based on clinical features, the fistulas were classified into Simple Type I VPFs, Conchal Type I VPFs, Retroauricular Groove Type I VPFs, External Auditory Canal Type I VPFs, and Hybrid Type I VPFs. Surgical management included complete fistula excision with adjacent crus helicis cartilage removal. Auxiliary incisions were made to debride granulation tissue based on its location, and primary flap reconstruction was performed for skin defects.

Results

The distribution of cases was as follows: Simple Type I VPFs (20.59 %, 7/34), Conchal Type I VPFs (35.29 %, 12/34), Retroauricular Groove Type I VPFs (29.41 %, 10/34), External Auditory Canal Type I VPFs (11.76 %, 4/34), and Hybrid Type I VPFs (2.94 %, 1/34). Approximately 29.41 % (10/34) of patients required flap reconstruction for defect repair, with these cases exclusively involving the conchal typeI VPFs.

Conclusion

Classification of Type I VPFs facilitates tailored surgical planning, achieving optimal functional and cosmetic outcomes.

目的根据临床表现对I型变异性耳前瘘进行分类和处理，评价个体化手术入路的疗效，为其治疗提供参考。方法2016年1月至2023年12月，我科共收治I型vpf 34例，男19例，女15例，年龄11个月~ 12岁，平均5岁5个月。16例累及左耳，18例累及右耳，其中4例出现双瘘。所有病例均有反复感染，其中7例有切口引流史。根据临床特点，将瘘分为单纯型VPFs、耳后沟型VPFs、外耳道型VPFs和混合型VPFs。手术治疗包括完全切除瘘管并切除邻近的腓骨软骨。根据肉芽组织的位置，进行辅助切口清除肉芽组织，对皮肤缺损进行一期皮瓣重建。结果单纯I型VPFs（20.59%, 7/34）、耳道I型VPFs（35.29%, 12/34）、耳后沟I型VPFs（29.41%, 10/34）、外耳道I型VPFs（11.76%, 4/34）和混合型VPFs（2.94%, 1/34）的分布情况为：单纯I型VPFs（20.59%, 7/34）、耳后沟I型VPFs（35.29%, 12/34）。大约29.41%（10/34）的患者需要皮瓣重建来修复缺陷，这些病例仅涉及耳甲型pei vpf。结论I型VPFs的分类有助于制定针对性的手术计划，达到最佳的功能和美容效果。

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引用次数: 0

Comparison between bougie and balloon dilation of benign esophageal strictures in infants and children 婴儿与儿童良性食管狭窄肿胀与球囊扩张的比较

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-25 DOI: 10.1016/j.amjoto.2025.104715

Yin Zhang , Xinwei Han , Yonghua Bi

Objectives

The clinical outcomes regarding esophageal dilation are mainly composed of data collected from adults, who are likely to differ from children. The safety and efficacy of the bougie and balloon dilation were compared in two groups with benign esophageal strictures (BES) in infants and children.

Methods

The medical records of the BES patients, who received esophageal dilation between 2013 and 2024, were reviewed retrospectively. Bougie dilators were used in 19 patients (Group A) and balloon dilators in 18 patients (Group B). The etiology of strictures, degree and location of strictures, dilation methods, complications and dilation outcomes of bougie and balloon dilations were evaluated and compared.

Results

Thirty-seven patients [21 males and 16 females with a mean age of 6.2 years (range, 0.1–17)] underwent 124 esophageal dilations. The stricture etiologies included corrosive strictures (40.5 %), anastomotic strictures (40.5 %), and others in 18.9 %. Dysphagia relief was observed in all patients after the dilation, except for one session of dilation in each of the two groups. The technical success rate was 99.2 % in group A and 98.9 % in group B, respectively. The mean diameter of strictures increased significantly after dilation (P < 0.0001). Thirty patients (81.1 %) had clinical symptoms regress after repeated dilations, and dysphagia was relieved in the remaining 6 patients during the follow-up period. There was no procedure-related mortality or major complications, including esophageal ruptures or massive bleeding. Mild bleeding was the most common complication.

