OTO Open最新文献

{"title":"Optimizing Corticosteroid Sinonasal Irrigation Outcomes Through 3D Printing: A Randomized Pilot Clinical Trial.","authors":"Zachary T Root, Thomas J Lepley, Kanghyun Kim, Aspen R Schneller, Songzhu Zhao, Raymond Wen, Veronica L Formanek, Sarah M Sussman, Joseph S Lee, Ahmad Odeh, Lai Wei, Kathleen M Kelly, Bradley A Otto, Kai Zhao","doi":"10.1002/oto2.70036","DOIUrl":"https://doi.org/10.1002/oto2.70036","url":null,"abstract":"<p><strong>Objective: </strong>Topical corticosteroid irrigation plays critical role in the management of chronic rhinosinusitis (CRS). Yet, its efficacy can be highly variable. We sought to determine if personalized, 3-dimensional (3D)-printed nasal models can optimize head positioning and irrigation parameters, therefore improving patient outcomes.</p><p><strong>Study design: </strong>Randomized, single-blinded clinical trial.</p><p><strong>Setting: </strong>Tertiary medical center from November 2021 to July 2023.</p><p><strong>Methods: </strong>Sixty-two patients with CRS were randomized into either control (CG), backfill (BG), or model (MG) groups; daily 2 mg mometasone irrigations were then performed for 2 months with either standard head-forward and natural side-tilt position (CG), a head tilt of 90° to the side with fluid entering the lower nostril (BG), or in an optimized position as determined by a patient-specific 3D printed irrigation model (MG), respectively.</p><p><strong>Results: </strong>A total of 36 patients completed the trial (CG: N = 14/23; BG N = 11/23, MG: N = 11/16). Significant posttreatment improvement in Lund-Mackay (LM) scoring was only observed in the MG (-3.73, 95% confidence interval = -5.71, -1.75; <i>P</i> < .001). Patient-reported outcome measures (Nasal Obstruction Symptom Evaluation, Sinonasal Outcome Test-22, and Visual Analog Scale of nasal congestion) improved significantly among all groups. Optimal model penetration scores significantly correlated to posttreatment MG LM score (Spearman's <i>r</i> = 0.65, <i>P</i> < .05). Among all groups, patients with prior endoscopic sinus surgery (ESS) (n = 19) had objectively less opacification at baseline; however, experienced the same degree of opacification reduction and symptom reduction as those without prior ESS (n = 17).</p><p><strong>Conclusion: </strong>The use of 3D printing to personalize head positioning may significantly improve objective corticosteroid irrigation outcomes. Mometasone irrigation may have similar subjective and objective effects on patients regardless of prior surgical history.</p><p><strong>Level of evidence: </strong>Level 1 prospective, randomized, single-blinded clinical trial NCT06118554.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70036"},"PeriodicalIF":1.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471768","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":"Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis.","authors":"Nader Wehbi, David Ahmadian, Claire Gleadhill, Helena T Yip","doi":"10.1002/oto2.70033","DOIUrl":"https://doi.org/10.1002/oto2.70033","url":null,"abstract":"<p><strong>Objective: </strong>Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors of successful decannulation and inform treatment decisions.</p><p><strong>Study design: </strong>This study is a retrospective case series of 22 adult patients presenting to the senior author with a tracheostomy and peristomal SGS precluding decannulation between 2018 and 2023.</p><p><strong>Setting: </strong>Department of Otolaryngology-Head & Neck Surgery, University of Arizona College of Medicine-Tucson.</p><p><strong>Methods: </strong>Patient demographics, relevant clinical factors, stenosis characteristics, and the number of endoscopic procedures performed were analyzed to identify predictors of successful decannulation. Endoscopic interventions were generally performed 3 months apart with CO₂ laser debridement, balloon dilation, and intralesional injection of steroid, all done with a laser-safe endotracheal tube in place through the stoma.