Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Convolutional Neural Network for Classification of Oropharynx Cancer with Video Nasopharyngolaryngoscopy.","authors":"Ryan Gifford, Abigail Reid, Sachin R Jhawar, Kyle VanKoevering, Samantha Krening","doi":"10.1177/19160216251326590","DOIUrl":"10.1177/19160216251326590","url":null,"abstract":"","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251326590"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657336","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":"In-Office Balloon Dilation for Idiopathic Subglottic Stenosis: A Pilot Study.","authors":"Catherine F Roy, Antonia Lagos-Villaseca, José A Correa, Jennifer A Silver, Eli Layous, Anne V Gonzalez, Jonathan Young, Karen M Kost","doi":"10.1177/19160216251314764","DOIUrl":"10.1177/19160216251314764","url":null,"abstract":"<p><p>ImportanceIdiopathic subglottic stenosis is a debilitating and recurrent disease, often requiring reintervention. Balloon dilation is a well-recognized, minimally invasive treatment to alleviate symptoms, and is typically performed in the operating room. In-office balloon dilation in the awake patient has rarely been reported, and may obviate the need for general anesthesia in this patient population.ObjectiveThis study aims to detail the safety and efficacy of in-office balloon dilation for mild to moderate subglottic stenosis.DesignMixed-methods study.SettingSingle tertiary-care institution in Montreal, Canada.Participants and InterventionAll adult patients with Cotton-Myer Grade I-II idiopathic subglottic stenosis undergoing in-office balloon dilation between June 1, 2022 and August 1, 2023 were prospectively recruited.Main Outcome MeasuresPre- and post-procedure validated dyspnea and voice scales, airway diameter and spirometry values were obtained. Patient- and physician-reported adverse events were thoroughly documented.ResultsEleven patients underwent in-office balloon dilation during the study period (F:M 10:1, mean age 55.8 years). The median Dyspnea Index and voice handicap index-10 scores both significantly decreased following the procedure. In-office balloon dilation improved airway patency, with an estimated median of 40% to 10% stenosis (median difference -25%, 95% CI (-45, -15), <i>P</i> = .003). The normalized peak expiratory flow percentage significantly increased from a median of 62% to 99% (median difference 27%, 95% CI (19, 40), <i>P</i> = .004). The median time to regular activities was one day. Six patients having previously undergone the procedure under general anesthesia indicated a preference for in-office dilation. There were no severe adverse events.Conclusion and RelevanceIn-office balloon dilation is a safe and effective option for the management of mild-moderate idiopathic subglottic stenosis, with demonstrated improvement in both patient-reported outcomes and objective measures.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251314764"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753084","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":"Punch Biopsy for Preoperative Depth of Invasion Assessment in Early Oral Tongue Squamous Cell Carcinoma: A Prospective Pilot Study.","authors":"Béatrice Voizard, Gabriel S Dayan, Olguta-Ecaterina Gologan, Tareck Ayad, Eric Bissada, Louis Guertin, Paul Tabet, Guillaume B Cardin, Laurent Létourneau-Guillon, Apostolos Christopoulos","doi":"10.1177/19160216251321452","DOIUrl":"10.1177/19160216251321452","url":null,"abstract":"<p><p>ImportanceThe inclusion of depth of invasion (DOI) in the American Joint Committee on Cancer's staging system for oral tongue squamous cell carcinoma (OTSCC) has major clinical implications. Few studies have evaluated the accuracy of preoperative biopsy to predict DOI.ObjectiveTo evaluate the reliability of preoperative punch biopsy for measuring DOI in early OTSCC and compare it to evaluation by digital palpation. Secondarily, to assess the punch biopsy's ability to differentiate between carcinoma in situ (Tis) and invasive carcinoma.DesignA prospective single-center cohort study.SettingCenter Hospitalier de l'Université de Montréal, a tertiary center in Canada.ParticipantsPatients with suspected early stage OTSCC.InterventionPunch biopsy was used to sample the deepest part of tumors to measure biopsy-derived DOI (bDOI). In addition, DOI was estimated