OTO Open最新文献

{"title":"Asymptomatic Primary Hyperparathyroidism: A Misnomer.","authors":"Hänel W Eberly, Bao Y Sciscent, F Jeffrey Lorenz, Neerav Goyal, David Goldenberg","doi":"10.1002/oto2.70039","DOIUrl":"10.1002/oto2.70039","url":null,"abstract":"<p><p>Primary hyperparathyroidism (PHPT) is an endocrine disorder marked by elevated secretion of parathyroid hormone (PTH), which results in hypercalcemia and may cause complications in the kidneys and bones. Diagnosing this condition involves ruling out secondary causes and understanding the complexities of the laboratory values associated with PHPT. The disease has become more recognizable to clinicians in an earlier phase thanks to updated screening guidelines. At present, patients can be diagnosed with \"classic,\" \"normocalcemic,\" \"normohormonal,\" or \"asymptomatic\" PHPT. Many patients are diagnosed through incidental findings of elevated calcium levels or PTH levels during routine blood tests rather than through the presentation of classic symptoms. If asked, patients will invariably harbor subtle or subclinical manifestations despite the absence of overt symptoms. There is debate on whether truly asymptomatic hyperparathyroidism exists.¹ We explore the definition and clinical patterns of asymptomatic hyperparathyroidism and propose concise recommendations for recognizing these patients.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Device for Performing Spirometry in Total Laryngectomized Patients.","authors":"Maria Rita Bianco, Salvatore Andrea Pullano, Federico Occhiuzzi, Daniele Latella, Marco Di Mieri, Corrado Pelaia, Eugenia Allegra","doi":"10.1002/oto2.70009","DOIUrl":"10.1002/oto2.70009","url":null,"abstract":"<p><p>Patients who have undergone total laryngectomy (TL) are, in most cases, affected by lung disease due to smoking habits. Therefore, as part of the follow-up protocol for these patients, a spirometry test should be performed to adequately assess lung function. Current spirometers do not allow for spirometry tests in patients who breathe through a tracheostomy, as the patient cannot perform respiratory acts from the spirometer mouthpiece, which is designed to be used by mouth. We have, therefore, designed a device that allows the test to be performed through the tracheostoma. The device is made of biocompatible polymeric material, modeled using a 3-dimensional printer, reusable, and hermetically connected to the spirometer distally and to the tracheostoma proximally. The device was used on 5 patients who underwent TL and was found to be comfortable, safe, and valid for diagnostic purposes.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nasopharyngo-Septal Butterfly Flap: A Novel Adjunct for Reconstructing Large Skull Base Defects.","authors":"Moataz D Abouammo, Maithrea S Narayanan, Mohammad B Alsavaf, Mohammed Alwabili, Jaskaran S Gosal, Govind S Bhuskute, Claudio Callejas, Kyle K VanKoevering, Kyle C Wu, Daniel M Prevedello, Ricardo L Carrau","doi":"10.1002/oto2.70016","DOIUrl":"10.1002/oto2.70016","url":null,"abstract":"<p><strong>Objective: </strong>Skull base defects can be challenging to reconstruct. The nasoseptal flap (NSF) remains the first-line option for reconstruction. However, it can be inadequate to cover wide defects or compromised by tumor invasion or prior surgery requiring additional reconstructive options. The goal of the study is to describe a novel flap for clival and craniovertebral junction (CVJ) reconstruction.</p><p><strong>Study design: </strong>Cadaveric study with an illustrative clinical case.</p><p><strong>Setting: </strong>Cadaver dissection laboratory and tertiary university hospital.</p><p><strong>Methods: </strong>Endoscopic endonasal dissection was performed in 15 cadavers. A modification of the inferior incision of the NSF was carried out. The inferior incision was performed at a more cranial location, sparing the mucosa of the posterior septum. Two lateral longitudinal incisions were carried out at the pterygo-sphenoidal junction freeing the nasopharyngeal mucosa. A third incision was performed separating the rostral mucosa from the nasal floor. The resulting flap was rotated postero-superiorly covering the clivus and CVJ.</p><p><strong>Results: </strong>An inferiorly based butterfly-shaped nasopharyngo-septal flap, consisting of nasopharyngeal and posterior septal mucosa and receiving blood supply from the bilateral ascending pharyngeal arteries, was formulated. The lower wings comprised nasopharyngeal mucosa while the upper wings comprised posterior septal mucosa. The mean surface area of the flap was 12.35 ± 0.21 cm² covering the clivus and CVJ in all cadavers.</p><p><strong>Conclusion: </strong>The nasopharyngo-septal flap is a novel vascularized flap that is well-suited for reconstructing clival and CVJ defects where the NSF is insufficient and can also be used as a salvage flap in cases where the NSF is unobtainable.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicancer Early Detection Tests: A State-of-the-Art Review for Otolaryngologists.","authors":"Elena Kennedy, Greg Durm, Janice L Farlow","doi":"10.1002/oto2.70040","DOIUrl":"10.1002/oto2.70040","url":null,"abstract":"<p><strong>Objective: </strong>To provide a review of the science and applicability of current multi-cancer early detection (MCED) tests for otolaryngologists.