</p><p><strong>Results: </strong>Out of the 22 patients in the study, 9 (40.9%) achieved decannulation, all through an endoscopic approach. Body mass index (BMI) and age were identified as significant negative predictors of decannulation success (<i>P</i> = .02; <i>P</i> = .05, respectively). Stenosis characteristics, such as the presence of tracheomalacia, excessive dynamic airway collapse, multilevel stenosis, posterior glottic stenosis, and anterior granulation tissue shelf did not significantly impact decannulation success.</p><p><strong>Conclusion: </strong>A 40.9% decannulation rate was achieved in our cohort. BMI and age were identified as negative predictors of decannulation success. Stenosis characteristics did not significantly affect decannulation outcomes. Further investigation is warranted to establish reliable predictors of decannulation.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70033"},"PeriodicalIF":1.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471767","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":"Diagnosis and Management of Retrograde Cricopharyngeal Dysfunction: A Systematic Review.","authors":"Raj Malhotra, Hamza Khan, Sydney Zaransky, Joseph Celidonio, Kenneth Yan, Rachel Kaye","doi":"10.1002/oto2.70014","DOIUrl":"https://doi.org/10.1002/oto2.70014","url":null,"abstract":"<p><strong>Objective: </strong>Retrograde cricopharyngeal dysfunction (R-CPD) is a syndrome with rapidly increasing awareness since being first described in March 2019. As such, few cases of R-CPD are currently reported in the literature. The goal of this study is to provide a comprehensive systematic review of the available literature on R-CPD, including patient characteristics, diagnosis, and management.</p><p><strong>Data sources: </strong>PubMed, Scopus, EMBASE.</p><p><strong>Review methods: </strong>A systematic review of the available English literature was conducted using the data sources PubMed, Scopus, and EMBASE. Studies with original data of patients experiencing classic symptoms of R-CPD were included. Independent abstract screening followed by full-text screening was performed to assess study eligibility. Data extraction of patient demographics, symptoms, treatment, and follow-up were subsequently performed.</p><p><strong>Results: </strong>Common presentations of R-CPD include abelchia (100%), abdominal bloating (83%), and gurgling noises (75%). 554 (86.9%) patients had improved symptoms after initial treatment with BTX. The most common initial dose was 50 units in 204 (37.3%) patients. Subsequent BTX injections resolved symptoms in 40 (80%) patients. Six patients ultimately received CP myotomy for recurrent symptoms, resulting in long-term resolution in 4 (67%) patients.</p><p><strong>Conclusion: </strong>R-CPD is a newly recognized syndrome with effective treatment options including botulinum toxin injections and cricopharyngeal myotomy, where appropriate. Diagnostic modalities including esophageal manometry may aid in the initial work up of R-CPD, however further studies are required to assess its diagnostic utility.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70014"},"PeriodicalIF":1.8,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471766","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":"An Analysis of the Otolaryngology Workforce in Pennsylvania.","authors":"Bao Y Sciscent, Kimberly Chan, Hänel W Eberly, David Goldenberg, Neerav Goyal","doi":"10.1002/oto2.70026","DOIUrl":"10.1002/oto2.70026","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to analyze the distribution of otolaryngologists between urban and rural counties in Pennsylvania.</p><p><strong>Study design: </strong>Retrospective database.</p><p><strong>Setting: </strong>American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) database and Centers for Medicare and Medicaid Services (CMS) Database.</p><p><strong>Methods: </strong>The AAO-HNS database (Entnet.org) and the CMS Database were used to identify otolaryngologists, their primary location, and their state of training. The 2023 Rural-Urban Continuum Codes were used to classify metropolitan (codes 1-3) and nonmetropolitan counties (codes 4-9) and determine county populations.