Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Biologics in the Treatment of Chronic Rhinosinusitis with Nasal Polyposis in Canada: Current Trends and Practice Patterns.","authors":"Alexie J Ouellette, Andrew Thamboo, Leigh J Sowerby, Christopher J Chin","doi":"10.1177/19160216241307551","DOIUrl":"10.1177/19160216241307551","url":null,"abstract":"<p><strong>Objectives: </strong>As the understanding of the pathophysiology of chronic rhinosinusitis has increased over the last few years, it has been discovered that biologic therapy targeting type 2 inflammatory molecules can be beneficial for those with difficult-to-treat chronic rhinosinusitis with nasal polyposis. Given the recency of biologics, there is somewhat limited evidence on when to prescribe these medications and who should receive them. A recent consensus paper published by a group of Canadian rhinologists gave recommendations regarding prescribing biologics to patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This study aimed to outline current practices and prescribing patterns of biologics for chronic rhinosinusitis in Canada and contrast this to existing guidelines.</p><p><strong>Materials/methods: </strong>An online survey was distributed to members of the Canadian Rhinology Group of the Canadian Society of Otolaryngology-Head and Neck Surgery. The survey contained 44 questions, with 17 questions covering various topics related to criteria for initializing biologic therapy, investigations ordered prior to initialization of a biologic, and follow-up schedules. The responses were subsequently compared to clinical guidelines.</p><p><strong>Results: </strong>Twenty-one physicians responded to the survey. One response was discarded for this analysis as the respondent did not prescribe biologics. The biologic agent of choice for the majority of physicians (85%) was Dupilumab (Dupixent). The most used patient-reported outcome measure used was the SNOT-22 (80%), and most physicians (90%) confirm that their patients have undergone adequate sinus surgery with a computed tomography (CT) scan prior to considering biologic therapy. Investigations ordered prior to therapy and follow-up schedules varied. Only 10% of respondents consistently refer their patients to a multidisciplinary clinic prior to prescribing biologics despite recommendations in guidelines, but 70% involve an allergist and/or a respirologist in the care of these patients.</p><p><strong>Conclusions: </strong>Most respondents follow the recommendations made by the Canadian and international guidelines [European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)]. The lack of multidisciplinary clinics across the country could be contributing to the low number of physicians using this resource for their patients despite recommendations. As our knowledge about biologics and CRSwNP improves, and with updated guidelines recently published, this survey should be expanded and repeated in the future to revaluate biologic prescribing practices in Canada.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241307551"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399396","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":"A Comparison of Transoral Versus Transcervical Surgical Approaches to Retropharyngeal Lymphadenectomy: A Scoping Review.","authors":"Sharon Tzelnick, Jillian Tsai, Ali Hosni, David P Goldstein, John R de Almeida, Christopher M K L Yao","doi":"10.1177/19160216241265092","DOIUrl":"10.1177/19160216241265092","url":null,"abstract":"<p><strong>Importance: </strong>A gap in knowledge exists concerning the functional outcomes and complications when comparing various surgical approaches for retropharyngeal lymph node (RPLN) metastases.</p><p><strong>Objective: </strong>To explore perioperative outcomes, functional outcomes, and complications associated in the treatment of RPLN metastases.</p><p><strong>Design: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the PubMed and Scopus databases.</p><p><strong>Review methods: </strong>We systematically searched 2 databases from inception to January 2023 for articles examining the treatment approaches and postoperative outcomes in the retropharyngeal space. We included English records about surgical approaches, complications, functional outcomes for patients >18 years old with retropharyngeal lymphadenopathy.