Conclusion

Bougies and balloon catheters are safe, effective and well tolerated in both groups with BES in infants and children. More future randomized prospective studies will be needed to validate the results.

目的食管扩张的临床结果主要由成人收集的数据组成，可能与儿童不同。比较两组婴儿和儿童良性食管狭窄（BES）的气囊扩张术和肿胀扩张术的安全性和有效性。方法回顾性分析2013 ~ 2024年行食管扩张术的BES患者的医疗记录。A组19例，球囊扩张器18例。对狭窄的病因、狭窄的程度和位置、扩张方法、并发症和扩张效果进行评价和比较。结果37例患者（男21例，女16例，平均年龄6.2岁，范围0.1 ~ 17岁）行124次食管扩张术。狭窄的病因包括腐蚀性狭窄（40.5%）、吻合口狭窄（40.5%）和其他狭窄（18.9%）。除两组各进行一次扩张外，所有患者在扩张后均观察到吞咽困难缓解。技术成功率A组为99.2%，B组为98.9%。扩张后狭窄的平均直径明显增加(P <；0.0001)。30例患者（81.1%）经反复扩张后临床症状消退，其余6例患者在随访期间吞咽困难缓解。没有手术相关的死亡或主要并发症，包括食管破裂或大出血。轻度出血是最常见的并发症。结论囊状导管和球囊导管在婴儿和儿童两组BES患者中均安全、有效且耐受性良好。未来需要更多的随机前瞻性研究来验证结果。

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引用次数: 0

Trends in postoperative complications following pediatric tonsillectomy & adenoidectomy: A 10-year analysis 儿童扁桃体切除术和腺样体切除术后并发症的趋势：10年分析

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-22 DOI: 10.1016/j.amjoto.2025.104712

Ogechukwu S. Anwaegbu , Delaney E.S. Clark , Samsudeen O. Iyamah , Chikobi Ezenwukwa , Ugonne L. Etufugh , Brian J. McKinnon

Objective

Assess the rates of post-operative complications following tonsillectomy with/without adenoidectomy over a 10-year span, comparing young children and adolescents, while examining the influence of comorbidities, social determinants of health, and potential racial, and gender differences.

Methods

A retrospective cohort study using TriNetX database with de-identified electronic medical records from 57 healthcare organizations for ages 0–17 who had tonsillectomy with/without adenoidectomy from January 2014 to December 2023. Risk analysis and incidence proportion over a 10-year period for 5 outcomes occurring within 30 days, stratified by gender, race, and ethnicity. Then further subdivided into two groups: Early Childhood (0–9 years) and Adolescence (10–17 years). Statistical analysis included risk ratios (RR), and 95 confidence intervals (CI), with statistical significance set at p ≤ 0.05.

Results

Before propensity score matching, 197,885 pediatric patients were identified. Most common complications occurring within 30 days were pain (3.1 %), post-operative hemorrhage (2.3 %) with 1.3 % requiring re-operation for control, dehydration (2.1 %), infection (0.26 %), and acute respiratory complications (0.21 %). Before propensity score matching, Early Childhood cohort (0–9 years: n = 71,024) and Adolescence cohort (10–17 years: n = 126,861). After propensity matching, n = 56,036 for both groups. Early Childhood cohort had higher rates for potential health hazards related to socioeconomic and psychosocial circumstances (p = 0.013) and environmental tobacco smoke exposure-related risks (p = 0.016) than Adolescence cohort. No significant differences in complication risks were observed between the two pediatric age groups.

Conclusion

Rates of dehydration and acute respiratory distress have declined, while post-operative hemorrhage, and pain have been increasing, and observable racial differences continue to persist within these complications.

