Otolaryngology- Head and Neck Surgery最新文献

{"title":"Phenotypes of Velopharyngeal Tube Law in Obstructive Sleep Apnea.","authors":"Devesh Kumar, B Tucker Woodson, Guilherme J M Garcia","doi":"10.1002/ohn.997","DOIUrl":"https://doi.org/10.1002/ohn.997","url":null,"abstract":"<p><strong>Objective: </strong>The biomechanics of upper airway collapse in obstructive sleep apnea (OSA) remains poorly understood. The goal of this study is to compare the area-pressure relationship (tube law) of the velopharynx at peak inspiration and peak expiration.</p><p><strong>Study design: </strong>Cross-sectional.</p><p><strong>Setting: </strong>Academic tertiary medical center.</p><p><strong>Methods: </strong>The velopharyngeal tube law was quantified in a convenience sample of 20 OSA patients via step reductions in nasal mask pressure during drug induced sleep endoscopy (DISE). The velopharyngeal airspace cross-sectional area was estimated from endoscopy while luminal pressure was recorded with a catheter. The tube law was quantified for nasal mask pressures from 14 to 0 cmH₂O at peak inspiration and at peak expiration in all patients. The tube law was also quantified during the breathing cycle at a constant nasal mask pressure of 4 cmH₂O in 3 patients representing different phenotypes.</p><p><strong>Results: </strong>Velopharyngeal compliance (the slope of the tube law) was not statistically different in the peak inspiration versus peak expiration tube laws. Three phenotypes were observed, namely inspiratory collapse (phenotype 1), expiratory collapse (phenotype 2 = palatal prolapse), and a mostly stable airway during inspiration and expiration that collapsed as CPAP was reduced (phenotype 3).</p><p><strong>Conclusion: </strong>Velopharyngeal compliance is not significantly different at peak inspiration and peak expiration, which suggests that muscle tone is low when luminal pressure is above the closing pressure. Additional studies are needed to investigate how different phenotypes of velopharyngeal collapse may affect therapeutic outcomes.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Barriers and Facilitators of Shared Decision Making in Pediatric Otolaryngology: A Qualitative Study.","authors":"Usman Khan, Erin Luther, Christine E Cassidy, Emily Boss, Kara D Meister, Lauren Bohm, M Elise Graham, Paul Hong","doi":"10.1002/ohn.972","DOIUrl":"https://doi.org/10.1002/ohn.972","url":null,"abstract":"<p><strong>Objective: </strong>To identify barriers and facilitators to implementing shared decision making (SDM) in pediatric otolaryngology.</p><p><strong>Study design: </strong>A qualitative study.</p><p><strong>Setting: </strong>Semistructured interviews of pediatric otolaryngologists.</p><p><strong>Methods: </strong>The Theoretical Domains Framework (TDF) was used as a guide for data collection and analysis to consider capability, opportunity, and motivation (COM-B) factors. The focal surgical procedures were tonsillectomy, adenoidectomy, and tympanostomy tube placement. Deductive and inductive coding of interview transcripts according to TDF/COM-B domains were performed by 2 separate reviewers.</p><p><strong>Results: </strong>A total of 11 interviews were conducted to achieve data saturation. The 4 dominant themes were: (1) inconsistent inclusion of SDM elements in practice, (2) social influences from parents, (3) environmental context, and (4) applicability of SDM in otolaryngology. Theme 1 identified that surgeons perceived SDM as a feature of their practice. However, the discussion of parents' values was seen as less explicit and structured interview formats were not commonly employed. Theme 2 demonstrated that surgeons saw parents' preconsult \"agenda\" as influencing their openness to consider multiple treatment options. Theme 3 pointed to the barriers of short appointment times, challenges in the use of support staff and lack of decision aids. Theme 4 emphasized surgeons' belief in the value of SDM and that parents' involvement in decision making reduced likelihood of decisional regret.</p><p><strong>Conclusion: </strong>Pediatric otolaryngologists strongly support the value of SDM during clinical encounters, particularly to allow parent ownership of decisions regarding treatment. The major barriers were lack of clinical translation of SDM knowledge, social influences, and environmental factors.