Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Panendoscopy for Head and Neck Cancers: Detection of Synchronous Second Primary Cancers, Complications and Cost-Benefit Analysis: A Systematic Review.","authors":"Samuel Bellavance, Michel Khoury, Eric Bissada, Tareck Ayad, Apostolos Christopoulos, Jean-Claude Tabet, Louis Guertin, Paul Tabet","doi":"10.1177/19160216251316215","DOIUrl":"10.1177/19160216251316215","url":null,"abstract":"<p><strong>Importance: </strong>In patients with head and neck squamous cell carcinoma (HNSCC), the discovery of a second synchronous primary cancer of the aerodigestive tract (SSPCA) significantly impacts management and prognosis. Recent advances in imaging have increasingly allowed for identifying SSPCA before performing panendoscopy, raising questions about the latter's role.</p><p><strong>Objective: </strong>To establish the incidence of SSPCA and panendoscopy's impact on management. Complications and costs associated with panendoscopy were also assessed.</p><p><strong>Design: </strong>Systematic review following the preferred reporting items for systematic reviews and meta-analysis guidelines.</p><p><strong>Setting: </strong>Operating room panendoscopy.</p><p><strong>Participants: </strong>Identifiable HNSCC undergoing initial staging workup.</p><p><strong>Intervention: </strong>Panendoscopy under general anesthesia for SSPCA detection.</p><p><strong>Main outcome measures: </strong>Incidence of SSPCA in HNSCC, change in management caused by panendoscopy, incidence of panendoscopy complications, costs for panendoscopy.</p><p><strong>Results: </strong>51 studies were included (n = 19,914 patients). SSPCA was present in 6.4% (n = 467/7262) of all panendoscopies. Among patients who had a prior computed tomography (CT) of the neck and chest, a change in management resulting from SSPCA detected through panendoscopy occurred in only 1.1% of cases (n = 3/268), and in 0% of cases for those who had a positron-emission tomography-computed tomography (PET) (n = 0/544). The rate of major complications of panendoscopy was 0.7% (n = 58/8386). Only two recent studies in a private healthcare system reported panendoscopy costs ranging from $3802 USD to $17,296 USD.</p><p><strong>Conclusions: </strong>The role of panendoscopy in the initial workup of HNSCC should be limited to confirming suspicious findings from initial CT or PET. The incidence of major complications for panendoscopy is low but carries a significant financial burden for patients in the private American healthcare system. More studies are needed to assess the cost-effectiveness of panendoscopies for SSPCA detection in a public healthcare system.</p><p><strong>Relevance: </strong>Confirms the lack of benefit for systematic panendoscopy for SSPCA detection in HNSCC patients when initial workup includes a CT of the neck and chest or PET.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251316215"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Role of Nasal Irrigation in Chronic Otorrhea in Children With Tympanostomy Tubes.","authors":"Michal Kulasek, Erika Mercier, Mathieu Bergeron","doi":"10.1177/19160216251315055","DOIUrl":"10.1177/19160216251315055","url":null,"abstract":"<p><strong>Importance: </strong>Nasal irrigation (NI) is effective in the treatment of sinonasal disease; however, its efficacy in treating otologic conditions is undetermined. Chronic otorrhea (CO) is an important complication in children with tympanostomy tubes (TT), requiring additional treatment.</p><p><strong>Objective: </strong>Determine potential factors of NI that put children with TT at risk of developing CO.</p><p><strong>Study design: </strong>Case-control study.</p><p><strong>Setting: </strong>Single tertiary level of care pediatric hospital.</p><p><strong>Participants: </strong>Consecutive patients under the age of 18 with bilateral TT presenting between June and September 2023 were selected.</p><p><strong>Intervention: </strong>All patients in this study used NI.</p><p><strong>Main outcome measures: </strong>The main outcome was the development of CO, defined as 10 or more consecutive days of ear drainage despite proper treatment.