Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Optokinetic After-Nystagmus: A Marker for Migraine? A Prospective Observational Study.","authors":"Mikaël Kassin-Dufresne, Marie-Catherine Charest Bossé, Margaret Aron","doi":"10.1177/19160216241307553","DOIUrl":"10.1177/19160216241307553","url":null,"abstract":"<p><strong>Introduction: </strong>Vestibular migraine (VM), particularly its chronic variant, poses a diagnostic challenge. Patients suffering from VM may not have the characteristic headaches associated with the dizziness. In these cases, a marker for migraine pathology in general could help appropriately diagnose certain types of dizziness as migrainous despite these patients not meeting current diagnostic criteria for VM. Migraine patients in general (headache and vestibular) are known to share a tendency toward intolerance of certain stimuli, including busy visual stimuli. True optokinetic stimulation, measured by the production of optokinetic after-nystagmus (OKAN) simulates these busy visual stimuli.</p><p><strong>Methods: </strong>Prospective observational study comparing response to optokinetic stimulation between migraine patients and controls. Questionnaires regarding general sensitivities to busy visual stimuli were completed prior to beginning the study. Both subjective and objective markers of stress were measured before and after exposure to the stimulus. Initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN were compared between the 2 groups.</p><p><strong>Results: </strong>The groups differed only with regard to sensitivity to blinking lights and history of motion sickness on initial questionnaire. Regarding subjective symptoms of discomfort, migraine patients tended to report higher scores than controls both before and after testing, but there was no significant difference from before to after stimulus in each group's scores. There were no statistically-significant differences between initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN between groups.</p><p><strong>Conclusions: </strong>In this study, OKAN measurements were not useful in differentiating migraine patients at large from control subjects. We hypothesize that there may be a distinct subgroup of migraine patients that are more sensitive to visually-disturbing situations that may differ from other migraine sufferers. Future studies will aim to identify such patients and compare them to controls.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216241307553"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006925","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":"Machine Learning-Based Dizziness/Vertigo Disease Diagnosis by Combining Medical History and Signs.","authors":"Yiwen Zhao, Xumeng Tian, Haiyan Wu, Muhao Xu, Ruizhe Yang, Jinlin Xiao, Zhenfeng Zhu","doi":"10.1177/19160216251375034","DOIUrl":"10.1177/19160216251375034","url":null,"abstract":"<p><p>ImportanceClinicians face great challenges in diagnosing dizziness/vertigo disease due to its subjectivity. Currently, there is an absence of machine learning model that could make full use of the information gained from both medical history and physical signs.ObjectiveTo develop and validate a machine learning model based on medical history and physical signs for dizziness/vertigo disease diagnosis, relieving the burden of diagnosis for clinicians.DesignA retrospective cohort study.SettingTertiary referral center.ParticipantsThis study included 1003 patients conformed to the inclusion criteria at the neuro-otologists' clinics.ExposuresThirty-one medical history items, and 9 bedside examination signs recorded by routinely performing a detailed ocular motor examination using video goggles.Main Outcome MeasuresThe accuracy, precision, recall, F1 scores, and Matthews' correlation coefficient of disease diagnosis.ResultsOn the collected dataset of 16 categories of dizziness/vertigo diseases, the proposed model achieved an accuracy of 98.11% and an F1 score of 95.43%. The model demonstrated its optimal robustness when tested with datasets containing added noise. Additionally, an analysis of the correlation between medical history and signs was conducted, along with several case studies.ConclusionsA machine learning-based model was proposed for the diagnosis of dizziness/vertigo, which effectively combined patients' medical history and signs. In terms of diagnostic accuracy, it outperforms models that rely solely on either medical history or signs for diagnosis.RelevanceThe proposed method can effectively combine the patient's medical history and physical sign information to make the diagnosis of dizziness/vertigo disease, which has the potential to relieve the burden of diagnosis for clinicians to a certain extent.