</p><p><strong>Results: </strong>One-hundred ninety-nine articles were identified, of which 17 were included in the analysis. Three studies assessed RPLN dissection in the postradiation setting. We identified limited knowledge about functional outcomes and complications following surgery for retropharyngeal lymphadenopathy. Overall, acute postoperative dysphagia was documented in 35/170 patients (20.5%). However, the assessment of dysphagia was limited, and not described in the majority of studies. The overall rate of postoperative neuropathy and hematoma were 4.1% and 4.7%, respectively. No postoperative hematomas were documented in the transcervical approach.</p><p><strong>Conclusion: </strong>Our findings underscore the need for further research on postoperative outcomes following RPLN dissection. We recommend further studies focusing on objective swallow assessments and long-term outcomes of either surgical approaches.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241265092"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792706","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 a Non-Surgical Adhesive Bone Conduction Device on Temporal Processing Performance in Adults with Single Sided Deafness: A Pilot Study.","authors":"Li Qi, Elizabeth Hui, Desmond A Nunez","doi":"10.1177/19160216241296136","DOIUrl":"10.1177/19160216241296136","url":null,"abstract":"<p><strong>Background: </strong>There is a dearth of information on the effects of bone conductive devices on temporal processing in individuals with single-sided deafness (SSD). This study investigates the effect of an adhesive bone conductive device on temporal processing in adults with SSD.</p><p><strong>Methods: </strong>A prospective cohort study of temporal processing in adults with SSD was undertaken. Outcome measures were the pitch pattern test (PPT) and the duration pattern test (DPT) scores, sound field pure tone audiometric (PTA) averaged hearing thresholds, and word recognition scores (WRS). These were measured under 3 conditions: unaided in quiet, unaided in noise, and aided in noise. Eight SSD novice hearing amplification users were recruited.</p><p><strong>Results: </strong>The adhesive bone conduction device (BCD) resulted in a statistically-significant improvement (Wilcoxon signed ranks test, <i>P</i> = .018) in median [interquartile range (IQR)] PPT score, 65% (IQR = 35.5), and DPT score, 38% (IQR = 42.5) in noise.</p><p><strong>Conclusions: </strong>Adults with SSD demonstrated improved temporal processing scores with masking of the normal-hearing ear when using an adhesive BCD placed behind the deafened ear.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241296136"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854278","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":"Evaluating Perceptions of Head and Neck Surgeons on the Role of Single-Entry Models in Managing Surgical Waitlists in Ontario: A Qualitative Study.","authors":"Justin Shapiro, Charlotte Axelrod, Ben B Levy, Saruchi Bandargal, Emily C Steinberg, Emily Wener, John de Almeida, Joel Davies, Brian Rotenberg, Antoine Eskander, Janet Chung, David Urbach, Yvonne Chan","doi":"10.1177/19160216241286793","DOIUrl":"10.1177/19160216241286793","url":null,"abstract":"<p><strong>Background: </strong>Long surgical wait times have long plagued health systems in Canada and abroad. This backlog and associated strain on health human resources has been exacerbated by the COVID-19 pandemic, affecting surgeries of varying degrees of urgency across all surgical specialties, including head and neck surgery. Single-entry models (SEMs) are being increasingly studied as one possible strategy to help manage surgical wait times, and a growing number of health systems have implemented SEMs within departments such as otolaryngology-head and neck surgery. We sought to evaluate the views of head and neck surgeons at all 8 designated head and neck cancer centers across Ontario on the role of SEMs in managing surgical backlogs.</p><p><strong>Results: </strong>We interviewed 10 Ontario head and neck surgeons on the role of SEMs in managing wait times within the field. The following themes were elicited from interview transcripts: (1) anticipated positive impact, (2) barriers to implementation, (3) patient experience, and (4) roadmap to implementation. Participants agreed that SEMs may have utility for certain types of surgeries if implemented to address local needs. They also believe this model would have the greatest impact if employed together with other approaches, such as increasing operating room time or nursing availability.