</p><p><strong>Results: </strong>Twenty consecutive patients with CO were recruited and compared to 100 consecutive controls without CO. The mean age was similar, with 22.9 ± 18.4 months for the CO group and 25.2 ± 16.4 months for the control group (<i>P</i> = .59). An immediate discharge occurred more frequently in the CO group (80%) than in the control group (46%, <i>P</i> = .005; OR: 4.70; 95% CI: 1.5-13.5). A fast rate of administration of NI was more prevalent in the CO group (75%) compared to the control group (51%, <i>P</i> = .049; OR: 2.88; 95% CI: 1.0-7.6). TT insertion under local anesthesia occurred more frequently in the CO group (45%) than in the control group (22%, <i>P</i> = .03; OR: 2.9; 95% CI: 1.1-7.4). No statistical difference was found between groups in the frequency and volume of NI. No patients with CO used a small volume of NI (≤5 mL).</p><p><strong>Conclusion and relevance: </strong>A fast rate of administration of NI was correlated with an increased risk of CO. Patients should be encouraged to apply gentle pressure as it could potentially prevent this complication.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251315055"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facial Nerve Palsy Amid the SARS-CoV-2 Pandemic: A Pooled Analysis.","authors":"Ahmad A Mirza, Abdulaziz H Almalki, Faisal A Noori, Sultan A Neazy, Valerie Dahm, Münir Demir Bajin, Vincent Y Lin","doi":"10.1177/19160216251315057","DOIUrl":"10.1177/19160216251315057","url":null,"abstract":"<p><strong>Importance: </strong>Idiopathic facial nerve palsy (FNP) has devastating sequelae and is potentially linked to coronavirus disease-19 (COVID-19).</p><p><strong>Objective: </strong>The rate of FNP was compared in the pandemic versus pre-pandemic periods. Furthermore, the risk of FNP was estimated among the COVID-19 vaccinated group.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>An electronic search was conducted in 7 databases: Scopus, Web of Science core collection, PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL.</p><p><strong>Participants: </strong>English observational studies investigating an association between idiopathic FNP and COVID-19 or its vaccination were included, irrespective of patients' demographics.</p><p><strong>Exposures: </strong>COVID-19 or COVID-19 vaccine.</p><p><strong>Main outcome measures: </strong>Change in FNP incidence between the pre-pandemic and pandemic periods; risk of developing FNP in individuals vaccinated against COVID-19 compared to those who were unvaccinated against COVID-19.</p><p><strong>Results: </strong>After excluding duplicates, the search yielded 906 related articles, of which 118 articles were included. The risk of FNP was statistically significantly higher during the COVID-19 pandemic than the pre-pandemic period (RR: 1.68, [95% CI: 1.16-2.43], <i>P</i> = .01). A nonsignificant increase in FNP risk was identified among COVID-19 vaccinated individuals compared to unvaccinated individuals (overall OR: 1.07, [95% CI: 0.85-1.35], <i>P</i> = .55).</p><p><strong>Conclusions and relevance: </strong>A remarkable increase in FNP rates was identified during the pandemic compared to pre-pandemic, which seemed unlikely to be attributed to COVID-19 vaccination.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251315057"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review: Effectiveness of Carbon Dioxide Lasers for Treatment of Adult Laryngeal Hemangioma.","authors":"Kenny Do, Eric Kawana, Suparna Shah, Jonathan Salinas, Jo-Lawrence Bigcas","doi":"10.1177/19160216251314789","DOIUrl":"10.1177/19160216251314789","url":null,"abstract":"<p><strong>Importance: </strong>Adult laryngeal hemangiomas are rare and may cause symptoms such as dysphonia, dysphagia, and dyspnea. Carbon dioxide (CO2) lasers offer an alternative approach to managing this rare condition.</p><p><strong>Objective: </strong>The objective of this study is to evaluate the effectiveness of CO2 lasers in treating adult hemangioma and to identify potential side effects associated with this treatment modality.</p><p><strong>Design/methods: </strong>The study utilizes the PRISMA model to systematically collect articles available in the current literature. The numbers obtained from each academic manuscript were then used to calculate the effectiveness of CO2 laser therapy in patients with laryngeal hemangiomas. Articles from 1949 to 2023 were gathered using the PRISMA systematic review method.