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251375034"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12612544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199673","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":"Thyroid Nodule Experts Evaluating ChatGPT's Assessment of Thyroid Nodules Classified by the Bethesda System for Reporting Thyroid Cytopathology.","authors":"Alexander Moise, Luiza Tatar, Noa Sela, Sabrina Daniela da Silva, Jasmine Kouz, Michael Tamilia, Michael P Hier, Veronique-Isabelle Forest, Richard J Payne","doi":"10.1177/19160216251387617","DOIUrl":"10.1177/19160216251387617","url":null,"abstract":"<p><p>ImportanceChatGPT has emerged as a medical resource through advanced language processing. Patients with thyroid nodules classified under The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) may use it to complement discussions with physicians.ObjectiveWe aimed to determine whether ChatGPT's recommendations on managing thyroid nodules classified by TBSRTC align with those of experienced thyroid specialists.Setting/ParticipantsA multidisciplinary panel of 5 thyroid cancer specialists, including otolaryngologists and endocrinologists, from 3 university-affiliated teaching hospitals in Montreal, Canada, evaluated the responses.Intervention/ExposureChatGPT-3.5 was prompted with 4 questions for each of the 6 Bethesda categories regarding the meaning and management of thyroid nodules, generating 24 responses for evaluation.Main Outcome/MeasuresWe assessed ChatGPT's accuracy against the latest American Thyroid Association (ATA) guidelines using a 4-point Likert scale (<50%, 50-74%, 75-89%, >90%). Additionally, specialists rated their comfort or reluctance in recommending ChatGPT as a complementary tool for patient discussions.ResultsOf the 24 ChatGPT-generated responses, 19 (79.2%) demonstrated moderate to good consistency with the ATA guidelines. The mean consistency score was 3.38/4 and median was 3.5. Consensus (IQR ≤ 1) was achieved in 23 out of 24 responses (95.8%), reflecting strong inter-rater reliability. Consistency scores were highest in Bethesda I-III and declined progressively in higher-risk categories, with the lowest mean score observed in Bethesda VI. Similarly, an upward trend in clinician reluctance was observed from Bethesda I through VI, indicating greater caution in recommending ChatGPT responses for patients suspicious for or diagnosed with malignancy (Bethesda V-VI).Conclusion and RelevanceWhile ChatGPT's responses generally align with specialist recommendations, they are not fully reliable. ChatGPT lacks the ability to serve as an independent or accurate source of medical advice for thyroid nodule management. It remains a useful complement for patient discussions, especially in low-risk scenarios, but further improvements are necessary to make it a safe, reliable component of patient care in complex cases.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251387617"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12669496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648800","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 Economic Burden of Management of Pituitary Adenomas: A Propensity-Score-Matched Cost Analysis.","authors":"Lisa Caulley, Andrea Lasso, Brandon Zagorski, Andrew S Wilton, Refik Saskin, Nick Sahlollbey, Jeanne M Séguin, Kednapa Thavorn, Mary-Anne Doyle, Janine Malcolm, Fahad Alkherayf, Stephanie Johnson-Obaseki, David Schramm, Shaun Kilty","doi":"10.1177/19160216251314793","DOIUrl":"10.1177/19160216251314793","url":null,"abstract":"<p><strong>Importance: </strong>Pituitary adenomas (PAs) present a notable economic burden on healthcare systems due to their management's reliance on multimodal, often costly interventions.</p><p><strong>Objective: </strong>To determine total and relative healthcare costs for PAs at Ontario-based institutions.</p><p><strong>Design: </strong>A retrospective, propensity-score-matched cohort analysis.</p><p><strong>Setting: </strong>Ontario, Canada, encompassing public healthcare facilities and covering costs over a 6-year study period.