</p><p><strong>Conclusion: </strong>Our results highlighted the necessity for a nuanced approach to single-entry model implementation in head and neck surgery. While participants recognized the utility of SEMs for high-volume and low-variation surgeries, participants remained divided on the optimal approach to triaging patients necessitating more complex oncologic treatments. Deliberate collaboration among stakeholder organizations and senior surgeons will be critical if SEMs are to succeed in an intricate and political healthcare environment.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241286793"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348614","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":"Timing of Surgery and Outcomes in Chronic Rhinosinusitis: A Narrative Review and Meta-Analysis.","authors":"Christopher M Bell, Jonathan Yip","doi":"10.1177/19160216241248541","DOIUrl":"10.1177/19160216241248541","url":null,"abstract":"<p><strong>Background: </strong>Surgery is often indicated in the treatment of medically recalcitrant chronic rhinosinusitis (CRS). There is conflicting evidence on the impact of timeliness of sinus surgery on the degree of perceived symptom improvement in CRS.</p><p><strong>Objective: </strong>The goal of this study was to systematically evaluate the available literature on the relationship between patient wait times for endoscopic sinus surgery (ESS) and postoperative changes in patient-reported outcome measures.</p><p><strong>Methods: </strong>Ovid, MEDLINE, CINAHL, and Cochrane Library of Systematic Reviews between January 2000 and September 1, 2023, were searched. A total of 931 studies were independently screened by 2 reviewers. Two studies were included in the meta-analysis, while 4 others were included in a narrative review.</p><p><strong>Results: </strong>Two studies consisting of 1606 patients were included in the meta-analysis. A mean difference in 22-Item Sino-Nasal Outcome Test (SNOT-22) of -0.3 (95% CI = -3.9 to 3.3, <i>I</i>² = 89%, <i>P</i> < .01 was observed between \"long\" and \"short\" groups, while a mean difference in SNOT-22 of -0.1 (95% CI = -2.5 to 2.3, <i>I</i>² = 80%, <i>P</i> = .03) was observed between \"long\" and \"mid\" groups. Patients who receive surgery earlier on their disease process (ie, earlier from the time of diagnosis to eventual surgery) appear to require less access to healthcare resources including prescription medications, thus suggesting better disease control.</p><p><strong>Conclusion: </strong>There is conflicting evidence to conclude whether timing of ESS affects disease-specific measures in patients with CRS. Patients who receive surgery earlier appear to have lower demands on healthcare utilization including visits and prescription use. Our study suggests there is a need for increased access to surgical specialists who manage patients with CRS, and better understanding by primary care specialists in how to manage CRS when specialist access is not available.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241248541"},"PeriodicalIF":3.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419600","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":"Canadian French Translation and Validation of the Neck Dissection Impairment Index: A Quality of Life Measure for the Surgical Oncology Population.","authors":"Michel Khoury, William Guertin, Cameo Hao, Mikhail Saltychev, Tareck Ayad, Eric Bissada, Apostolos Christopoulos, Sami Moubayed, Marie-Jo Olivier, Douglas Chepeha, Stephen Y Lai, Anastasios Maniakas","doi":"10.1177/19160216241263852","DOIUrl":"10.1177/19160216241263852","url":null,"abstract":"<p><strong>Background: </strong>Neck dissections (ND) are a routine procedure in head and neck oncology. Given the postoperative functional impact that some patients experience, it is imperative to identify and track quality of life (QoL) symptomatology to tailor each patient's therapeutic needs. To date, there is no validated French-Canadian questionnaire for this patient-population. We therefore sought to translate and validate the Neck Dissection Impairment Index (NDII) in Canadian French.