</p><p><strong>Setting: </strong>Not applicable.</p><p><strong>Participants: </strong>Adult patients with laryngeal hemangioma who were treated with CO2 lasers.</p><p><strong>Intervention or exposures: </strong>Surgical management with CO2 lasers.</p><p><strong>Main outcome measures: </strong>Number of patients with at least a 50% reduction in laryngeal hemangioma size.</p><p><strong>Results: </strong>Two case reports, 4 case series, and 2 observational studies were included in this systematic review. For the case reports and series, only 1 out of the 19 patients experienced recurrence following CO2 laser treatment. However, some studies did not have adequate follow-up time. In the 2 observational studies, efficacy rates of 100% and 90.9% were reported by the authors respectively.</p><p><strong>Conclusion and relevance: </strong>Adult laryngeal hemangioma can be safely and successfully treated with CO2 laser microsurgery in well-selected cases. More studies, as well as longer patient follow-ups, are needed to truly assess the efficacy of CO2 laser in treating laryngeal hemangioma. This method provides a minimally invasive technique for adult patients with this rare disease.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251314789"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram Predicting Progression-Free Survival in Locally Advanced Papillary Thyroid Cancer with Recurrent Laryngeal Nerve Invasion.","authors":"Yixuan Song, Yudong Ning, Han Li, Yuqin He, Yang Liu, Shaoyan Liu","doi":"10.1177/19160216251314750","DOIUrl":"10.1177/19160216251314750","url":null,"abstract":"<p><strong>Objectives: </strong>The recurrence rate of T4a papillary thyroid cancer (PTC) is relatively high, but research on the prognosis of T4a PTC is rarely investigated. This study aims to analyze the prognosis of T4a PTC patients with recurrent laryngeal nerve (RLN) invasion.</p><p><strong>Methods: </strong>Univariable and multivariable Cox proportional hazard models were employed to identify prognostic factors for the progression-free-survival (PFS) of PTC patients. A nomogram was constructed based on essential prognostic factors to predict the risk of disease progression in T4a PTC patients with RLN invasion.</p><p><strong>Results: </strong>A total of 418/602 (69.4%) T4a PTC patients with RLN invasion underwent surgery, the 5-year PFS rate was 89.8%. The multivariable analyses showed that age ≥55 years, preoperative vocal cord paralysis (VCP), microvascular invasion, and the number of cervical lymph node metastases (CLNM) >10 were prognostic risk factors of PFS in T4a PTC patients with RLN invasion. Our nomogram provided good discrimination, with a C-index of 0.778 in the training set and 0.793 in the validation set. No statistical difference (<i>P</i> = .918) was found between PFS and the surgical methods of RLN. By following up on the patient's voice condition, the RLN function was restored in approximately 82.7% of patients after RLN separation.</p><p><strong>Conclusion: </strong>T4a PTC patients with RLN invasion are prone to disease progression under the following conditions: age ≥55 years old, preoperative VCP, microvascular invasion, and CLNM >10. The RLN nerve preservation surgery does not increase the risk of disease progression.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251314750"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Use of Patient-Reported Outcome Measures in the Routine Clinical Care of Chronic Rhinosinusitis Patients: A Canadian Perspective.","authors":"Hugh Andrew Jinwook Kim, Daniel J Lee, Dongho Shin, Garret Horton, Monique Gignac, John M Lee, Yvonne Chan","doi":"10.1177/19160216241288806","DOIUrl":"https://doi.org/10.1177/19160216241288806","url":null,"abstract":"<p><strong>Importance: </strong>Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses with significant quality of life impairments. There is a need to implement outcome-based metrics to evaluate the outcomes of CRS treatment with endoscopic sinus surgery or biologics.</p><p><strong>Objective: </strong>We aimed to understand Canadian otolaryngologists' opinions on patient-related outcome measures (PROM) for CRS and identify potential barriers to implementation.