Maria-Pia Tuset, Jaimee N Cooper, Dario Ebode, Jeenu Mittal, Carolyn Garnham, Teresa Melchionna, Roland Hessler, Sören Schilp, Dimitri Godur, Keelin McKenna, Rahul Mittal, Adrien A Eshraghi
{"title":"Intracochlear Drug Delivery Using a Catheter and Dexamethasone-Eluting Electrode Preserves Residual Hearing Post-Cochlear Implantation.","authors":"Maria-Pia Tuset, Jaimee N Cooper, Dario Ebode, Jeenu Mittal, Carolyn Garnham, Teresa Melchionna, Roland Hessler, Sören Schilp, Dimitri Godur, Keelin McKenna, Rahul Mittal, Adrien A Eshraghi","doi":"10.1002/ohn.1252","DOIUrl":"10.1002/ohn.1252","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess the feasibility and safety of a cochlear catheter (cannula) for inner ear drug delivery during cochlear implantation. We evaluated the otoprotective effect of L-N-acetylcysteine (L-NAC) administered via a cannula in combination with a dexamethasone-eluting cochlear implant (CI).</p><p><strong>Study design: </strong>An animal model study.</p><p><strong>Setting: </strong>Animal facility of an academic institution.</p><p><strong>Methods: </strong>Animals were divided into 8 groups: (1) implantation with a CI; (2) implantation with a dexamethasone-eluting CI (CIDexel); (3) cannula injection of artificial perilymph (Can+AP); (4) cannula injection of Ringer (Can+R); (5) cannula injection of R and CI (Can+CI); (6) cannula injection of R and Dexel (Can+Dexel); (7) cannula injection of 2 mM L-NAC and CI (Can L-NAC 2 mM+CI); or (8) cannula injection of 2mM L-NAC and Dexel (Can L-NAC 2 mM++Dexel). The contralateral ear served as the control group. Hearing thresholds were determined preoperatively, and at postoperative day (POD 7) and POD 30 post-cochlear implantation, using auditory brainstem responses (ABRs). The organ of Corti dissections were performed at POD 30 for hair cell (HC) viability, and oxidative stress assessment using immunostaining.</p><p><strong>Results: </strong>The L-NAC (2 mM) and dexamethasone-eluting electrode group had significantly lower hearing thresholds than the standard CI, Can L-NAC 2 mM, and Dexel groups. The animal group treated with L-NAC (2 mM) and dexamethasone-eluting electrode showed higher HC viability and reduced oxidative stress.</p><p><strong>Conclusion: </strong>An intracochlear cannula can deliver pharmaceutical interventions without causing additional hearing loss. L-NAC presents strong anti-apoptotic potential and administration through a cannula together with Dexel implantation, and achieves a synergistic effect enhancing the otoprotection.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"208-217"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026550","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":"Improved Pharyngeal Contraction and Oral Intake Status After Modified Central-Part Laryngectomy for Late-Stage ALS.","authors":"Rumi Ueha, Maria Angela Dealino, Misaki Koyama, Kaoru Yamakawa, Naoyuki Matsumoto, Taku Sato, Takao Goto, Aiko Mizukami, Kenji Kondo","doi":"10.1002/ohn.1229","DOIUrl":"10.1002/ohn.1229","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of modified central-part laryngectomy with pharyngeal space reduction (CPL-PR) on patients with weak deglutitive pharyngeal contraction, as seen in late-stage amyotrophic lateral sclerosis (ALS).</p><p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Single-institution academic center.</p><p><strong>Methods: </strong>Patients with late-stage ALS confined at The University of Tokyo Hospital between 2019 and March 2024 in whom CPL-PR had been performed were identified. Patients who had undergone simultaneous pharyngeal flap surgery or had no preoperative high-resolution manofluorography done were excluded. Preoperatively, penetration-aspiration scale (PAS) scores were determined via videofluoroscopic swallowing study. Functional oral intake scale (FOIS) scores and high-resolution manometric parameters were measured and compared preoperatively and postoperatively.</p><p><strong>Results: </strong>Eighteen patients were identified with a median age of 66.5 (interquartile range [IQR]: 58.0-74.8). The median preoperative PAS score was 7.5 (IQR: 5.5-8.0), indicating severe dysphagia. There was significant improvement in oral intake status with FOIS scores increasing from 1 (IQR: 1-1) to 3 (IQR: 2-3) at 3 months postoperatively (P = .0002). Significant increases in velopharyngeal closure integral (P = .024) and mesohypopharyngeal contractile integral (P = .0001) were observed. Upper esophageal sphincter (UES) resting pressure was reduced (P = .0002), and UES relaxation time was prolonged during swallowing (P < .0001).</p><p><strong>Conclusion: </strong>There were tangible improvements in pharyngeal contraction, UES bolus passage, and oral intake status following CPL-PR, which contribute to regaining oral intake in late-stage ALS. CPL-PR is an option for patients requiring tracheostomy who wish to prevent aspiration and regain their ability to take food orally.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"154-161"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658116","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}