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utility and Safety of Prophylactic Tranexamic Acid in Tonsillectomy: A Systematic Review and Meta-analysis.","authors":"Hussein Smaily, Patrick Cherfane","doi":"10.1002/ohn.973","DOIUrl":"https://doi.org/10.1002/ohn.973","url":null,"abstract":"<p><strong>Objective: </strong>We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of tranexamic acid (TXA) in reducing posttonsillectomy hemorrhage (PTH).</p><p><strong>Data sources: </strong>We searched MEDLINE, EMBASE, and CENTRAL for RCT comparing prophylactic TXA to control in patients undergoing tonsillectomy.</p><p><strong>Review methods: </strong>Per Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, the databases were searched from date of inception through October 2023. RCTs of patients undergoing tonsillectomy or adenotonsillectomy and receiving prophylactic TXA versus control were included. Two reviewers screened citations, extracted data, assessed the risk of bias, and classification of Grading of Recommendations, Assessment, Development, and Evaluation independently. Standardized mean difference with 95% confidence interval (CI) was applied for continuous variables. Dichotomous data were expressed as relative risk with 95% CI.</p><p><strong>Results: </strong>A total of 10 RCT were included in our quantitative analysis. Eight studies reported on PTH rate. Prophylactic TXA showed non-significant decrease in PTH (relative risk or risk ratio [RR]: 0.62 [0.35, 1.10]). Sensitivity analysis showed significant decrease in PTH after exclusion of High-risk bias studies (RR: 0.48 [0.30, 0.77]). Intraoperative blood loss volume was significantly lower in the TXA group (35.59 mL [-48.19, -22.99]).</p><p><strong>Conclusion: </strong>Overall, this study showed a tendency toward lesser PTH rate with prophylactic TXA. However, this tendency only reaches statistical significance when studies with high risk of bias are excluded. Well-designed trials are still needed to support our observations.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Long-Term Quality of Life Concerns Through Survivorship Clinic in Head and Neck Cancer Patients.","authors":"Andrew Yousef, Ariadne Nichol, Bao Luu, Carie Montesa, Celia Ramsey, Philipp Verpukhovskiy, Liza Blumenfeld, Kristen Linnemeyer-Risser, Theresa Guo","doi":"10.1002/ohn.985","DOIUrl":"https://doi.org/10.1002/ohn.985","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the concerns of head and neck cancer (HNC) patients and discern changes in quality-of-life (QoL) during long-term follow-up.</p><p><strong>Study design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Survivorship clinic at a tertiary academic center.</p><p><strong>Methods: </strong>A retrospective review was conducted on HNC patients seen in our survivorship clinic between 1/2020 and 1/2024 using the University of Washington Quality of Life (UW-QOL) Questionnaire.</p><p><strong>Results: </strong>Three hundred and forty-two patients were seen for 914 encounters. Patients were divided into 4 groups: pretreatment (n = 326), 0 to 12 months posttreatment (n = 247), 1 to 3 years posttreatment (n = 248), and more than 3 years posttreatment (n = 64). The average follow-up after treatment was 459 days (range: 0-5.2 years). Multivariable analysis revealed significant improvements in overall QoL, health-related QoL, social-emotional composite scores, activity, anxiety, appearance, chewing, mood, pain, speech, and recreation at more than 1-year posttreatment compared to less than 1-year posttreatment. However, declines were noted in saliva and taste scores. No differences in scores were observed between patients 1 to 3 years posttreatment and those >3 years posttreatment. At all timepoints before and after treatment, top concerns were pain, activity, and swallowing. Patients with oral cancer followed for more than 1-year posttreatment had worse scores in appearance, chewing, pain, and speech compared to those with oropharyngeal cancer.</p><p><strong>Conclusions: </strong>Understanding the evolving concerns of HNC patients is imperative for enhancing care. Most QoL domains improve at 1-year posttreatment except for saliva, taste, swallowing, and shoulder function. QoL scores stabilize after 1-year post-treatment. Pain, activity, and swallowing remain the top concerns at all time points.