</p><p><strong>Methods: </strong>A 3-phased approach was used. Phase 1: The NDII was translated from English to Canadian French using a \"forward and backward\" translational technique following international guidelines. Phase 2: A cognitive debriefing session was held with 10 Canadian French-speaking otolaryngology patients to evaluate understandability and acceptability. Phase 3: The final version was administered prospectively to 30 patients with prior history of ND and 30 control patients. These patients were asked to complete the questionnaire 2 weeks after their first response. Test-retest reliability was calculated with Spearman's correlation. Internal consistency was elicited using Cronbach's alpha.</p><p><strong>Results: </strong>NDII was successfully translated and validated to Canadian French. Cronbach's alpha revealed high internal consistency (0.92, lower 95% confidence limit 0.89). The correlation for test-retest validity were strong or very strong (0.61-0.91).</p><p><strong>Conclusion: </strong>NDII is an internationally recognized QoL tool for the identification of ND-related impairments. This validated Canadian French version will allow clinicians to adequately assess the surgery-related QoL effect of neck surgery in the French-speaking population, while allowing French institutions to conduct and/or participate in multisite clinical trials requiring the NDII as an outcome measure.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241263852"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427082","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":"Hypothyroidism Predicts Fistula Development Following Salvage Oropharyngectomy.","authors":"Andrew D P Prince, Zachary M Huttinger, Molly E Heft-Neal, Steven B Chinn, Kelly M Malloy, Chaz L Stucken, Keith A Casper, Mark E P Prince, Matthew E Spector, Andrew J Rosko","doi":"10.1177/19160216241296126","DOIUrl":"10.1177/19160216241296126","url":null,"abstract":"<p><strong>Importance: </strong>Previous work demonstrated postoperative hypothyroidism adversely affects wound healing in salvage laryngectomy. Currently, no studies have evaluated the association between wound healing and hypothyroidism in patients undergoing salvage oropharyngectomy.</p><p><strong>Objective: </strong>The primary objective was studying hypothyroidism and other factors associated with oropharyngocutaneous fistula development and fistula requiring reoperation within 30 days after salvage oropharyngectomy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary academic center.</p><p><strong>Participants: </strong>All patients who underwent salvage oropharyngectomy for recurrent or second primary oropharyngeal squamous cell carcinoma between 2001 and 2017 after radiation or chemoradiation. Patients with no preoperative thyroid-stimulating hormone (TSH) values were excluded.</p><p><strong>Exposures: </strong>Salvage oropharyngectomy for recurrent or second primary oropharyngeal squamous cell carcinoma.</p><p><strong>Main outcomes measures: </strong>The principle explanatory variable was postoperative hypothyroidism, defined as TSH greater than 5.5 mIU/L. Univariate, bivariate, and binary logistical regression multivariate analysis was performed.</p><p><strong>Results: </strong>Fifty-three patients met inclusion criteria, 37.7% of patients developed hypothyroidism, 18.9% developed a fistula, and 9.4% required an operation to manage the fistula. Postoperative fistula rate was 35% among hypothyroid patients, which was significantly greater than among euthyroid patients (9.1%; <i>P</i> = .03). A fistula requiring reoperation occurred in 20% of hypothyroid patients compared with that of euthyroid patients (3%; <i>P</i> = .061). In a multivariate analysis, postoperative hypothyroid patients were at a 9.5-fold increased risk of developing a fistula [95% confidence interval (CI) 1.6-57.0, <i>P</i> = .013]. Additionally, postoperative hypothyroid patients were at 13.6-fold increased risk for development of a fistula requiring reoperation (95% CI 1.2-160.5, <i>P</i> = .038).</p><p><strong>Conclusions and relevance: </strong>Postoperative hypothyroidism in patients who underwent salvage oropharyngectomy can predict fistula development and fistula requiring operative management. This study supports the treatment of hypothyroidism after surgery to reduce wound complications.