Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"A Single Intratympanic Triamcinolone Acetonide Administration Elicits Long-Term Reduction in Impedances Following Cochlear Implantation.","authors":"Michael Nieratschker, Rudolfs Liepins, Clemens Honeder, Alice Barbara Auinger, Julia Clara Gausterer, Wolf-Dieter Baumgartner, Dominik Riss, Christoph Arnoldner, Valerie Dahm","doi":"10.1177/19160216241288819","DOIUrl":"10.1177/19160216241288819","url":null,"abstract":"<p><strong>Background: </strong>Intracochlear fibrosis and inflammation remain important limitations in cochlear implantation (CI). Glucocorticoids are routinely used to ameliorate the inflammatory response following CI. This study investigates the long-term effects of an intratympanically-applied triamcinolone-acetonide suspension on intracochlear impedance changes in CI recipients and investigates differences in drug concentrations and timepoints of injection.</p><p><strong>Methods: </strong>A total of 87 patients were included in the study, of whom 39 received an intratympanically-applied triamcinolone-acetonide suspension at either 10 or 40 mg/ml, 1 hour or 24 hours prior to cochlear implantation, while 48 patients served as an untreated control group. Electrode impedances were measured and compared over a period of 3 years following cochlear implantation.</p><p><strong>Results: </strong>The preoperative intratympanic application of a triamcinolone-acetonide suspension resulted in significantly lower mean impedances following cochlear implantation compared with an untreated control group at first fitting (4.66 ± 1.3 kΩ to 5.90 ± 1.4 kΩ, <i>P</i> = .0001), with sustained reduction observed over 3 months. A sustained reduction was observed after spatial grouping of the electrode contacts, with significant improvements in both the middle cochlear region over a 24 month period (from 3.97 ± 1.3 kΩ to 5.85 ± 1.3 kΩ, <i>P</i> = .049) and the basal region over a 6 month period (from 5.02 ± 1.3 kΩ to 5.85 ± 1.3 kΩ, <i>P</i> = .008). The injection of 10 mg/ml of triamcinolone-acetonide 1 hour prior to cochlear implantation resulted in higher impedances compared with 40 mg/ml and 24 hour time interval until surgery.</p><p><strong>Conclusion: </strong>A single preoperative intratympanic injection of triamcinolone-acetonide significantly reduces electrode impedances across the entire cochlea. This effect is sustained for up to 2 years, after which impedances gradually equalize between the groups. A preoperative triamcinolone-acetonide injection could therefore be a favorable approach to attenuate the immediate tissue response following cochlear implantation.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241288819"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468071","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":"Plasma Radiofrequency Tuboplasty and Cartilage Underlay Myringoplasty for Repairing Chronic Large Perforation with Eustachian Tube Dysfunction.","authors":"Zhengcai Lou, Zihan Lou, Tian Lv, Zhengnong Chen","doi":"10.1177/19160216241291822","DOIUrl":"10.1177/19160216241291822","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to compare the outcomes of endoscopic cartilage myringoplasty (ECM) with or without plasma radiofrequency (RF) tuboplasty (PRT) for repairing chronic large perforation with Eustachian tube dysfunction (ETD).</p><p><strong>Materials and methods: </strong>Chronic large perforations with ETD were randomly divided into receiving ECM or ECM plus PRT. During the 24 months follow-up, the Eustachian tube score (ETS), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), ET inflammation scale, hearing results, and graft success rate of the patients were analyzed.</p><p><strong>Results: </strong>A total of 61 subjects were included in the study. Difference of ETS was significant before and after surgery in the ECM + PRT group (<i>P</i> < .05) but the ECM group was not (<i>P</i> > .05). Also, significant between-group difference was found regardless of post-24 months ETS and improvement value. Postoperative ETDQ-7 scores were significantly reduced compared with preoperative ETDQ-7 scores in both groups (<i>P</i> < .05), also, significant between-group difference was found regardless of post-24 months ETDQ-7 scores and improvement value. The graft success rate was 86.7% in the ECM group and 96.8% in the ECM + PRT group at postoperative 24 months (<i>P</i> > .05). In addition, although the ECM + PRT group showed a better air-bone gap improvement than the ECM group, the difference was not significant (13.01 ± 2.97 vs 10.92 ± 0.69 dB; <i>P</i> > .05). No PRT procedure-related serious adverse events were reported during the follow-up process. No patients developed atelectasis or otitis media with effusion in either group.</p><p><strong>Conclusion: </strong>ECM combined with low-temperature PRT did not affect the graft success rate but showed a better long-term improvement in ETS and ETDQ-7 than cartilage myringoplasty for the treatment of chronic perforation with ETD. In addition, although PRT showed a better hearing improvement, the difference was not significant between the 2 groups.