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Discrepancy: How Cost of Living (COL) Adjustments Impact Otolaryngology Residents' Salaries.","authors":"Douglas P Nanu, Hardeep S Tiwana, Deepthi S Akella, Shaun A Nguyen, Sofia Khan, Michele M Carr","doi":"10.1002/ohn.978","DOIUrl":"https://doi.org/10.1002/ohn.978","url":null,"abstract":"<p><strong>Objective: </strong>To compare differences in otolaryngology residents' salaries in different cities and states before and after adjusting for the cost of living.</p><p><strong>Study design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>Accreditation Council for Graduate Medical Education (ACGME) otolaryngology residency program websites.</p><p><strong>Methods: </strong>US otolaryngology residency programs were identified via the ACGME database in December 2023. Stipends posted by each residency program were compared to the cost of living (COL) for related states and major cities. A baseline value of 100 was used as the mean COL, values over 100 indicate above-mean COL. The weighted salary by state and cities for postgraduate year (PGY) 1 to 5 combined was expressed as mean (SD). Comparisons between salaries before and after adjustment for the COL were assessed using t tests.</p><p><strong>Results: </strong>The mean otolaryngology residency stipend across the nation, by city, was $70,572 (n = 1290, range: $58,100-$93,402; SD = $8370), with a post-COL adjustment mean stipend of $64,055 (range: $39,193-$76,674, SD = $10,094, p < .001). Otolaryngology residents in Manhattan, New York State faced a mean decrease from $89,282 to $39,193 (-56%) post-COL adjustments. Following that were Boston and Los Angeles programs which saw a -$26,402 (-32%) and -$24,761 (-32%) mean decrease after COL adjustments, respectively.</p><p><strong>Conclusion: </strong>Otolaryngology residents in high-cost areas experience significant salary reductions because of COL adjustments, resulting in financial strain. Residents in such regions endure increased financial pressure compared to those in low-cost areas, as current salaries fail to align with living expenses.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a 3D-Printed Silicone-Based Laryngeal Model for Resident Education.","authors":"Andrew Yousef, Benjamin T Ostrander, Jui-Te Lin, Ariadne A Nichol, Andrew M Vahabzadeh-Hagh, Daniel Cates, Tania K Morimoto, Philip A Weissbrod","doi":"10.1002/ohn.1000","DOIUrl":"https://doi.org/10.1002/ohn.1000","url":null,"abstract":"<p><strong>Objective: </strong>We sought to validate a laryngeal simulation model and subsequently demonstrate its efficacy in improving surgical technique.</p><p><strong>Study design: </strong>Pre-post interventional study.</p><p><strong>Setting: </strong>Otolaryngology Program at a Tertiary Care Center.</p><p><strong>Methods: </strong>A low-cost, high-fidelity laryngeal model was created using a 3-dimensional-printed cast and multilayered silicone to mimic vocal fold lesions. Participants (attendings and trainees) were first given a series of tasks including mucosal vocal fold lesion resection and microflap excision of a submucosal lesion. Trainees were then provided with an instructional video from a laryngologist and asked to repeat the same tasks on the model. Performance data was then assessed using validated surveys and blinded expert reviewers.</p><p><strong>Results: </strong>Eighteen participants completed the simulation. All subjects agreed that the \"simulation experience was useful\" and 93% agreed \"the simulator helped improve my ability to do microsurgical tasks.\" In the postinstruction self-evaluation, trainees reported a significant decrease in mental demand (95% confidence interval [CI]: 0.37-0.91; P = .038) and significant increase in subjective performance (95% CI: 1.51-51.89; P = .016) compared to the preinstruction self-evaluation. On the postinstruction attempt, there was a significant improvement in all domains of the adapted objective structured assessment of technical skills as measured by 3 blinded, expert reviewers.</p><p><strong>Discussion: </strong>This study demonstrates the usefulness of a silicone larynx model and the value of instructional video in developing laryngeal microsurgical skills. Participants positively reviewed the laryngeal model and trainees saw both a subjective and objective improvement indicating tangible operative benefits from the use of this laryngeal simulation.