Level of Evidence: III

目的评估扁桃体切除术合并/不合并腺样体切除术后10年的并发症发生率，比较幼儿和青少年，同时检查合并症、健康的社会决定因素以及潜在的种族和性别差异的影响。方法采用TriNetX数据库，对2014年1月至2023年12月57家医疗机构0-17岁扁桃体切除术合并/不合并腺样体切除术的电子病历进行回顾性队列研究。30天内发生的5种结局的10年风险分析和发病率，按性别、种族和民族分层。然后进一步细分为两组：幼儿期（0-9岁）和青春期（10-17岁）。统计分析包括风险比（RR）和95个置信区间（CI）， p≤0.05为有统计学意义。结果在倾向评分匹配前，共发现197,885例儿科患者。30天内最常见的并发症是疼痛（3.1%）、术后出血（2.3%）（其中1.3%需要再次手术控制）、脱水（2.1%）、感染（0.26%）和急性呼吸道并发症（0.21%）。倾向评分匹配前，幼儿组（0-9岁：n = 71,024）和青少年组（10-17岁：n = 126,861）。倾向匹配后，两组n = 56,036。与青少年组相比，幼儿组与社会经济和社会心理环境相关的潜在健康危害（p = 0.013）和与环境烟草烟雾暴露相关的风险（p = 0.016）的比例更高。在两个儿童年龄组之间观察到并发症风险无显著差异。结论脱水和急性呼吸窘迫发生率下降，而术后出血和疼痛发生率增加，且在这些并发症中存在明显的种族差异。证据水平：III

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引用次数: 0

The impact of COVID-19 and socio-economic crisis on primary hyperparathyroidism patients in Lebanon: A trend to operate more acute and advanced-stage cases 2019冠状病毒病和社会经济危机对黎巴嫩原发性甲状旁腺功能亢进症患者的影响：手术治疗更多急性和晚期病例的趋势

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-22 DOI: 10.1016/j.amjoto.2025.104713

Bassam Abboud , Christopher Abboud

Backgrounds

Evaluate contribution of COVID-19 pandemic, the socio-economic crisis, and explosion of Beirut port to a concerning trend of operating on more advanced-stage in primary hyperparathyroism (PHPT).

Methods

We included all patients operated for PHPT between 1997 and 2024. Two groups were established: Group 1 between 1997 and 2018, and Group 2 after 2018.

Results

Asymptomatic PHPT was statistically significantly more frequent in group 1. The rates of systemic manifestations were comparable but with a more advanced stage for some system in group 2. The rates of acute pancreatitis and acute hypercalcemia were significantly higher in group 2. The rate of parathyroid carcinoma was significantly higher in group 1. The hospital stay was statistically significantly longer in the group 2.

Conclusion

COVID-19 pandemic and economic crisis has affected early intervention and comprehensive treatment for PHPT patients, resulting in a concerning rise in late-stage and acute cases requiring surgical intervention.

评估2019冠状病毒病大流行、社会经济危机和贝鲁特港爆炸对原发性甲状旁腺功能亢进（PHPT）晚期手术趋势的影响。方法纳入1997 - 2024年间所有接受PHPT手术的患者。分为两组：第一组在1997年至2018年之间，第二组在2018年之后。结果1组无症状PHPT发生率明显高于对照组。全身性表现的发生率与对照组相当，但在第二组中，某些系统的进展更为严重。急性胰腺炎和急性高钙血症发生率明显高于对照组。甲状旁腺癌发生率明显高于对照组。2组住院时间明显延长。结论新冠肺炎大流行和经济危机影响了PHPT患者的早期干预和综合治疗，导致晚期和急性期需要手术干预的病例增加。

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引用次数: 0

Telehealth utilization and perceptions among deaf or hard of hearing adults: A cross-sectional analysis of the HINTS6 national dataset 聋人或重听成年人的远程医疗利用和感知：对HINTS6国家数据集的横断面分析

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-21 DOI: 10.1016/j.amjoto.2025.104716

Andrew W. Liu , Sara J. Yi , Divya A. Chari

Objective

Telehealth has emerged as a vital medium for healthcare delivery and has been integrated increasingly in clinic and hospital settings in the post-COVID-19 era. However, accessibility of telehealth for individuals who are deaf or hard of hearing (DHH) remains underexplored. As effective communication is critical to high-quality healthcare, a deeper understanding of how DHH individuals interact with telehealth and identifying specific barriers they face can inform targeted interventions to improve care.