</p><p><strong>Design: </strong>Qualitative research.</p><p><strong>Setting and participants: </strong>A cross-sectional survey was distributed via the Canadian Society of Otolaryngology-Head and Neck Surgery and direct emailing.</p><p><strong>Measures: </strong>Participants' demographics, practice information, and opinions on PROM were collected.</p><p><strong>Results: </strong>Of 346 (23%) Canadian otolaryngologists, 78 responded to the survey (26 rhinology fellowship-trained, 51 non-fellowship-trained, and 1 missing data). Thirty-eight responded that they collect PROM (69% with fellowship-trained, 39% non-fellowship-trained, <i>P</i> = .029). Regarding opinions on PROM, 74% of respondents agreed that it helps patients report their symptoms, 42% agreed that it improves the efficiency of the patient encounter, 54% agreed that it is easy for patients to understand, 62% agreed that it improves management and monitoring of clinical outcomes, and 71% disagreed that PROM is not helpful. Fellowship-trained otolaryngologists were 4 times more likely to agree that PROM improves management and monitoring of clinical outcomes (<i>P</i> = .014), and no other differences in opinions were significant. The most-frequently-identified barriers to PROM usage were lack of time for 67% of respondents, difficulty integrating into clinical workflow for 64%, and lack of integration into the electronic medical record for 47%. If these barriers were addressed, 86% of respondents said they would use PROM in their practice.</p><p><strong>Conclusions and relevance: </strong>Despite the low uptake of PROM among otolaryngologists without rhinology fellowship, opinions were generally favorable. We identified barriers that, if addressed, may increase their use in clinical practice. As resource-limited therapies such as biologics become more prevalent in CRS management, PROM may find more applications in shared clinical decision making.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241288806"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Analysis and Prognostic Factors After Endonasal Resection of Advanced Olfactory Neuroblastomas: A Single Institution Experience.","authors":"Xiaole Song, Jingyi Yang, Cuncun Yuan, Dantong Gu, Li Wang, Qianqian Zhang, Chengle Zhou, Huan Wang, Li Hu, Chen Zhang, Quan Liu, Dehui Wang, Xicai Sun, Hongmeng Yu","doi":"10.1177/19160216241267737","DOIUrl":"10.1177/19160216241267737","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the prognostic factors in patients with advanced olfactory neuroblastoma (ONB) underwent endoscopic surgery.</p><p><strong>Materials and methods: </strong>Retrospective medical records were reviewed of patients with pathologically proven ONB who underwent endoscopic surgical resection. Clinicopathological characteristics including patient demographics, treatment, complications, follow-up, and outcomes were analyzed. Kaplan-Meier overall survival (OS) and disease-free survival (DFS) curves were plotted. Univariate and multivariate Cox regression models were used to determine prognostic factors.</p><p><strong>Results: </strong>Eighty-five patients with Kadish stage C ONB were examined. According to the various staging systems used, most patients harbored modified Kadish stage C (78.8%). Twenty-six patients (30.6%) underwent bony skull base resection, 11 (12.9%) underwent dura resection, and 24 (28.2%) underwent additional intracranial resection that included the olfactory bulb and duct. Median follow-up was 39 months. Five-year OS and DFS rates were 83.7% and 74.9%, respectively. Five-year OS was 100% in patients treated with bony skull base resection and 77.5% in those who were not (<i>P</i> = .052). Dura resection did not improve OS. Multivariate Cox regression analysis identified perioperative complications (<i>P</i> = .009), gross total resection (<i>P</i> = .004), orbital invasion (<i>P</i> = .014), postoperative radiotherapy (<i>P</i> = .030), and bony skull base resection (<i>P</i> = .019) as independent prognostic predictors.