</p><p><strong>Participants: </strong>Adults diagnosed with PA (n = 1675) between April 1, 2013, and March 31, 2019, compared to a general population cohort and a hospitalized control cohort matched on demographics and health factors.</p><p><strong>Intervention/exposures: </strong>Analysis of healthcare cost components (inpatient, outpatient, and diagnostic services) and cost trajectories postsurgery for PAs.</p><p><strong>Main outcome measures: </strong>Primary outcome was total annualized healthcare costs for patients with PA relative to the general and hospitalized cohorts. Relative costs were estimated using a negative binomial regression model.</p><p><strong>Results: </strong>Of 1675 patients with PA, total annualized costs were $49,992. Highest total costs were associated with inpatient hospitalization ($24,796) and physician services/diagnostic evaluations ($20,075). After propensity score matching, patients with PA had 12.7 times higher costs [95% confidence interval (CI) (10.9, 14.8), <i>P</i> < .0001] during the preadmission/admission period, which remained elevated postoperatively (<i>P</i> < .05). Total costs did not differ between patients with PA and the hospitalized cohort [RR 0.97, 95% CI (0.92, 1.03); <i>P</i> = .3271] in the preadmission/admission period; however, follow-up costs were 37% lower for patients with PA in the 1st follow-up year [RR 0.63, 95% CI (0.51, 0.77); <i>P</i> < .0001], and up to 50% lower by the 5th year [RR 0.50, 95% CI (0.36, 0.68); <i>P</i> < .0001].</p><p><strong>Conclusions: </strong>This study provided a comprehensive assessment of the economic burden of PAs on the publicly-funded healthcare system. Patients with PA had higher annualized total costs across all observed time periods compared to the general population and lower annualized total costs compared to patients admitted to a surgical ward.</p><p><strong>Relevance: </strong>This study highlights the financial impact of PA management on healthcare resources and provides a basis for future research aimed at cost-efficiency improvements in long-term PA care.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251314793"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046914","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 Prediction of Response to Neoadjuvant Chemotherapy Plus Pembrolizumab in Locally Advanced Hypopharyngeal Squamous Cell Carcinoma.","authors":"Zhangwei Hu, Yi Chen, Renqiang Ma, Wei Sun, Lin Chen, Zhimou Cai, Weiping Wen, Wenbin Lei","doi":"10.1177/19160216251318255","DOIUrl":"10.1177/19160216251318255","url":null,"abstract":"<p><strong>Importance: </strong>The objective response (ORR) rate in patients with locally advanced hypopharyngeal squamous cell-carcinoma (LA-HPSCC) following neoadjuvant chemotherapy (NACT) of albumin-bound paclitaxel plus carboplatin is low. At present, it is unclear whether the addition of pembrolizumab could increase the ORR or not.</p><p><strong>Objective: </strong>To investigate whether the addition of pembrolizumab could increase the ORR, and to develop a nomogram to predict the response of pembrolizumab addition.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>This study was conducted at a single institution.</p><p><strong>Participants: </strong>This study included 129 patients who conformed to the inclusion criteria.</p><p><strong>Intervention or exposures: </strong>NACT with or without pembrolizumab for patients with LA-HPSCC.</p><p><strong>Main outcome measures: </strong>The ORR was analyzed according to the RECIST 1.1 criteria and a nomogram was developed based on least absolute shrinkage and selection operator and multivariable Cox regression analysis. Predictive accuracy and discriminative ability of the nomogram were evaluated by receiver operating characteristics, precision recall, calibration curves, and decision curve analysis.</p><p><strong>Results: </strong>Eighty-two patients received NACT and 47 also received pembrolizumab. ORR was higher in patients receiving additional pembrolizumab (66.0% vs 47.6%, χ² = 4.074, <i>P</i> = .044). The nomogram identified pretreatment levels of lymphocytes and red blood cells as independent predictors of a high ORR, while basophil levels were an independent predictor of a low ORR. Calibration curve showed that the nomogram-based predictions corresponded well with actual observations. C-index of the nomogram was 0.925 (0.848-1.002) and the area under curve was 0.925. Decision curve analysis affirmed that the nomogram had important clinical value.