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscope-Assisted Transcervical Resection of Parapharyngeal Space Tumors.","authors":"Joshua D Smith, Steven B Chinn, Shaum Sridharan, Kevin J Contrera, Molly E Heft-Neal, Matthew E Spector","doi":"10.1002/ohn.976","DOIUrl":"https://doi.org/10.1002/ohn.976","url":null,"abstract":"<p><strong>Objective: </strong>We describe a novel technique for endoscope-assisted (EA) transcervical (TC) approach for resection of parapharyngeal space (PPS) tumors and compare perioperative outcomes of this approach to standard TC approaches.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Single tertiary care center.</p><p><strong>Methods: </strong>This was a single-institution, retrospective analysis of all patients undergoing TC approach for resection of PPS tumors over a 10-year period. We describe unique advantages of our surgical approach utilizing a 0° endoscope for improved surgical access, visualization, and efficiency. χ² and Student's t test were used to compare perioperative outcomes between cases in which an endoscope was utilized EA for resection versus standard TC approach.</p><p><strong>Results: </strong>Our cohort included 77 patients (n = 40 EA, n = 37 TC). There was no difference in patient age, sex, tumor laterality, tumor size, or tumor location between groups. The EA approach was associated with significantly shorter operative times (median [range] for EA 73 [33-270] minutes vs TC 112 [56-362] minutes, P < .01) and reduced rates of immediate postoperative marginal mandibular nerve paresis (EA: n = 5 [12.5%] vs TC: n = 16 [43.2%], P < 0.01).</p><p><strong>Conclusion: </strong>EA TC approach for resection of PPS tumors offers improved surgical access and is associated with reduced surgical time and rates of marginal mandibular nerve paresis compared to standard transcervical approaches.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 Pandemic on the Incidence, Etiology, Demographics, and Treatment of Craniomaxillofacial Trauma.","authors":"F Jeffrey Lorenz, Andrew J Rothka, Heather K Schopper, Jessyka G Lighthall","doi":"10.1002/ohn.981","DOIUrl":"https://doi.org/10.1002/ohn.981","url":null,"abstract":"<p><strong>Objective: </strong>To compare the incidence, etiology, demographics, and treatment of craniomaxillofacial (CMF) trauma before, during, and after COVID-19.</p><p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Eighty-three health care organizations across the United States.</p><p><strong>Methods: </strong>The TriNetX Research Network identified 77,977,880 patients during 2017 to 2022. CMF fractures and soft tissue injuries during March to August of each year, aligning with the 2020 pandemic lockdown, were analyzed.</p><p><strong>Results: </strong>In 2020, compared to immediately prepandemic in 2019, there were significant reductions of -17.5% in facial fractures and -19.0% in soft tissue injuries (P < .001). Conversely, in 2021, both injury types increased by +16.7% and +16.3%, respectively, compared to 2020 (P < .001). Changes in injury mechanisms in 2020 included significant decreases in athletic injuries (-57.6%), falls (-16.8%), assaults (-15.5%), motor vehicle collisions (-8.7%), and pedestrian accidents (-6.9%) (P < .01), while off-road vehicle (+48.4%), bicycle (+16.2%), and motorcycle (+8.9%) accidents increased (P < .01). The 10- to 14- and 5- to 9-year-old age groups experienced the most substantial reductions in facial fractures (-39.7% and -29.9%, respectively) and soft tissue injuries (-29.2% and -28.3%, respectively) in 2020 compared to 2019 (P < .001). Operative management of fractures and soft tissue injuries dropped by -20.3% and -12.4%, respectively, in 2020 versus 2019, and then rebounded with +15.8% and +14.6% increases in 2021 compared to 2020 (P < .001). In 2022, compared to prepandemic rates of 2019, there were fewer patients with facial fractures (-2.8%), soft tissue injuries (-4.5%), and operative repairs (-6.9% for fractures, -1.2% for soft tissue injuries) (P < .03).</p><p><strong>Conclusion: </strong>CMF trauma decreased in 2020, with subsequent years showing a rebound to levels slightly below those immediately prior to pandemic onset. Changes in etiology, demographics, and treatment highlight the complex dynamics of traumatic injuries during periods of societal disruption.