</p><p><strong>Conclusion: </strong>For patients with advanced ONB, endoscopic surgery in conjunction with radiotherapy and chemotherapy is effective and safe. Dura resection should be performed with caution in selected patients to balance survival and complications. Postoperative radiotherapy is important to improve OS and DFS.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241267737"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Vestibuloocular Reflex Gain and Dynamic Visual Acuity Responsible of Oscillopsia After Complete Unilateral Vestibular Loss?","authors":"Emeline Drapier, Edwin Regrain, Laurent Seidermann, Christian Van Nechel, Marc Labrousse, Jean-Charles Kleiber, Arnaud Bazin, Esteban Brenet, Xavier Dubernard","doi":"10.1177/19160216241265091","DOIUrl":"10.1177/19160216241265091","url":null,"abstract":"<p><strong>Background: </strong>Acute and complete unilateral vestibular deafferentation induces a significant change in ipsilateral vestibuloocular reflex gain, making the patient unable to stabilize gaze during active or passive head movements. This inability creates the illusion that the visual environment is moving, resulting in persistent visual discomfort during rapid angular or linear acceleration of the head. This is known as oscillopsia. Our objective was to understand if the spontaneous sensation of oscillopsias after complete unilateral vestibular deafferentation by vestibular neurotomy at 5 days (D5) and at 3 months (M3) is correlated with the loss of vestibuloocular reflex gain and dynamic visual acuity.</p><p><strong>Methods: </strong>Retrospective cohort study was conducted in an otolaryngology tertiary care center (2019-2022) on patients with complete unilateral vestibular loss by vestibular neurotomy. They were divided into 2 groups according to the presence (group G1) or absence (group G2) of a spontaneous complaint of oscillopsia assessed at M3. Severity of oscillopsias evaluated by Oscillopsia Severity Questionnaire. Vestibuloocular reflex gain based on video head impulse test (vHIT) and the dynamic visual acuity were measured for each group at D5 and M3. Categorical variables were compared using χ² test and quantitative variables using the nonparametric Wilcoxon-Mann-Whitney test.</p><p><strong>Results: </strong>All patients have a complete vestibular deafferentation at D5 and M3. At D5 (G1 = 8 patients, G2 = 5 patients), there is no significant difference for ipsilateral and contralateral vestibuloocular reflex gains and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.68 ± 1.03 in G1 and 1.23 ± 1.03 in G2 (<i>P</i> < .05). At M3 (G1 = 9 patients, G2 = 6 patients), there is no significant difference between groups for epidemiologic and clinical data and for vestibuloocular reflex and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.10 ± 0.63 in G1 and 1.24 ± 0.28 in G2 (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>The spontaneous disabling sensation of oscillopsia after complete unilateral vestibular loss is well assessed by the Oscillopsia Severity Questionnaire but cannot be explained by objective vestibular tests assessing vestibuloocular reflex gain (vHIT) or dynamic visual acuity loss at D5 or M3. Further studies are needed to measure the sensation of oscillopsia under real-life conditions and to identify the factors responsible for its persistence.</p><p><strong>Trial registration: </strong>Retrospectively registered.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241265091"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Unnecessary Instruments in Tonsil Hemorrhage Trays at a Canadian Tertiary Care Center: A Quality Improvement Project.","authors":"Kylen Van Osch, Edward Madou, Sheena Belisle, Julie E Strychowsky","doi":"10.1177/19160216241267719","DOIUrl":"10.1177/19160216241267719","url":null,"abstract":"<p><strong>Background: </strong>In the emergency department (ED), there are pre-assembled tonsillar hemorrhage trays for management of post-tonsillectomy hemorrhage and peritonsillar abscess. After use, the tray is sent to the medical device reprocessing (MDR) department for decontamination, sterilization, and re-organization, all at a significant cost to the hospital and environment.</p><p><strong>Objective: </strong>The goal of this project was to reduce unnecessary instruments on the tonsil hemorrhage tray by 30% by 1 year and report on the associated cost and carbon dioxide (CO₂) emissions savings.