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241296126"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604776","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":"Microbial Dysbiosis in Nasopharyngeal Carcinoma: A Pilot Study on Biomarker Potential.","authors":"Yen-Ting Lu, Chung-Han Hsin, Chun-Yi Chuang, Cheng-Chen Huang, Mao-Chang Su, Wei-Sheng Wen, Shao-Hung Wang, Yih-Yuan Chen, Cheng-Yang Lee, Yu-Xuan Li, Ying-Chou Lu, Tzu-Hao Chang, Shun-Fa Yang","doi":"10.1177/19160216241304365","DOIUrl":"10.1177/19160216241304365","url":null,"abstract":"<p><strong>Importance: </strong>Nasopharyngeal carcinoma (NPC) is closely linked to microorganisms, especially intra-tumoral microbiota. However, the role of commensal microbiota in NPC remains underexplored, with implications for understanding disease mechanisms.</p><p><strong>Objective: </strong>This study aims to analyze and compare the bacterial microbiota in the nasopharynx and middle meatus (MM) of individuals with NPC and those without NPC. Additionally, the study seeks to identify potential microbial biomarkers that can distinguish between NPC and non-NPC (nNPC) individuals.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Study conducted in a clinical setting with NPC and non-NPC participants to evaluate microbial diversity relevant to NPC.</p><p><strong>Participants: </strong>Ten NPC cases and 15 non-NPC controls were recruited based on clinical eligibility.</p><p><strong>Main outcome measures: </strong>Bacterial microbiota sampling from the nasopharynx and MM was analyzed by 16S rRNA sequencing. Microbiota diversity (alpha and beta diversity indices), presence of bacterial taxa with biomarker potential, and prediction model accuracy [area under the curve (AUC)].</p><p><strong>Results: </strong>Microbiota diversity was significantly lower in NPC patients versus controls. In nasopharyngeal samples, alpha diversity (Chao1 index, <i>P</i> = .02) and beta diversity (PERMANOVA, <i>P</i> = .001) differed notably between groups, though MM samples showed no significant difference (Chao1 index, <i>P</i> = .23). Machine learning identified <i>Pseudomonas, Cutibacterium</i>, and <i>Finegoldia</i> as potential NPC biomarkers (AUC = 0.86).</p><p><strong>Conclusions and relevance: </strong>This pioneering study highlights dysbiosis in nasopharyngeal microbiota among NPC patients. Findings suggest that <i>Pseudomonas, Cutibacterium</i>, and <i>Finegoldia</i> may be useful biomarkers for NPC diagnosis, warranting further investigation into microbial roles in NPC pathogenesis.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241304365"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864578","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 INMSG Survey on the Loss of Signal Management on the First Side During Planned Bilateral Thyroid Surgery.","authors":"Tzu-Yen Huang, Hsin-Yi Tseng, Francesco Frattini, Marika D Russell, Amr H Abdelhamid Ahmed, Frank Weber, Paulina Wierzbicka, I-Cheng Lu, Kwang Yoon Jung, Özer Makay, Young Jun Chai, Feng-Yu Chiang, Rick Schneider, Marcin Barczyński, Henning Dralle, Gregory W Randolph, Che-Wei Wu, Gianlorenzo Dionigi","doi":"10.1177/19160216241265684","DOIUrl":"10.1177/19160216241265684","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to describe the management and associated follow-up strategies adopted by thyroid surgeons with different surgical volumes when loss of signal (LOS) occurred on the first side of planned bilateral thyroid surgery, and to further define the consensus on intraoperative neuromonitoring (IONM) applications.</p><p><strong>Methods: </strong>The International Neural Monitoring Study Group (INMSG) web-based survey was sent to 950 thyroid surgeons worldwide. The survey included information on the participants, IONM team/equipment/procedure, intraoperative/postoperative management of LOS, and management of LOS on the first side of thyroidectomy for benign and malignant disease.