</p><p><strong>Conclusions and relevance: </strong>Pembrolizumab could improve the ORR in LA-HPSCC patients treated with NACT. Furthermore, a risk-prediction nomogram incorporating readily assessable routine pretreatment blood parameters can accurately estimate the response to NACT with pembrolizumab, leading to precise treatment and minimizing the waste of medical resources.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251318255"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374361","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":"Resource Utilization and Cost Analysis of Pediatric Esophageal Foreign Bodies.","authors":"Tanya Chen, Jennifer M Siu, Yasmine Madan, Gar-Way Ma, Peter J Gill, Nicholas Carman, Evan J Propst, Nikolaus E Wolter","doi":"10.1177/19160216251318256","DOIUrl":"10.1177/19160216251318256","url":null,"abstract":"<p><strong>Objective: </strong>Impacted esophageal foreign bodies (EFBs) are a common but preventable presentation in children, requiring prompt removal in the operating room by esophagoscopy. Our objective was to describe the overall cost of impacted pediatric EFBs and determine factors that increase resource burden.</p><p><strong>Methods: </strong>A cost analysis of pediatric patients undergoing esophagoscopy for EFB removal from 2010 to 2021 was performed. Characteristics of each EFB, patient transfer, and hospital course were collected. Direct and indirect healthcare costs were calculated using hospital-specific costs and provincial fees. Amounts were calculated in Canadian dollars.</p><p><strong>Results: </strong>Six hundred and eighty patients were included. The total amount spent on pediatric EFBs from 2010 to 2021 was $2,673,288. The mean total cost per child with an EFB was $3469. An extra hour of delay before Otolaryngology-Head and Neck Surgery (OHNS) consultation at a tertiary hospital corresponded to an $816 cost [95% confidence interval (CI; 244.7-1287.4)]. On average, children requiring transfer to a tertiary care center cost $1965 more than those initially presenting to a tertiary care center (<i>P</i> = .001). Higher-risk EFBs (n = 165, 24%) were associated with a longer hospital stay and greater complication rate and resulted in a $4095 increase in overall cost compared to lower-risk EFBs [$6829 (standard deviation (SD) $11,347) vs $2734 (SD $10,451), <i>P</i> = .02]. Button battery ingestions cost 8.8 times more than non-dangerous EFBs, such as coins. Longer distance for transfer was associated with a higher likelihood of having complications [odds ratios (OR) 1.5, 95% CI (1.1-1.8)].</p><p><strong>Conclusion: </strong>EFBs pose a significant economic burden to the healthcare system, driven by transfer to a tertiary care center, delays in transfer to the operating room, and high-risk EFBs. It is critical to identify areas for improved efficiency such as increased parental education for primary prevention, early involvement of the OHNS team and improving the capacity of community hospitals to manage EFB to limit transfers when possible.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251318256"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391123","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":"Quality Indicators in Otolaryngology-Head and Neck Surgery: A Scoping Review.","authors":"Phillip Staibano, Shireen Samargandy, Justin Cottrell, Lily Wang, Michael Au, Michael K Gupta, Han Zhang, Doron D Sommer, Christopher Walsh, Eric Monteiro","doi":"10.1177/19160216251330627","DOIUrl":"https://doi.org/10.1177/19160216251330627","url":null,"abstract":"<p><p>ImportanceQuality indicators are used to evaluate the quality of healthcare delivery and as a speciality, otolaryngology-head and neck surgery (OHNS) is beginning to transition toward this empirical understanding of healthcare quality and delivery.ObjectiveTo describe the number and quality of studies that have developed novel quality indicators for any subdiscipline in OHNS.DesignWe performed a database search of MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Cochrane Database of Systematic Reviews. We did not employ language or study-type restrictions and included studies published from database inception to October 2024.Study SelectionFollowing abstract screening, 184 articles underwent full-text screen. Eligible studies developed quality indicators in