Methods

We conducted a cross-sectional analysis of the 2022 Health Information National Trends Survey (HINTS 6), a nationally representative dataset. Respondents were stratified by self-identified DHH status. Demographic, internet access, health behavior, and telehealth perception variables were compared between DHH and normal hearing individuals. Statistical analyses were performed using chi-square tests and t-tests.

Results

Among 5694 respondents, 521 identified as DHH. Chi-square testing found that DHH patients reported poorer general health (p < 0.01), lower internet use (p < 0.01), and less engagement with online health resources (p < 0.01), with similar rates of telehealth being offered and utilized. However, DHH individuals were less likely to perceive telehealth as convenient (p = 0.04) and more likely to cite difficulty using the platform (p = 0.01). They were also more likely to value the inclusion of others in their telehealth visits (p < 0.01) and report technical issues (p < 0.01).

Conclusions

While DHH individuals use telehealth at similar rates to the general population, they face significant barriers related to convenience, usability, and communication. Enhancing platform accessibility and expanding support for these patients can help reduce difficulties and further promote equity in telehealth.

目的在后covid -19时代，远程医疗已成为医疗保健服务的重要媒介，并越来越多地融入诊所和医院环境。然而，聋人或重听人（DHH）获得远程医疗的可能性仍未得到充分探索。由于有效的沟通对高质量的医疗保健至关重要，因此更深入地了解DHH个人如何与远程医疗互动，并确定他们面临的具体障碍，可以为有针对性的干预措施提供信息，以改善护理。方法对2022年健康信息全国趋势调查（HINTS 6）这一具有全国代表性的数据集进行了横断面分析。受访者按自我认定的DHH状况分层。比较DHH和正常听力个体的人口统计学、互联网访问、健康行为和远程医疗感知变量。采用卡方检验和t检验进行统计学分析。结果5694名被调查者中，521人被确定为DHH。卡方检验发现DHH患者总体健康状况较差(p <；0.01)，互联网使用率较低(p <；0.01)，较少使用在线健康资源(p <；0.01)，提供和利用远程保健的比率相似。然而，DHH个体不太可能认为远程医疗方便（p = 0.04），更有可能引用使用平台的困难（p = 0.01）。他们也更有可能重视将他人纳入远程医疗访问(p <；0.01)并报告技术问题(p <；0.01)。虽然DHH患者使用远程医疗的比例与一般人群相似，但他们在便利性、可用性和沟通方面面临着重大障碍。加强平台的可及性和扩大对这些患者的支持有助于减少困难并进一步促进远程保健的公平性。