</p><p><strong>Data sources: </strong>PubMed, clinicaltrials.gov, company websites.</p><p><strong>Review methods: </strong>Using PRISMA methodology, primary literature regarding MCED tests was queried from April 26 to May 12, 2024 using MCED search terms. Ongoing clinical trials incorporating MCED screens were identified via the National Institutes of Health clinicaltrials.gov website. Company websites for available or upcoming MCED tests were reviewed.</p><p><strong>Conclusion: </strong>Long-term robust data regarding the performance characteristics, effects on clinical outcomes, and cost-utility of MCED tests for head and neck cancer are currently lacking. Otolaryngologists should be aware of the implications of MCED tests as these assays become more widely used.</p><p><strong>Implications for practice: </strong>Although not FDA-approved or covered by insurances at the time of writing of this manuscript, MCED testing is rapidly gaining interest, and patients with positive tests are presenting to otolaryngologists for evaluation. While MCED technologies hold great promise for early detection of disease and potential reduction of morbidity and mortality, more study is needed about their utility for head and neck cancer and optimal diagnostic workflows.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hearing Loss in the Petrified Ears.","authors":"Bao Y Sciscent, Marc D Polanik, Hanel W Eberly, Mark E Whitaker","doi":"10.1002/oto2.70042","DOIUrl":"10.1002/oto2.70042","url":null,"abstract":"","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Otolaryngology Simulation Curriculum Development and Evaluation for Medical Education in Rwanda.","authors":"Sarah Nuss, Rachel Wittenberg, Valerie Salano, Ivy Maina, Gratien Tuyishimire, Mary Jue Xu, Ornella Masimbi, Natnael Shimelash","doi":"10.1002/oto2.155","DOIUrl":"https://doi.org/10.1002/oto2.155","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the feasibility and acceptability of a new low-cost otolaryngology simulation training curriculum for medical students in Rwanda. Given the limited access to hands-on training and equipment in low-middle-income countries, building confidence in performing basic otolaryngology skills is vital for all medical students, especially where all graduates initially serve in primary care before specializing.</p><p><strong>Study design: </strong>Preintervention and postintervention assessments of simulation training.</p><p><strong>Setting: </strong>Conducted at the University of Global Health Equity in Rwanda.</p><p><strong>Methods: </strong>The simulation program comprised 3 primary components: (1) a low-cost, moderate-fidelity model for cricothyrotomy and tracheostomy practice, (2) a low-cost, low-fidelity ear model for foreign body and cerumen removal, and a high-fidelity manikin for practicing, (3) epistaxis management, and (4) nasal foreign body removal. Students underwent pretest and posttest assessments measuring their knowledge, experience, perceived skill, and confidence in performing these procedures. A survey collected feedback on the program.</p><p><strong>Results: </strong>A total of 29 medical students participated in the simulation program, integrated into a 1-week otolaryngology \"boot camp\" preceding a 3-week clerkship rotation. All models were created using basic, locally available materials, at a total cost of $1.02 for cricothyrotomy and $0.20 for foreign body models. Knowledge and perceived confidence increased for all 3 simulations. All students found the simulations useful, enjoyable, and anticipated using these skills in future training.</p><p><strong>Conclusion: </strong>The study's results demonstrated that the low-cost otolaryngology simulation was well-received and enhanced knowledge, interest, and confidence in performing basic otolaryngology skills across all simulations.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of the Profunda Artery Perforator Free Flap for Head and Neck Reconstruction.","authors":"Renita Wilson, Taylor Cave, Payam Entezami, Erin Ware, Brent A Chang","doi":"10.1002/oto2.70028","DOIUrl":"https://doi.org/10.1002/oto2.70028","url":null,"abstract":"<p><strong>Objective: </strong>The profunda artery perforator (PAP) flap has gained popularity in head and neck reconstruction with a favorable donor site providing a relatively hidden scar and the ability to harvest a large amount of pliable tissue with consistent vascular anatomy. The primary aim of this study is to evaluate the safety and efficacy of this PAP flap in head and neck reconstruction.</p><p><strong>Data sources: </strong>PUBMED, EMBASE, Web of Science, Google Scholar (January 1948-February 2022).</p><p><strong>Review methods: </strong>A systematic review of the English language literature was conducted for studies with at least 3 patients 18 years or older undergoing head and neck reconstruction utilizing the PAP. Study quality and risk of bias were evaluated using the MINORS scoring system. Main analysis endpoints were flap failure rate, donor site morbidity, and complication rate.