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241291822"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468076","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":"Fine Needle Aspirate Flow Cytometry's Ancillary Utility in Diagnosing Non-Hodgkin Lymphoma in the Head and Neck.","authors":"Saruchi Bandargal, Livia Florianova, Svetlana Dmitrienko, Tina Haliotis, Marc Philippe Pusztaszeri, Michael P Hier, Alex M Mlynarek, Marco A Mascarella, Richard J Payne, Sabrina Daniela da Silva, Nathalie Johnson, Véronique-Isabelle Forest","doi":"10.1177/19160216241296127","DOIUrl":"10.1177/19160216241296127","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;While ultrasound-guided fine-needle aspiration cell block (FNACB) is a cost-effective, expeditious, and reliable procedure used routinely in the initial evaluation of head and neck masses, it has limited efficacy in diagnosing lymphoproliferative disorders such as non-Hodgkin lymphoma (NHL). Flow cytometry performed on an fine-needle aspiration (FNA) sample [ultrasound-guided fine-needle aspirate flow cytometry or flow cytometry performed on an FNA sample (FNAFC)], has been shown to be a valuable adjunct to FNACB in the diagnosis of lymphoproliferative disorders of the spleen, kidney, and thyroid. The objective of this study was to appraise FNAFC's utility as an ancillary tool to detect NHL arising in the head and neck region in adult patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a retrospective study involving 52 adult patients with head and neck lymphadenopathies and masses suspicious for lymphoproliferative disorders, who underwent ultrasound-guided FNACB and ultrasound-guided FNAFC between January 2017 and November 2022. Patient demographics, FNACB histopathological and immunophenotypic results, postoperative histopathology results (when available), and follow-up information until May 2023 were reviewed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 52 FNACB samples, 23 samples (44.2%) yielded a diagnosis negative for carcinoma, 20 samples (38.5%) were nondiagnostic on account of scant cellularity, 8 samples (15.4%) were suspicious for malignancy, and a single sample (1.9%) was compatible with malignancy. Regarding FNAFC samples, 37 samples (71.2%) were diagnosed as showing no evidence for a lymphoproliferative disorder, 4 samples (7.7%) as nondiagnostic because of insufficient cell count, 4 samples (7.7%) as suspicious for a lymphoproliferative neoplasm, and 7 samples (13.5%) as compatible with a lymphoproliferative neoplasm, most frequently a B-cell lymphoma. 7 of the 11 patients (63.6%) with a suspicious/positive FNAFC result underwent excisional biopsy for additional work up. Postoperative histopathology reports corroborated FNAFC's findings in 6 patients (85.7%), while the remaining patient's (14.3%) suspicious FNAFC result was discordant with postoperative histopathology results. The other 4 patients (36.4%) did not require excisional biopsy as the hemato-oncologist deemed the information provided by the FNAFC as sufficient for the diagnosis and treatment of an NHL in the specific clinical contexts of those patients. All patients with nondiagnostic (due to insufficient cell count), inconclusive, or negative FNAFC (ie, nondiagnostic of a lymphoproliferative disorder) were followed up for a mean follow-up period of 11.9 months (range: 61.2 months; SD: 10.2 months), during which no new lymphadenopathies/masses nor progression was observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FNAFC is a useful and practical supplementary tool in the diagnosis of lymphoproliferative disorders in the head and neck region, principa","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241296127"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604775","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":"Surgical Margin Definition and Assessment in Head and Neck Oncology: A Cross-Sectional Survey of Canadian Head and Neck Surgeons.","authors":"Ryan C Daniel, Bernie Yan, Shamir Chandarana, Anthony C Nichols, Antoine Eskander, Danny Enepekides, Kevin Higgins","doi":"10.1177/19160216241296121","DOIUrl":"10.1177/19160216241296121","url":null,"abstract":"<p><strong>Importance: </strong>Head and neck squamous cell carcinomas (HNSCC) are responsible for a significant amount of morbidity and mortality in Canada. Surgical margins are one of the most important factors used to guide treatment; however, currently there is a lack of consensus on the ideal surgical margin definition, sampling, and assessment method.</p><p><strong>Objective: </strong>To understand the current perspectives and practice patterns of Canadian head and neck surgeons with respect to surgical margin: (1) definition, (2) sampling, (3) pathological assessment.</p><p><strong>Design: </strong>A 24-question cross-sectional survey was sent via email through the Canadian Society of Otolaryngology-Head & Neck Surgery (CSOHNS), and responses were gathered from December 19, 2023, to March 12, 2024. Responses were aggregated and reported using descriptive statistics.</p><p><strong>Setting/participants: </strong>The survey was conducted in Canada among self-reported staff head and neck oncology surgeons with membership in the CSOHNS.</p><p><strong>Results: </strong>A total of 36 staff head and neck oncology surgeons responded from across Canada. The most common (58.3%) definition of a negative surgical margin for oral cavity HNSCC was \">5 mm formalin fixed paraffin embedded distance.\" To obtain surgical margins, surgeons were split with 44.1% using only a tumor bed approach and 32.4% using only a specimen-driven approach. A dedicated head and neck pathologist is always available more commonly for final pathological assessment (63.6%) versus intraoperative frozen section assessment (15.5%). Finally, most surgeons reported having a synoptic standardized reporting system for annotating margin status (78.8%).</p><p><strong>Conclusions/relevance: </strong>The results of this survey provide a current-state analysis of head and neck surgeons across Canada and set the stage for future efforts to be directed toward standardizing the collection method and reporting criteria for surgical margins in HNSCC.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"53 ","pages":"19160216241296121"},"PeriodicalIF":4.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604777","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}

{"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}