{"title":"Telehealth utilization and perceptions among deaf or hard of hearing adults: A cross-sectional analysis of the HINTS6 national dataset","authors":"Andrew W. Liu , Sara J. Yi , Divya A. Chari","doi":"10.1016/j.amjoto.2025.104716","DOIUrl":"10.1016/j.amjoto.2025.104716","url":null,"abstract":"<div><h3>Objective</h3><div>Telehealth has emerged as a vital medium for healthcare delivery and has been integrated increasingly in clinic and hospital settings in the post-COVID-19 era. However, accessibility of telehealth for individuals who are deaf or hard of hearing (DHH) remains underexplored. As effective communication is critical to high-quality healthcare, a deeper understanding of how DHH individuals interact with telehealth and identifying specific barriers they face can inform targeted interventions to improve care.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of the 2022 Health Information National Trends Survey (HINTS 6), a nationally representative dataset. Respondents were stratified by self-identified DHH status. Demographic, internet access, health behavior, and telehealth perception variables were compared between DHH and normal hearing individuals. Statistical analyses were performed using chi-square tests and <em>t</em>-tests.</div></div><div><h3>Results</h3><div>Among 5694 respondents, 521 identified as DHH. Chi-square testing found that DHH patients reported poorer general health (<em>p</em> < 0.01), lower internet use (p < 0.01), and less engagement with online health resources (p < 0.01), with similar rates of telehealth being offered and utilized. However, DHH individuals were less likely to perceive telehealth as convenient (<em>p</em> = 0.04) and more likely to cite difficulty using the platform (<em>p</em> = 0.01). They were also more likely to value the inclusion of others in their telehealth visits (<em>p</em> < 0.01) and report technical issues (p < 0.01).</div></div><div><h3>Conclusions</h3><div>While DHH individuals use telehealth at similar rates to the general population, they face significant barriers related to convenience, usability, and communication. Enhancing platform accessibility and expanding support for these patients can help reduce difficulties and further promote equity in telehealth.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104716"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678980","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

Evidence synthesis of tinnitus treatment methods: An umbrella review 耳鸣治疗方法的证据综合：综述

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-21 DOI: 10.1016/j.amjoto.2025.104707

Jiawen Xian , Shipeng Zhang , Xinyue Xiao , Jiaqing Yuan , Yilan Zhao , Jinyi Li , Yunyue Zhang , Qinwei Henry Fu , Yujie Zhang , Qinxiu Zhang

Objective

We collated and evaluated evidence from meta-analyses and systematic reviews on tinnitus treatment to establish a reference for clinical decision-making in tinnitus management.

Methods

Major medical databases such as CNKI, PubMed, Embase, Web of Science and the Cochrane Library were searched. Literature on systematic review/meta-analysis of evidence of tinnitus treatment was collected without reference language restrictions. The methodological quality, reporting quality, and evidence quality of the included studies were assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool, respectively.

Results

In the end, a total of 48 out of 2642 screened publications met the eligibility criteria. The primary treatment modalities included tinnitus counseling, cognitive behavioral therapy, auditory therapy, tinnitus retraining therapy and pharmacotherapy. We analyzed seven treatment approaches, among which three demonstrated definitive efficacy while four showed probable efficacy.

Conclusion

The primary objective of this systematic review was to synthesize and critically evaluate evidence-based data on tinnitus treatment derived from multiple meta-analyses and systematic reviews, while also assessing methodological quality, reporting quality, and evidence quality of the included studies. Our study consolidated the most recent evidence-based findings on various tinnitus treatments to guide clinical decision-making in tinnitus management.

目的整理和评价耳鸣治疗的meta分析和系统综述证据，为耳鸣治疗的临床决策提供参考。方法检索中国知网、PubMed、Embase、Web of Science、Cochrane Library等主要医学数据库。收集耳鸣治疗证据的系统回顾/荟萃分析文献，无参考语言限制。分别使用评估系统评价方法质量2 （AMSTAR-2）、系统评价和荟萃分析首选报告项目（PRISMA）清单和建议评估、发展和评价分级（GRADE）工具评估纳入研究的方法学质量、报告质量和证据质量。结果在2642篇筛选的文献中，共有48篇符合入选标准。主要治疗方式包括耳鸣咨询、认知行为治疗、听觉治疗、耳鸣再训练治疗和药物治疗。我们分析了7种治疗方法，其中3种表现出明确的疗效，4种表现出可能的疗效。本系统综述的主要目的是综合和批判性评价来自多个荟萃分析和系统综述的耳鸣治疗的循证数据，同时评估纳入研究的方法学质量、报告质量和证据质量。我们的研究整合了最近各种耳鸣治疗的循证研究结果，以指导耳鸣治疗的临床决策。

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引用次数: 0

Comparing the multi-disciplinary approach utilizing cognitive behavioral therapy and sound therapy to standard audiological treatment in chronic tinnitus patients: Impact on severity reduction and quality of life improvement 认知行为疗法和声音疗法与标准听力学治疗慢性耳鸣患者的多学科方法比较：对严重程度降低和生活质量改善的影响

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-21 DOI: 10.1016/j.amjoto.2025.104700

Qi Kang , Lingfeng Xiong , Zhu Shi , Yimei Li , Tongkai Xing , Lize Yang

Objective

To compare the impact of a multi-disciplinary approach utilizing Cognitive Behavioral Therapy (CBT) and Sound Therapy (ST) in chronic tinnitus patients.