</p><p><strong>Results: </strong>A total of 388 otolaryngologists were identified across 67 Pennsylvania counties (33 metropolitan, 34 nonmetropolitan), 80% of which were male. There were 354 otolaryngologists in metropolitan counties serving 11.2 million people, with an average of 2.4 otolaryngologists per 100,000 people (/100 k). The majority of otolaryngologists (n = 235, 60.6%) are located in counties designated by code 1. There were 34 otolaryngologists in nonmetropolitan counties serving 1.8 million people, with an average of 2.4 otolaryngologists/100 k. Montour County (code 6) is home to a large academic center and accounts for 14/34 otolaryngologists in the nonmetropolitan counties. With the exception of Montour County, the remaining nonmetropolitan counties averaged 1.0 otolaryngologist/100 k. Only 3 metropolitan counties did not have otolaryngologists compared to 19 nonmetropolitan counties without otolaryngologists. Most otolaryngologists received their residency training in Pennsylvania (n = 177). New York (n = 35) and Maryland (n = 24) were the second most common states for training.</p><p><strong>Conclusion: </strong>There is a lack of otolaryngologists in rural counties of Pennsylvania, except in counties home to large academic centers.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70026"},"PeriodicalIF":1.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392277","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":"Unmasking Nasal Septal Hematoma/Abscess: A Systematic Review and Meta-analysis.","authors":"Douglas P Nanu, Daniel Adelsberg, Shaun A Nguyen, Nicholas P Radulovich, Michele M Carr","doi":"10.1002/oto2.174","DOIUrl":"https://doi.org/10.1002/oto2.174","url":null,"abstract":"<p><strong>Objective: </strong>We aim to discuss the demographics, symptoms, bacteriology, treatment, and sequelae associated with nasal septal hematoma/nasal septal abscess (NSH/NSA).</p><p><strong>Data sources: </strong>CINAHL, PubMed, and Scopus were searched from inception until October 15, 2023.</p><p><strong>Review methods: </strong>Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines were followed. Inclusion criteria included patients who were diagnosed with a traumatic NSH/NSA. NSH/NSA due to surgical procedures was excluded. Demographics included N of patients, patient age, and gender. Symptoms, antibiotics given, bacteriology, and sequelae were analyzed. Meta-analysis of continuous measures (mean, median), and proportions (%) with a 95% confidence interval (CI) was conducted.</p><p><strong>Results: </strong>Thirty studies (N = 598) were included. In total, 72.1% were males (95% CI: 67-78). The total mean age was 21.6 years (range: 0.2-85, 95% CI: 17.2-26.1). The mean time from trauma to diagnosis was 8.2 days. Common symptoms at presentation included nasal obstruction/congestion at 60.3% (95% CI: 37.1-81.4), nasal pain at 30.0% (17.2-44.6), swelling at 20.4% (8.7-35.5), headache at 15.5% (7.3-26.0), and fever at 13.9% (7.3-22.2). The most common pathogens isolated included <i>Staphylococcus</i> <i>aureus</i> at 56.5% (49.0-63.8), <i>Streptococcus</i> species at 8.9% (5.2-14.0), and <i>Klebsiella pneumoniae</i> at 6.3% (3.2-10.8). Antibiotics given included amoxicillin-clavulanate at 10.3% (4.5-18.2), metronidazole at 9.5% (1.1-24.9), ampicillin-sulbactam at 8.9% (0.4-26.5), and unspecified antibiotics at 39.7% (13.8-69.2). The most common sequelae were nasal septal deformity/cartilage destruction at 14.3% (7.7-22.6).</p><p><strong>Conclusion: </strong>NSA/NSH has an 8-day delay in diagnosis from the time of trauma. First-line practitioners should be made aware of the signs and symptoms of this condition to minimize the risk of morbidity.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e174"},"PeriodicalIF":1.8,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392279","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":"Variability of the Microbiota in Chronic Rhinosinusitis: A Scoping Review.","authors":"Fabricio Ccami-Bernal, Fernanda Barriga-Chambi, Zhamanda N Ortiz-Benique, Evelyne Ferrary, Renato Torres","doi":"10.1002/oto2.70029","DOIUrl":"10.1002/oto2.70029","url":null,"abstract":"<p><strong>Objective: </strong>Chronic rhinosinusitis (CRS) is characterized by a persistent inflammation of the nasal and paranasal sinus mucosa that could be potentially linked to a dysregulation between the microbiota and the immune system. We aim to explore general, methodological, and microbiological aspects of microbiota research in CRS compared to disease-free individuals.