</p><p><strong>Results: </strong>Out of 950, 318 (33.5%) respondents completed the survey. Subgroup analyses were performed based on thyroid surgery volume: <50 cases/year (n = 108, 34%); 50 to 100 cases/year (n = 69, 22%); and >100 cases/year (n = 141, 44.3%). High-volume surgeons were significantly (<i>P</i> < .05) more likely to perform the standard procedures (L1-V1-R1-S1-S2-R2-V2-L2), to differentiate true/false LOS, and to verify the LOS lesion/injury type. When LOS occurs, most surgeons arrange otolaryngologists or speech consultation. When first-side LOS occurs, not all respondents decided to perform stage contralateral surgery, especially for malignant patients with severe disease (eg, extrathyroid invasion and poorly differentiated thyroid cancer).</p><p><strong>Conclusions: </strong>Respondents felt that IONM was optimized when conducted under a collaborative team-based approach, and completed IONM standard procedures and management algorithm for LOS, especially those with high volume. In cases of first-site LOS, surgeons can determine the optimal management of disease-related, patient-related, and surgical factors. Surgeons need additional education on LOS management standards and guidelines to master their decision-making process involving the application of IONM.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241265684"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875123","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":"Alterations of Gut Microbiome Composition and Function Pre- and Post-Adenotonsillectomy in Children with Obstructive Sleep Apnea.","authors":"Hai-Hua Chuang, Li-Ang Lee, Li-Pang Chuang, Hsueh-Yu Li, Yu-Shu Huang, Shih-Hsuan Chou, Guo-She Lee, Terry B J Kuo, Cheryl C H Yang, Chung-Guei Huang","doi":"10.1177/19160216241293070","DOIUrl":"10.1177/19160216241293070","url":null,"abstract":"<p><strong>Importance: </strong>Obstructive sleep apnea (OSA) in children is linked with alterations in the gut microbiome. The influence of adenotonsillectomy (AT), a primary intervention for OSA, on gut microbiota dynamics relative to disease severity remains to be elucidated.</p><p><strong>Objective: </strong>This study aimed to investigate the impact of OSA severity and AT on the gut microbiome in pediatric patients.</p><p><strong>Design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Participants: </strong>A cohort of 55 pediatric patients treated with AT for OSA.</p><p><strong>Intervention: </strong>Total tonsillectomy and adenoidectomy procedures.</p><p><strong>Main outcome measures: </strong>Comprehensive evaluations included in-laboratory polysomnography and 16S rRNA gut microbiome profiling at baseline, and again at 3rd and 12thmonth following surgery.</p><p><strong>Results: </strong>Initial findings showed uniform α-diversity across different severities of OSA, while β-diversity was significantly elevated in the severe OSA subgroup. Certain gut microbiota taxa (<i>Lachnospiraceae NK4A136 group</i>, <i>Ruminococcaceae UCG-002</i>, <i>Ruminococcaceae UCG-014</i>, <i>Alloprevotella</i>, <i>Christensenellaceae R-7 group</i>, <i>Ruminococcaceae UCG-005</i>, <i>Lactobacillus murinus</i>, and <i>Prevotella nigrescens</i>) were found to inversely correlate with the apnea-hypopnea index (AHI). Significant post-AT improvements in AHI and other polysomnographic metrics were observed. Notably, AHI changes post-AT were positively associated with microbial α-diversity (species richness), β-diversity, and specific bacterial taxa (<i>Enterobacter</i>, <i>Parasutterella</i>, <i>Akkermansia</i>, <i>Roseburia</i>, and <i>Bacteroides plebeius DSM 17135</i>), but negatively with other taxa (<i>Fusicatenibacter</i>, <i>Bifidobacterium</i>, <i>UBA1819</i>, <i>Ruminococcus gnavus group</i>, <i>Bifidobacterium longum subsp. Longum</i>, and <i>Parabacteroides distasonis</i>) and specific metabolic pathways (purine metabolism, transcription factors, and type II diabetes mellitus). The postoperative patterns of α- and β-diversity mirrored baseline values.</p><p><strong>Conclusions and relevance: </strong>This study documents significant changes in the gut microbiome of pediatric patients after AT, including variations in α- and β-diversities, bacterial communities, and inferred metabolic functions. These changes suggest a potential association between the surgical intervention and microbiome alterations, although further studies are necessary to discern the specific contributions of AT amidst possible confounding factors such as antibiotic use.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241293070"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622451","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}