Methods

The clinical data of 111 adult patients with chronic tinnitus were retrospectively analyzed. Patients were divided into the CBT + ST Group (CBT + ST, n = 55) and the Standard Group (standard therapy, n = 56). Baseline demographic characteristics, severity of tinnitus symptoms, audiometric measures, quality of life scores, treatment efficacy, and anxiety and depression scores were evaluated.

Results

Comparing with control, the CBT + ST group significantly reduced tinnitus severity scores, including Tinnitus Handicap Inventory, Tinnitus Functional Index, and Tinnitus Visual Analog Scale. Audiological measures revealed improved hearing thresholds and speech recognition in the CBT + ST group. CBT + ST also improved quality of life, with significant higher percentages of complete and partial treatment responses and lower anxiety and depression scores.

Conclusion

Multi-disciplinary approach utilizing CBT + ST effectively reduces tinnitus severity, improves quality of life, and enhances treatment efficacy.

目的比较认知行为疗法（CBT）与声音疗法（ST）治疗慢性耳鸣的效果。方法回顾性分析111例成人慢性耳鸣患者的临床资料。患者分为CBT + ST组（CBT + ST, n = 55）和标准组（标准治疗，n = 56）。评估基线人口统计学特征、耳鸣症状严重程度、听力测量、生活质量评分、治疗疗效、焦虑和抑郁评分。结果与对照组相比，CBT + ST组显著降低了耳鸣严重程度评分，包括耳鸣障碍量表、耳鸣功能指数和耳鸣视觉模拟量表。听力学测量显示CBT + ST组的听力阈值和语音识别有所改善。CBT + ST也改善了生活质量，完全和部分治疗反应的百分比显著提高，焦虑和抑郁评分较低。结论CBT + ST多学科联合治疗可有效降低耳鸣严重程度，改善生活质量，提高治疗效果。

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引用次数: 0

Impact of patient-centered care (PCC)-based personalized interventions on postoperative pain management and recovery in children undergoing adenotonsillectomy: A retrospective study 以患者为中心的护理（PCC）为基础的个性化干预对儿童腺扁桃体切除术后疼痛管理和恢复的影响：一项回顾性研究

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-21 DOI: 10.1016/j.amjoto.2025.104706

Xinyue Qi , Yan Li , Meng Zhang , Yan Liu

Objective

To evaluate the impact of patient-centered care (PCC)-based personalized interventions on postoperative pain management and recovery outcomes in children undergoing adenotonsillectomy.

Methods

A single-center retrospective cohort study was conducted at a tertiary hospital from January 2023 to March 2025, involving 216 children aged 3–12 years. Participants were divided into a PCC intervention group (n = 108) and a routine care group (n = 108). The PCC protocol included individualized pain education, non-pharmacological interventions (cold therapy, distraction techniques), and family-involved decision-making. Data on pain scores (FLACC/FACES scales), analgesic use, hospitalization duration, and complications within 48 h postoperatively were extracted from electronic medical records. Group differences were analyzed using repeated-measures ANOVA, multivariate regression, and subgroup analyses.