via digital palpation: clinical DOI (cDOI) by surgeons.Main Outcome MeasuresPathologic DOI (pDOI) from final histopathology reports was the gold standard. Spearman's correlations were calculated between cDOI, bDOI, and pDOI. Diagnostic performance metrics were calculated for the ability to distinguish pDOI of ≥2 mm, and to differentiate Tis from invasive carcinoma.ResultsAmong 27 patients, correlation coefficients between bDOI and pDOI, and cDOI and pDOI were 0.603 (95% CI: 0.202-0.884) and 0.894 (95% CI: 0.749-0.955), respectively. Punch biopsy sensitivity and specificity were 0.88 (95% CI: 0.62-0.98) and 0.91 (95% CI: 0.59-0.99) to detect pDOI ≥ 2 mm, and 0.89 (95% CI: 0.65-0.99) and 0.86 (95% CI: 0.42-1.00) for distinguishing Tis from invasive carcinoma. Digital palpation sensitivity and specificity for pDOI ≥ 2 mm were 0.86 (95% CI: 0.57-0.98) and 1.00 (95% CI: 0.63-1.00).ConclusionsPunch biopsy and clinical palpation demonstrate high diagnostic yield for identifying lesions with pDOI ≥ 2 mm. Punch biopsy appears to be reliable to distinguish Tis from invasive carcinoma.RelevanceLarger studies are needed to corroborate these findings and assess the role of punch biopsy in guiding elective neck dissection decisions.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321452"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764197","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":"Management of Anterior Epistaxis in the Emergency Department Using Rapid Rhino and Merocel: A Cost Analysis.","authors":"Dhatri Shukla, James Fowler, Taciano Rocha, Sisira Sarma, Leigh Sowerby","doi":"10.1177/19160216251321459","DOIUrl":"10.1177/19160216251321459","url":null,"abstract":"<p><strong>Importance: </strong>Epistaxis affects approximately 60% of the population over their lifetime. When conservative attempts fail, nasal tampons are often required to stop anterior bleeding. Health economics is critical in our publicly funded system. Determination of cost-effective interventions is crucial.</p><p><strong>Objective: </strong>To compare the total cost of Merocel and Rapid Rhino from the perspective of a provincial payer and an academic hospital for the management of anterior epistaxis.</p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>London Health Sciences Centre emergency department (Victoria and University campus).</p><p><strong>Participants: </strong>Patients ≥18 years of age presenting with anterior epistaxis. The participants were 67% men and 33% women. Approximately, 63% were on anticoagulant medication, and 35% used an ambulance to arrive at the hospital.</p><p><strong>Intervention: </strong>Rapid Rhino or Merocele, which was dependent on the site of presentation.</p><p><strong>Main outcome measures: </strong>Rebleed rate.</p><p><strong>Results: </strong>The rate of rebleeds with Merocel was 42% (26/62), whereas it was 24% (4/17) with Rapid Rhino. The inverse probability weighted regression adjustment results show that patients receiving Rapid Rhino did not have a statistically significant difference in costs per patient ($62.40, 95% CI: -$25.75 to $150.55) from the hospital perspective or the provincial health care payer perspective ($78.25, 95% CI: -$18.38 to $174.89).</p><p><strong>Conclusion and relevance: </strong>There was no significant difference in cost between Rapid Rhino and Merocel for anterior epistaxis from a hospital or provincial payer perspective.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321459"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468517","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":"Vestibular Implant Surgery: How to Deal With Obstructed Semicircular Canals-A Diagnostic and Surgical Guide.","authors":"Raymond van de Berg, Joost Johannes Antonius Stultiens, Marc van Hoof, Vincent Van Rompaey, Janke Roelofke Hof, Bernd Lode Vermorken, Benjamin Volpe, Elke Maria Johanna Devocht, Angélica Pérez Fornos, Alida Annechien Postma, Vincent Lenoir, Minerva Becker, Nils Guinand","doi":"10.1177/19160216241291809","DOIUrl":"10.1177/19160216241291809","url":null,"abstract":"<p><strong>Background: </strong>A vestibular implant can partially restore vestibular function by providing motion information through implanted electrodes. During vestibular implantation, various obstructions of the semicircular canals, such as protein deposits, fibrosis, and ossification, can be encountered. The objective was to explore the relationship between preoperative imaging and intraoperative findings of semicircular canal obstruction and to develop surgical strategies for dealing with obstructions of the semicircular canal(s) in patients eligible for vestibular implantation.