any subdiscipline within OHNS. Article screening and full-text review was performed in duplicate.Data Extraction and SynthesisWe extracted study-specific and methodological data in duplicate. Quality appraisal was assessed using the Appraisal of Indicators through Research and Evaluation instrument.ResultsWe identified 10,592 studies, of which 25 studies developed new quality indicators. Quality indicator development studies primarily focused on otology/neurotology, pediatric OHNS, and head and neck surgery. Few studies investigated facial plastics, rhinology and skull base surgery, and laryngology. Most studies employed Delphi consensus methods and patient engagement was rare. Consensus methodology reporting was poor and indicators were often not validated. Outcome indicators were often measured with fewer studies investigation structure or process indicators.ConclusionsQuality indicators may help standardize and improve patient care in OHNS. Future research should focus on structure and process indicators, while improving reporting, optimizing panel composition, and validating quality indicators.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251330627"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012346","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":"Coblation-Assisted Transoral Endoscopic Excision of Lingual Thyroglossal Duct Cysts.","authors":"Yanyan Niu, Tingting Cui, Wuyi Li, Xiaofeng Jin, Hong Huo, Jian Wang","doi":"10.1177/19160216251333351","DOIUrl":"https://doi.org/10.1177/19160216251333351","url":null,"abstract":"<p><p>ImportanceLingual thyroglossal duct cysts (LTGDCs) are rare congenital anomalies that necessitate proactive surgical intervention due to their potential for life-threatening airway obstruction. The challenging anatomical location of LTGDCs complicates their surgical management, and there are currently no standardized surgical modalities in place.ObjectiveTo analyze the clinical features of LTGDCs and evaluate the feasibility, safety, and efficacy of coblation-assisted transoral endoscopic excision of LTGDCs.DesignRetrospective case series (2009-2022) analyzing preoperative, intraoperative, and postoperative data.SettingTertiary academic center.ParticipantsTwenty-nine patients (20 males, 9 females; ages 3-70, with a median age of 34 years) were diagnosed with LTGDCs, including 7 (24.1%) with recurrent LTGDCs following prior surgeries at other institutions.InterventionCoblation-assisted transoral endoscopic excision of LTGDC using FK retractors and a 30° Hopkins telescope for optimal visualization and manipulation.Main Outcome MeasuresComplete cyst excision, postoperative recovery, recurrence rates, complications, and surgical feasibility.ResultsAll LTGDCs were completely excised. During the procedure, it was found that the LTGDCs abutted but did not adhere to the hyoid bone, which allowed for their dissection from the periosteum of the hyoid bone using coblation. Postoperative recovery was uneventful, with an average postoperative stay of 3.1 days (range 1-5 days). No complications, such as bleeding, infection, or airway obstruction, occurred. The mean follow-up period was 5.3 years (range 6 months to 12.4 years), with no recurrences observed during this time.ConclusionsCoblation-assisted transoral endoscopic excision is a reliable, effective, and minimally invasive approach for managing LTGDCs. It ensures complete removal with low recurrence and complication rates, aided by superior visualization and manipulation space provided by FK retractors and a 30° Hopkins telescope.RelevanceThis technique offers a safe alternative to traditional surgeries, reducing trauma and enhancing recovery. Future studies should explore comparisons with other surgical modalities to validate their broader applicability.