Results

The PCC group demonstrated significantly lower pain scores at 6 h, 24 h, and 48 h compared to controls (all P < 0.001). Daily acetaminophen and ibuprofen doses were reduced by 19.2 % and 55 %, respectively (both P < 0.001). Median pain relief time was 2.6 h shorter in the PCC group (3.2 h vs. 5.8 h, P < 0.001). Hospitalization duration decreased by 5.5 h (18.5 h vs. 24.0 h, P < 0.001), and overall complication risk was reduced (OR = 0.31, P < 0.001). Subgroup analysis revealed greater benefits in children aged 3–6 years, with a 28.6 % shorter hospitalization (P < 0.001).

Conclusion

PCC-based personalized interventions effectively alleviate postoperative pain, reduce analgesic dependence, and accelerate recovery, particularly in younger children. This model provides an evidence-based framework for optimizing pain management in pediatric ambulatory surgery.

目的评价以患者为中心的个性化干预对儿童腺扁桃体切除术后疼痛管理和康复的影响。方法于2023年1月至2025年3月在某三级医院进行单中心回顾性队列研究，纳入216例3 ~ 12岁儿童。参与者分为PCC干预组（n = 108）和常规护理组（n = 108）。PCC方案包括个体化疼痛教育、非药物干预（冷疗法、分散注意力技术）和家庭参与决策。从电子病历中提取疼痛评分（FLACC/FACES量表）、镇痛药使用、住院时间和术后48 h内并发症的数据。采用重复测量方差分析、多元回归和亚组分析分析组间差异。结果PCC组在6 h、24 h和48 h的疼痛评分明显低于对照组(P <；0.001)。每日对乙酰氨基酚和布洛芬剂量分别减少19.2%和55% (P <；0.001)。PCC组中位疼痛缓解时间缩短2.6 h (3.2 h vs. 5.8 h, P <；0.001)。住院时间减少5.5 h (18.5 h vs. 24.0 h, P <；0.001)，总体并发症风险降低(OR = 0.31, P <；0.001)。亚组分析显示，3-6岁儿童获益更大，住院时间缩短28.6% (P <；0.001)。结论以pcc为基础的个性化干预措施可有效缓解术后疼痛，减少镇痛依赖，加速术后恢复，尤其对低龄儿童疗效显著。该模型为优化儿科门诊手术疼痛管理提供了循证框架。

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引用次数: 0

ChatGPT as a decision-support tool for better self-monitoring of hearing ChatGPT作为一种决策支持工具，可以更好地自我监测听力

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-21 DOI: 10.1016/j.amjoto.2025.104711

Małgorzata Pastucha , Anna Ratuszniak , Małgorzata Ganc , Edyta Piłka , Iryna Drohobycka , Henryk Skarżyński , W. Wiktor Jedrzejczak

Background

The rapid development of large language model chatbots, such as ChatGPT, has created new possibilities for healthcare support. This study investigates the feasibility of integrating self-monitoring of hearing (via a mobile app) with ChatGPT's decision-making capabilities to assess whether specialist consultation is required. In particular, the study evaluated how ChatGPT's accuracy to make a recommendation changed over periods of up to 12 months.

Methods

ChatGPT-4o was tested on a dataset of 1000 simulated cases, each containing monthly hearing threshold measurements over periods of up to 12 months. Its recommendations were compared to the opinions of 5 experts using percent agreement and Cohen's Kappa. A multiple-response strategy, selecting the most frequent recommendation from 5 trials, was also analyzed.

Results

ChatGPT aligned strongly with the experts' judgments, with agreement scores ranging from 0.80 to 0.84. Accuracy scores improved to 0.87 when the multiple-query strategy was employed. In those cases where all 5 experts unanimously agreed, ChatGPT achieved a near-perfect agreement score of 0.99. It adapted its decision-making criteria with extended observation periods, seemingly accounting for potential random fluctuations in hearing thresholds.

Conclusions

ChatGPT has significant potential as a decision-support tool for monitoring hearing, able to match expert recommendations and adapting effectively to time-series data. Existing hearing self-testing apps lack capabilities for tracking and evaluating changes over time; integrating ChatGPT could fill this gap. While not without its limitations, ChatGPT offers a promising complement to self-monitoring. It can enhance decision-making processes and potentially encourage patients to seek clinical expertise when needed.