</p><p><strong>Data sources: </strong>Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science.</p><p><strong>Review methods: </strong>All studies comparing the composition of the resident microbiota of the sinonasal cavities in 2 groups: CRS and normal participants. We conducted systematic study selection, data extraction, and analysis first using the title and abstract, and then the full texts based on predefined inclusion and exclusion criteria. Compiled and presented findings include sampling site and technique, and microbiological results such as the relative abundance and the variability of the composition of the microbiota in both groups.</p><p><strong>Results: </strong>Twenty-seven studies, using genomic identification with 16s RNA were analyzed. Case definitions primarily followed EPOS or AAO-HNS guidelines, with endoscopic swabs (82%), and middle meatus sampling (74%) being prevalent techniques. Despite relative abundance variability, patterns emerged across studies, indicating an increase in <i>Haemophilus</i> (19%) and <i>Pseudomonas</i> (11%), and decrease in <i>Propionibacterium</i> (15%) and <i>Anaerococcus</i> (11%). Another pattern was observed, showing a decreased alpha diversity (6/19; 22%) in CRS compared to normal individuals.</p><p><strong>Conclusion: </strong>While variations exist among studies, analysis of CRS microbiota suggests an association with dysbiosis, potentially contributing to chronic inflammation. Future research must prioritize standardized criteria for diagnostics and patient selection, fostering a more comprehensive understanding of CRS microbiota.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70029"},"PeriodicalIF":1.8,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392280","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":"Outcomes in Minor Salivary Gland Tumors-A 20+ Year Tertiary-Care Center Experience.","authors":"Emily S Zhang, Samuel Doty, Neil Woody, Danielle Bottalico, Jamie A Ku, Brandon Prendes, Shlomo A Koyfman, Shauna R Campbell, Natalie Silver, Joseph Scharpf, Eric D Lamarre","doi":"10.1002/oto2.70030","DOIUrl":"https://doi.org/10.1002/oto2.70030","url":null,"abstract":"<p><strong>Objective: </strong>Minor salivary gland carcinomas are challenging to study due to their rarity and heterogeneity. We aim to further characterize clinical characteristics, treatment, and outcomes over 20 years within a single institution.</p><p><strong>Study design: </strong>Retrospective chart review was conducted on 210 patients who received primary treatment for minor salivary gland malignancy from 2000 to 2022.</p><p><strong>Setting: </strong>Single tertiary-care center.</p><p><strong>Methods: </strong>Multivariable Cox proportional hazards method was used to examine the relationship between pre-determined clinically important variables and outcomes.</p><p><strong>Results: </strong>Five-year overall survival was 77.8% (72.0-84.1). Advanced clinical T stage portended over a 2 times higher risk of death and recurrence. High pathologic grade was associated with a near 3 times higher risk of death and recurrence. There was a predominance of occult nodal metastases in level II for oral cavity and oropharynx site tumors.</p><p><strong>Conclusion: </strong>Clinical T stage and grade were important for overall survival, local, regional, and distant recurrence-free survival. Occult nodal metastases occurred most often in level II.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70030"},"PeriodicalIF":1.8,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392278","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":"Peroperative Notification of Schwartze Sign in Otosclerosis.","authors":"Kanu Lal Saha, Farhan Tarafder","doi":"10.1002/oto2.70021","DOIUrl":"10.1002/oto2.70021","url":null,"abstract":"","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70021"},"PeriodicalIF":1.8,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381442","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":"Implementing a Streamlined Hypoglossal Nerve Stimulator Pathway: Cost, Time to Surgery, and Outcomes.","authors":"Nicholas R Lenze, Jayden Garcia, Punithavathy Vijayakumar, Sonja G Schütz, Michael J Brenner, Jeffrey J Stanley, Paul T Hoff","doi":"10.1002/oto2.70007","DOIUrl":"10.1002/oto2.70007","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the costs, time to surgery, and clinical outcomes associated with implementing a streamlined hypoglossal nerve stimulator (HGNS) implantation pathway.