</p><p><strong>Results: </strong>Nine articles and 206 total PAP flaps were included. The rate of flap-related and medical complications was 33%, with only 2 (0.97%) instances of complete flap failure. Other complications included partial flap failure (10, 4.86%) and donor site wound complications (12, 5.83%). A total of 16 flaps (7.77%) required subsequent revision in the operating room. Average MINORS score of the studies suggested a moderate to high risk of bias.</p><p><strong>Conclusion: </strong>Based on limited quality evidence, this review suggests that the PAP flap is a safe and feasible tool for head and neck reconstruction, with comparable complication and success rates as other free flaps. Further large-scale studies are warranted.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preference Signals and Interview Invitations: Insight Into Recent Updates to the Oto-HNS Residency Application Process.","authors":"Radhika Duggal, Kyra Osborne, Alan Kominsky, William S Tierney","doi":"10.1002/oto2.70024","DOIUrl":"https://doi.org/10.1002/oto2.70024","url":null,"abstract":"<p><strong>Objective: </strong>While students in the 2023 Otolaryngology-Head and Neck Surgery (Oto-HNS) residency match were allowed 7 preference signals, this number increased to 25 for the 2024 match with the goal of reducing the overall application volume. We sought to understand the impact of this change to application volume and interview patterns.</p><p><strong>Study design: </strong>Cross-sectional survey.</p><p><strong>Setting: </strong>Program directors of US Oto-HNS residency programs were invited to participate in an anonymous, electronic survey.</p><p><strong>Methods: </strong>An anonymous REDCap questionnaire was sent via email to all current Oto-HNS program directors in January 2024. Data were analyzed using R Version 4.3.1.</p><p><strong>Results: </strong>Forty-four program directors completed the survey. While programs received a median [interquartile range] of 400 [363, 445] applications last year, this year they reported receiving 295 [233, 339] applications of which a median of 110 applicants (40%) signaled the program. While the median percent of applicants who were interviewed by a program was 16%, the percent of interviews among applicants who had signaled the program was 37%. Of all interviews, nearly all (median 100% [91, 100]) were of applicants who had signaled the program. Finally, 40 (91%) of program directors reported that signaling played an important role in deciding to interview a candidate.</p><p><strong>Conclusion: </strong>Preference signals play an important role in a residency program's decision to interview a candidate. Our findings suggest that the implementation of preference signals successfully decreased the average number of applications received by each program and that medical students applying to more programs than available signals may experience diminishing returns.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Letter Regarding \"Improvement in Nasal Symptoms of Chronic Rhinitis After Cryoablation of the Posterior Nasal Nerve\".","authors":"Mattie Rosi-Schumacher, Paul R Young","doi":"10.1002/oto2.154","DOIUrl":"https://doi.org/10.1002/oto2.154","url":null,"abstract":"","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Lymph Node Characteristics and Extranodal Extension in Oral Cavity Squamous Cell Carcinoma.","authors":"Piper A Wenzel, Steven L Van Meeteren, Nitin A Pagedar, Marisa R Buchakjian","doi":"10.1002/oto2.70032","DOIUrl":"10.1002/oto2.70032","url":null,"abstract":"<p><strong>Objective: </strong>Identify correlations between lymph node characteristics and extranodal extension (ENE).</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Tertiary care center.</p><p><strong>Methods: </strong>Patients who underwent neck dissection for oral cavity squamous cell carcinoma from 2004 to 2018 were included, with a starting sample of 496. The primary outcome was ENE in at least 1 lymph node. Additional variables included number of dissected nodes, positive nodes by level, positive lymph node ratio (LNR), and diameter of metastatic deposit and ENE focus. Univariate and multivariate binary logistic regression analyses were performed to determine correlations between included variables and ENE.</p><p><strong>Results: </strong>Of the 496 patients, 233 had nodal metastasis (47.0%). 13,814 nodes were removed, with 714 (5.2%) containing metastasis. Of the positive nodes, 28.0% had ENE, 47.2% did not have ENE, and 24.8% were unknown. The mean ENE diameter was 5.1 mm (SD, 9.9). On univariate logistic regression analysis, ipsilateral neck LNR per 0.1 unit increase (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.02-1.32, <i>P</i> = .02), metastatic deposit size per 1 mm increase (OR 1.06, CI 1.04-1.08, <i>P</i> < .0001), and clinical T- (<i>P</i> = .02) and N-class (<i>P</i> = .0003) significantly correlated with ENE. On multivariate logistic regression analysis, size of metastatic deposit (OR 1.06, CI 1.03-1.08, <i>P</i> < .0001) remained significantly correlated with ENE.</p><p><strong>Conclusion: </strong>Controlling for confounding variables, size of metastatic deposit was an independent predictor of ENE, suggesting that as the metastatic deposit size increases, the odds of extension through the capsule also increases. This may be due to capsule thinning as the deposit grows or could represent the invasive nature of aggressive disease.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}