</p><p><strong>Methods: </strong>This quality improvement project was framed according to the Institute for Healthcare Improvement's Model for Improvement. ED and Otolaryngology-Head & Neck Surgery staff and residents were surveyed to determine which instruments on the tonsil hemorrhage trays were used regularly. Based on results, a new tray was developed and compared to the old tray using MDR data and existing CO₂ emissions calculations.</p><p><strong>Results: </strong>Tray optimization resulted in a total cost reduction from $1092.63 to $330.21 per tray per year, decreased processing time from 12 to 6-8 minutes per tray, and decreased CO₂ emissions from 6.11 to 2.85 kg per year for the old versus new tray, respectively. Overall, the new tray contains half the number of instruments, takes half the time to assemble, produces 50% less CO₂ emissions, and will save the hospital approximately $100,000 over 10 years.</p><p><strong>Conclusion: </strong>Healthcare costs and environmental sustainability are collective responsibilities. Surgical and procedure tray optimization is a simple, effective, and scalable form of eco-action.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241267719"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Different Concentrations of Epinephrine in Otoendoscopic Surgery on Surgical Field Clarity: A Double-Blind, Randomized Study.","authors":"Wenying Shu, Tingting Jin, Jinya Shi, Jingjie Li, Zhaoyan Wang","doi":"10.1177/19160216241288811","DOIUrl":"10.1177/19160216241288811","url":null,"abstract":"<p><strong>Importance: </strong>At present, there is no consensus on the concentration of epinephrine/physiological saline for subcutaneous injection into external auditory canal (EAC) under general anesthesia in otoendoscopic surgery. A randomized controlled trial (RCT) research is needed to provide reference, as this concentration can provide satisfactory surgical field clarity while maintaining patients' hemodynamic stability.</p><p><strong>Objective: </strong>Comparison of the effect of subcutaneous injection of different concentrations of epinephrine/physiological saline into EAC under general anesthesia in otoendoscopic surgery on surgical field clarity and hemodynamics.</p><p><strong>Design: </strong>This double-blind, RCT study was about the effect of topical epinephrine injection in otoendoscopic surgery.</p><p><strong>Setting: </strong>This study was conducted at a single institution.</p><p><strong>Participants: </strong>This study included 168 patients conformed to the inclusion criteria.</p><p><strong>Intervention: </strong>Patients were randomized to receive different concentrations of epinephrine/physiological saline injection (1:5000, 1:10,000, 1:20,000, or 1:40,000) into the junction of bone and cartilage at posterior wall of EAC during surgery.</p><p><strong>Main outcome measures: </strong>Surgical field clarity was assessed with surgical field clarity grading scale and tympanic membrane flap flipping time. Hemodynamic changes were monitored by clinical parameters of blood pressure, heart rate, and ST segment of ECG.</p><p><strong>Results: </strong>There were no statistically-significant differences in surgical field clarity grade (<i>P</i> = .577) and tympanic membrane flap flipping time (<i>P</i> = .490) among 4 concentration groups. Epinephrine injection did cause an increase in hemodynamic parameters when compared with baseline (<i>P</i> < .05). Compared with the relatively-lower concentration groups (1:20,000 and 1:40,000), the relatively-higher concentration groups (1:5000 and 1:10,000) had more significant and long-lasting effect until 30 minutes after injection.</p><p><strong>Conclusions and relevance: </strong>Four concentration groups of topical epinephrine injection in otoendoscopic surgery have the same effect on surgical field clarity. For the stability of patients' hemodynamics, we would prefer to recommend the use of concentrations with minimal impact on hemodynamics, ranging from 1:20,000 to 1:40,000.</p><p><strong>Trial registration: </strong>Clinical Trial Registry-China: ChiCTRI1800016647.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241288811"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}