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary care center in the United States from 2016 to 2023.</p><p><strong>Methods: </strong>Patients with a lack of complete concentric collapse of the velum during volitional snore on in-office laryngoscopy qualified for the streamlined HGNS pathway. This pathway consisted of confirmatory drug-induced sleep endoscopy (DISE) followed immediately by HGNS implantation during the same surgical encounter. Outcomes were compared to patients in the traditional pathway (standalone DISE followed by HGNS implantation on a later date).</p><p><strong>Results: </strong>A total of 68 patients (13 streamlined, 55 traditional) with obstructive sleep apnea who underwent HGNS implantation were included. Patients were predominately male (70.6%) and White (95.6%) and had a mean (SD) age of 63.5 (10.0) years. The streamlined pathway was associated with a significant reduction in both hospital costs (mean difference $9258, 95% confidence interval [CI]: 3690-14,825; <i>P</i> = .002) and time to surgery (mean decrease of 3.82 months, 95% CI: 0.83-6.80 months; <i>P</i> = .013) compared to the traditional pathway. Patients in both groups had reduction in apnea-hypopnea index and Epworth Sleepiness Scale score, with no significant differences in comparisons between groups.</p><p><strong>Conclusion: </strong>In select patients, the streamlined HGNS pathway may expedite time to surgery and reduce hospital costs with comparable clinical outcomes to a traditional 2-stage pathway. Further research is warranted to validate patient selection and better understand longitudinal outcomes.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e70007"},"PeriodicalIF":1.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372487","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":"Retrospective Exploration of Botulinum Toxin Injection for Pharyngoesophageal Segment Dysfunction Post-laryngectomy.","authors":"Ruby J Kazemi, Andrew D P Prince, Keith A Casper, Matthew E Spector, Joshua D Smith, Mark E P Prince","doi":"10.1002/oto2.181","DOIUrl":"10.1002/oto2.181","url":null,"abstract":"<p><strong>Objective: </strong>To assess our institution's experience with botulinum toxin A injection management of pharyngoesophageal (PE) segment dysfunction after laryngectomy in tracheoesophageal voice and swallowing restoration<b>.</b></p><p><strong>Study design: </strong>A retrospective review of 43 patients who had Botox as treatment for PE dysfunction.</p><p><strong>Setting: </strong>Tertiary academic center with fellowship-trained otolaryngologists.</p><p><strong>Methods: </strong>Pre- and post-injection outcomes were evaluated using chart review, and the severity of symptoms was recorded based on the subjective assessment by the patient, speech language pathologists, and the treating surgeon.</p><p><strong>Results: </strong>Forty-three patients were treated for PE dysfunction with botulinum toxin A injection. Most patients were male (n = 35, 81.4%), underwent primary cricopharnygeal myotomy (n = 36, 83.7%), and 37 (86%) had both dysphagia and speech concerns. Our injection methods included percutaneous injection by videofluoroscopy (n = 19, 44.2%), transnasal esophagoscopy (17, 40.5%), electromyography (n = 3, 7%), ultrasound (n = 1, 2.3%), or in the operating room (n = 3,7%). We found that 37 (86%) patients had subjective improvement in their symptoms, with 16 (38.1%) improving in both swallow and voice. There were no significant complications, or subjective difference in speech and swallowing outcomes by method of injection.</p><p><strong>Conclusion: </strong>Botulinum toxin A injection appears to be safe and effective for treating difficulty with speech and swallowing due to PE dysfunction after laryngectomy. Institutions should develop standard protocols for treatment and assessment.</p>","PeriodicalId":19697,"journal":{"name":"OTO Open","volume":"8 4","pages":"e181"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361876","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}