大型语言模型聊天机器人（如ChatGPT）的快速发展为医疗保健支持创造了新的可能性。本研究探讨了将听力自我监测（通过移动应用程序）与ChatGPT的决策能力相结合的可行性，以评估是否需要专家咨询。特别是，该研究评估了ChatGPT在长达12个月的时间内做出推荐的准确性是如何变化的。方法在1000个模拟病例的数据集上对schatgpt - 40进行测试，每个病例在长达12个月的时间内包含每月的听力阈值测量。它的建议与5位专家的意见进行了比较，使用了百分比同意和科恩的Kappa。还分析了从5项试验中选择最频繁推荐的多重反应策略。结果gpt与专家判断的一致性较强，一致性得分在0.80 ~ 0.84之间。采用多查询策略时，准确率提高到0.87。在所有5位专家一致同意的情况下，ChatGPT获得了0.99的近乎完美的一致分数。它根据延长的观察期调整了决策标准，似乎考虑到了听力阈值的潜在随机波动。结论schatgpt作为听力监测的决策支持工具具有很大的潜力，能够匹配专家建议并有效适应时间序列数据。现有的听力自测应用缺乏追踪和评估变化的能力；集成ChatGPT可以填补这一空白。虽然ChatGPT并非没有局限性，但它为自我监控提供了一个很有希望的补充。它可以加强决策过程，并可能鼓励患者在需要时寻求临床专业知识。

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引用次数: 0

Salivary and tissue CD44 expression in laryngeal cancer 喉癌涎腺及组织CD44表达

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-07-21 DOI: 10.1016/j.amjoto.2025.104702

Maria Rita Bianco , Federico Occhiuzzi , Cosimo Galletti , Mario Lentini , Lidia Puzzo , Eugenia Allegra

The most common malignant tumor of head and neck cancer is laryngeal carcinoma, often diagnosed at advanced stages, underscoring the need for reliable diagnostic and prognostic biomarkers. This study investigates the correlation between CD44 expression in tumor tissues and its soluble fraction (CD44sol) in saliva, evaluating their potential as diagnostic and prognostic markers. The study was conducted on 74 patients with laryngeal carcinoma. CD44 expression in tumor tissues was assessed using immunohistochemical techniques, while salivary CD44sol levels were measured using Enzyme Linked ImmunoSorbent Assay (ELISA). A significant statistical correlation was found between CD44 tumor expression and salivary CD44sol levels. Furthermore, CD44 expression was identified as a prognostic biomarker for low-grade tumors, and metastatic lymphadenopathy at diagnosis. Similarly, positive salivary CD44sol levels were identified as predictive factors for low-grade tumors, tumor site, and lymph node metastasis at diagnosis. To the best of our knowledge, this study is the first to demonstrate a significant correlation between salivary levels and tumor tissue expression of CD44 in patients with laryngeal cancer.

头颈癌中最常见的恶性肿瘤是喉癌，通常在晚期诊断出来，强调需要可靠的诊断和预后生物标志物。本研究探讨了CD44在肿瘤组织中的表达与唾液中CD44可溶性组分（CD44sol）的相关性，评估了它们作为诊断和预后指标的潜力。研究对象为74例喉癌患者。使用免疫组织化学技术评估肿瘤组织中CD44的表达，而使用酶联免疫吸附试验（ELISA）测量唾液中CD44sol的水平。CD44肿瘤表达与唾液CD44sol水平有显著的统计学相关性。此外，CD44表达被确定为低级别肿瘤和转移性淋巴结病诊断时的预后生物标志物。同样，唾液CD44sol阳性水平被确定为诊断时低级别肿瘤、肿瘤部位和淋巴结转移的预测因素。据我们所知，本研究首次证明喉癌患者唾液水平与肿瘤组织CD44表达之间存在显著相关性。

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引用次数: 0