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251333351"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009780","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":"Etiology, Clinical Presentation, and Management of Retrograde Cricopharyngeus Dysfunction: A Systematic Review.","authors":"Jérôme R Lechien, Marie Mailly, Stephane Hans, Lee M Akst","doi":"10.1177/19160216251329012","DOIUrl":"10.1177/19160216251329012","url":null,"abstract":"<p><p>ImportanceThe retrograde cricopharyngeus dysfunction (R-CPD) is an emerging topic in otolaryngology, gastroenterology, and primary care.ObjectiveTo review the current literature about the etiology, clinical presentation, and management of retrograde cricopharyngeus dysfunction (R-CPD).DesignSystematic review.SettingThree investigators conducted the PubMED, Scopus, and Cochrane Library review of the literature related to the etiologies and management of patients with R-CPD through the PRISMA statements.ParticipantsStudies that incorporated R-CPD patients.InterventionsIn-office, or operating room botulinum toxin injection, or no treatment.Main outcome measuresEtiology, clinical presentation, and therapeutic outcomes.ResultsSeventeen studies met the inclusion criteria (826 patients). A family history was reported in 28.0% of cases with most patients developing R-CDP symptoms in childhood (55.5%). In addition to the cardinal symptom of the inability to belch, associated complaints of bloating and chest pain, gurgling noises, and excessive flatulence were found in 95.7%, 86%, and 80.2% of cases, respectively.The diagnosis was recognized by patients themselves in 78.9% of cases. The immediate success rate of botulinum toxin injection into the cricopharyngeal sphincter in facilitating burping was 92.5%. Recurrence occurred in the first month of follow-up in 9.5% of cases, whereas 12.6% and 27.9% of patients had recurrence during the 1-5 months and more than 6 months posttreatment, respectively. Transient dysphagia is the most prevalent complication after botulinum toxin injection (31.1%). The heterogeneity was high across studies, limiting the establishment of further combined analyses.Conclusion and relevanceR-CPD is a recently-recognized and likely-underdiagnosed condition associated with severe symptoms affecting the quality of life of patients. Future studies are needed to elucidate the etiology of this condition, develop adequate patient-reported outcome questionnaires for the baseline and follow-up evaluations of symptoms, and propose therapeutic consensus.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251329012"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136208","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":"Level IIb Metastases in cN0 Oral Squamous Cell Carcinoma: Multicenter Retrospective Study.","authors":"Takuma Kugimoto, Takumi Hasegawa, Takashi Niiyama, Masaya Akashi, Michihiro Ueda, Hiroyuki Harada","doi":"10.1177/19160216251349446","DOIUrl":"10.1177/19160216251349446","url":null,"abstract":"<p><p>ImportanceNeck dissection is a common surgical treatment for patients with oral squamous cell carcinoma (OSCC). Due to the low incidence of level IIb metastases and the risk of injury to the spinal accessory nerve during level IIb dissection, the need for preventive neck dissection of this area has been discussed.ObjectiveThis study aimed to verify the incidence of level IIb metastases in patients with cN0 OSCC and to discuss the need for excision.DesignRetrospective cohort study.SettingThis study was conducted at 3 centers: the Department of Oral and Maxillofacial Surgical Oncology at the Institute of Science Tokyo Hospital, the Department of Oral and Maxillofacial Surgery at Kobe University Graduate School of Medicine, and the Department of Clinical Oral Oncology, Hokkaido Cancer Center.ParticipantsIn total, 222 patients with cN0 OSCC underwent supraomohyoid neck dissection (SOHND) between 2013 and 2021.Main Outcome MeasuresIncidence of level IIb metastases in patients with cN0 OSCC.ResultsLymph node metastasis was confirmed in 57 patients (25.7%). Two patients (0.9%) had level IIb metastasis. The primary site in these cases was the tongue in 1 case and the lower gingiva in the other, both with advanced cT4 primary tumors. Isolated level IIb metastasis was observed in tongue OSCC samples. Both patients with level IIb metastases experienced primary recurrence. The 5 year overall survival rates for pN(-) and pN(+) patients were 80.6% and 74.3%, respectively (<i>P</i> = .229). The 5 year disease-specific survival rates for the pN(-) and pN(+) patients were 89.6% and 77.2%, respectively (<i>P</i> = .057).Conclusions and RelevanceLevel IIb lymph node involvement in clinical N0 neck cancers is rare. Thus, SOHND may be adequate for most patients with OSCC. Therefore, level IIb dissection may be omitted in patients with cN0 in early-stage OSCC.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251349446"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333327","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}