</p><p><strong>Methods: </strong>Patients undergoing vestibulocochlear implantation (in an active clinical trial) were included in the current study when preoperative imaging indicated an obstruction in the semicircular canal. Preoperative imaging consisted of CT and MRI scans. During surgery, the bony semicircular canals were skeletonized (\"bluelined\") to identify the course of the canals and create a fenestration to insert the electrodes. The aim was to place the electrodes in the semicircular canal ampullae. Surgical strategies were developed to deal with the soft tissue obstructions. These procedures were evaluated intraoperatively with microscopic visualization, postoperatively with CT imaging.</p><p><strong>Results: </strong>The three included patients suffered from bilateral vestibulopathy and hearing loss due to autosomal dominant nonsyndromic sensorineural deafness 9 (DFNA9). A soft tissue obstruction was predicted in one semicircular canal (2 patients) or two semicircular canals (1 patient), based on preoperative imaging. Intraoperatively, bluelining the semicircular canals aided in identifying these locations, by revealing a \"whiteline\" instead of blueline. Depending on the nature and location of the obstruction, different surgical procedures were employed to facilitate proper electrode insertion. These were as follows: a dummy electrode was used to probe the soft tissue, the obstructive tissue was removed, and/or a bypass fenestration was created. In all patients, the electrodes could be implanted in the semicircular canal ampullae. Based on these first experiences, a diagnostic and surgical guide to deal with obstructions of the semicircular canals during vestibular implantation was developed.</p><p><strong>Conclusions: </strong>Preoperative imaging can indicate locations of obstructions in the SCCs. Different surgical procedures can be applied to enable appropriate electrode positioning in the SCC ampulla. This article describes the first experiences with obstructions of the semicircular canals during intralabyrinthine vestibular implantation and presents a diagnostic and surgical guide.</p><p><strong>Trial registration: </strong>ABR NL73492.068.20, METC20-087 (Maastricht University Medical Center) and NAC 11-080 (Geneva University Hospitals).</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216241291809"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915102","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":"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":"Immediate Effects of Nasalance Exercises on Patients with Organic Dysphonia.","authors":"Liudmila Kuranova, Marie-Anne Kainz, Matthias Echternach, Michael Döllinger, Marie Köberlein","doi":"10.1177/19160216251333360","DOIUrl":"10.1177/19160216251333360","url":null,"abstract":"<p><p>ImportanceNasalance exercises (also known as resonance exercises) are widely used in voice therapy. Understanding their effects can guide therapeutic approaches and surgical decisions.ObjectiveTo analyze the immediate effects of nasalance exercises on vocal fold oscillation in patients with vocal fold mass lesions and a recommendation for phonosurgery.DesignProspective observational study following the STROBE guidelines.SettingDepartment of Phoniatrics, university hospital.ParticipantsSeven patients with vocal fold mass lesions (6 with polyps, 1 with Reinke edema) and indication for surgery.Intervention/ExposuresParticipants performed nasalance exercises for 10 minutes. Recordings were taken before the exercise (pre), immediately after (post0), and 10 minutes after completion (post10). Subjects phonated vowel [i:] on a sustained pitch (250 Hz for females, 125 Hz for males) at a comfortable level of loudness.Main Outcome MeasuresData were collected using transnasal high-speed videoendoscopy, a Rothenberg mask for airflow measurement, electroglottography, and audio recordings. Extracted parameters were: nasalance, open quotient (OQ), closing quotient (ClQ), sound pressure level (SPL), Jitter, and cepstral peak prominence (CPP).ResultsNasalance increased immediately after the exercises for 6 out of 7 subjects. OQ values varied: they increased in 3 subjects, decreased in 3, and remained unchanged in 1. No consistent relationship was found between SPL and ClQ. Jitter increased in 5 subjects. CPP did not show clear tendencies. The effects on voice parameters did not persist 10 minutes postexercise. There were no significant correlations with age, sex, or preintervention voice indices (Voice Handicap Index, Dysphonia Severity Index).ConclusionsIn patients with organic dysphonia and an indication for surgery, a raised nasalance value directly after the execution of nasalance exercises does not necessarily lead to stabilized voice parameters, and the possible effects do not seem to be persistent.RelevanceNasalance exercises might not provide sustained benefits in stabilizing vocal fold vibrations in subjects with an indication for surgery.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251333360"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110988","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":"Role of Publicly-Funded Molecular Testing in Surgical Management of Thyroid Nodules within Canadian Medicare: Clinical Assessment of ThyroSeqv3 Molecular Test Pilot Project at McGill University.","authors":"Saruchi Bandargal, Jessica Hier, Mawaddah Abdulhaleem, Véronique-Isabelle Forest, Maryse Brassard, Geneviève Rondeau, Orr Dimitstein, Marco A Mascarella, Alex Mlynarek, Michael P Hier, Keith Richardson, Nader Sadeghi, Karen M Kost, Anthony Zeitouni, Marc Philippe Pusztaszeri, Pierre Fortier, Danielle Beaudoin, Marie-Helene Massicotte, Andree Boucher, Richard J Payne","doi":"10.1177/19160216251336687","DOIUrl":"10.1177/19160216251336687","url":null,"abstract":"<p><p>ImportanceRecently, the Québec public health care system established a pilot project to cover costs of molecular testing for select patients with cytologically-indeterminate thyroid nodules.ObjectiveThis study aimed to evaluate the clinical utility of the ThyroSeqv3 molecular test pilot project at McGill University in surgical management of thyroid nodules within Canada's single-payer health care system.DesignMulticenter cohort study, in liaison with the Québec Health Ministry.SettingJewish General Hospital and Royal Victoria Hospital in Montreal, Canada.ParticipantsPatients with a Bethesda III or IV and TIRADS 3 or 4 thyroid nodule measuring between 1 and 4 cm in size on ultrasound were analyzed across pre- and post-pilot project phases.InterventionThe pre-pilot project surgical control group included patients who underwent surgical intervention, excluding those who opted for out-of-pocket molecular testing. The post-pilot project surgical exposure group encompassed participants in the pilot project, undergoing publicly-funded ThyroSeqv3 molecular testing and subsequent surgical intervention.Main Outcome MeasuresSurgical malignancy/noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) rate.ResultsA total of 314 patients qualified for the pilot project, with 207 (65.9%) having Bethesda III nodules and 107 (34.1%) having Bethesda IV nodules. Molecular testing yielded a result of negative in 238 (75.8%) cases and positive in 76 (24.2%) cases. Histopathology reports of positive patients who opted for surgery revealed a surgical malignancy/NIFTP rate of 73.1%. The surgical malignancy/NIFTP rate at our institution prior to the implementation of the pilot project for patients adhering to the inclusion criteria was statistically significantly lower at 47.9% (<i>P</i> = .0025).ConclusionsThe ThyroSeqv3 molecular test pilot project has improved upon physicians' traditional clinical practice by enabling a wider patient population to access this otherwise costly technology. It not only curtailed futile diagnostic hemithyroidectomies but also led to a more discerning allocation of surgeries, as corroborated by an increased surgical malignancy/NIFTP rate post-implementation.RelevanceThe results of our study suggest that publicly-funded molecular testing could contribute positively to the Canadian single-payer health care system by optimizing patient outcomes as well as fiscal policy.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251336687"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159642","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}