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship between Upper Esophageal Sphincter Manometry Function and Esophageal Motility Disorders.","authors":"Juliette Hall, Milli Gupta, Michelle Buresi, Dorothy Li, Yasmin Nasser, Christopher N Andrews, Matthew Woo, Derrick R Randall","doi":"10.1002/ohn.993","DOIUrl":"https://doi.org/10.1002/ohn.993","url":null,"abstract":"<p><strong>Objective: </strong>High-resolution manometry (HRM) provides measures of esophageal function which are used to classify esophageal motility disorders based on the Chicago Classification system. Upper esophageal sphincter (UES) measures are obtained from HRM, but are not included in the classification system, rendering the relationship between UES measures and esophageal motility disorders unclear. Furthermore, changes in the acceptable amount of esophageal dysfunction between versions of this classification system has created controversy. The objective of this study was to determine the relationship between UES measures and esophageal function.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Referral centre.</p><p><strong>Methods: </strong>HRM studies from the Calgary Gut Motility Center were reviewed for UES mean basal pressure, mean residual pressure, relaxation time-to-nadir, relaxation duration, and recovery time. Patients were grouped by number of failed swallows according to different iterations of the Chicago Classification: 0 to 4 (Group 1), 5 to 7 (Group 2), and 8 to 10 (Group 3).</p><p><strong>Results: </strong>2114 patients (65.1% female, median age 56 y) were included. There were significant increases in UES mean basal pressure (P < .001), mean residual pressure (P < .001), relaxation duration (P < .001), and recovery time (P < .001) between groups. Positive correlations existed between number of failed swallows and UES mean basal pressure (r = 0.143; P < .001), mean residual pressure (r = 0.201; P < .001), relaxation duration (r = 0.145; P < .001), and recovery time (r = 0.168; P < .001).</p><p><strong>Conclusions: </strong>Differences in UES measures exist among patients with failed swallows, with a positive correlation between UES dysfunction and increasing dysmotility. Our findings illustrate that UES measures are closely related to esophageal function, and that even minor esophageal dysfunction is related to UES dysfunction.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Changing Drug Classes in Patients With Refractory Laryngopharyngeal Reflux Disease.","authors":"Emilie Herman, Sven Saussez, Jérôme R Lechien","doi":"10.1002/ohn.996","DOIUrl":"https://doi.org/10.1002/ohn.996","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of drug class changes in patients with refractory laryngopharyngeal reflux disease (LPRD).</p><p><strong>Study design: </strong>Retrospective case series with prospective data.</p><p><strong>Setting: </strong>Multicenter study.</p><p><strong>Methods: </strong>The data of patients treated for a refractory LPRD from September 2017 to December 2023 were collected. The effectiveness of drug class changes was assessed through the reflux symptom score (RSS) change. Signs were evaluated with the Reflux Sign Assessment. The RSS reduction was used to categorize the therapeutic responses as mild (20%-40% RSS reduction), moderate (40.1%-60% RSS reduction), high (60.1%-80%), and complete (>80%).</p><p><strong>Results: </strong>Among the 334 medical records, 74 (22.2%) patients had refractory LPRD defined as no RSS change in the pre- to 3-month posttreatment. The mean age was 52.6 ± 15.5 years. Changing drug class was associated with significant 3- to 6-month posttreatment reductions of RSS and RSA. Thirty patients (39%) did not experience symptom reduction after changing drugs. Changing alginate to magaldrate and magaldrate to alginate was associated with the highest responder rate (76.9%). Changing PPI and alginate/magaldrate molecules led to a response rate of 62.5%. In patients initially treated with a combination of PPI and alginate or magaldrate, changing PPI without changing alginate/magaldrate led to a 37.5% response rate. The baseline RSS was predictive of the 3- and 6-month RSS (therapeutic response).</p><p><strong>Conclusion: </strong>Changing drug class, especially alginate-to-magaldrate, may be an effective therapeutic approach for patients with a refractory LPRD.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}