Anne Renée Juliette Péporté, Benoît Gallix, Aïna Venkatasamy
{"title":"Perilymphatic Signal Changes in Vestibular Schwannoma: A Potential Biomarker of Progressive Hearing Loss?","authors":"Anne Renée Juliette Péporté, Benoît Gallix, Aïna Venkatasamy","doi":"10.1002/ohn.1228","DOIUrl":"10.1002/ohn.1228","url":null,"abstract":"<p><strong>Objective: </strong>Vestibular schwannomas influence the magnetic resonance (MR) signal intensity (SI) in the vestibular cistern and cochlear perilymph. The aim of this study is to evaluate the relationship between perilymphatic signal changes on gradient-echo T2-weighted 3 T MR sequence and the clinical symptoms.</p><p><strong>Study design: </strong>Retrospective case-control study.</p><p><strong>Setting: </strong>The study was conducted at the Institute of Image-Guided Surgery in Strasbourg, France.</p><p><strong>Methods: </strong>Patients with vestibular schwannoma who underwent magnetic resonance imaging at our institution between 2008 and 2016 were retrospectively reviewed. A control group consisted of individuals without past or present otological symptoms. The vestibular schwannomas were divided into three groups, based on the degree of internal auditory canal obstruction. The SI ratios of the vestibular cistern to cerebrospinal fluid (CSF) and cochlea to CSF were compared with clinical data.</p><p><strong>Results: </strong>We included 172 patients with vestibular schwannoma and 61 controls. Vestibular schwannoma was associated with a significant decrease of the SI ratio of the vestibular cistern to CSF (0.716 ± 0.297 vs 1.06 ± 0.21, P = .004) and cochlea to CSF (0.66 ± 0.199 vs 0.903 ± 0.011, P = .004) compared to controls, with significant negative correlation between both the SI ratios of the vestibular cistern and cochlea to CSF with tumor volume (P < .001). Among all the symptoms studied, the SI ratio of the cistern normalized by CSF was significantly associated with progressive hearing loss (P = .003).</p><p><strong>Conclusion: </strong>Perilymphatic vestibular cistern and cochlear SI changes appear to be a promising noninvasive biomarker for hearing impairment in vestibular schwannoma.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"185-192"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657426","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":"Diagnostic Accuracy of Patient-Reported Outcome Measures and Finding Instruments in Laryngopharyngeal Reflux Disease.","authors":"Catherine Muscato, Jerome R Lechien","doi":"10.1002/ohn.1237","DOIUrl":"10.1002/ohn.1237","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the diagnostic accuracy of various combinations of patient-reported outcome measures (PROMs) and upper aerodigestive tract finding instruments dedicated to the clinical diagnosis of laryngopharyngeal reflux disease (LPRD).</p><p><strong>Study design: </strong>Prospective, multicenter study.</p><p><strong>Setting: </strong>University hospital.</p><p><strong>Methods: </strong>Patients with LPRD at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring were recruited from three European hospitals. Asymptomatic individuals served as the control group. Participants completed the Reflux Symptom Index (RSI), Reflux Symptom Score (RSS), and Reflux Symptom Score-12 (RSS-12) at baseline and 3-month posttreatment. Clinical signs were evaluated with the Reflux Finding Score (RFS), Reflux Sign Assessment (RSA), and Reflux Sign Assessment-10 (RSA-10). Sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated for each instrument and their combinations.</p><p><strong>Results: </strong>A total of 542 LPRD patients and 204 healthy controls were included. The RSS was the PROM with the highest SE (95.4%), whereas RSS-12 reported the highest SP (94.7%). RSA had the highest SE (94.0%), and RSA-10 reported the highest SP (76.3%). The highest SE and SP of combination tools were found for RSS+RSA (90.4%) and RSS+RSA-10 (99.4%), respectively. RSS+RSA-10 achieved the highest PPV value (99.7%) and RSS+RSA had the highest NPV (79.3%). Overall, the RSS demonstrated the greatest diagnostic accuracy with an area under the curve (AUC) of 0.985. The combination RSS+RSA reported an AUC of 0.934.</p><p><strong>Conclusion: </strong>The combination of RSS and RSA provided the most accurate diagnostic performance, maximizing SE, SP, PPV, and NPV. This combination offers enhanced utility for the preliminary diagnosis of LPRD.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"171-177"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693053","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":"Surgical Outcomes Comparison of Spontaneous Middle Cranial Fossa Cerebrospinal Fluid Leaks: Systematic Review and Meta-analysis.","authors":"Dimitrios Spinos, Panagiotis Varoutis, Georgios Geropoulos, Georgios Vavoulis, Georgios Georgountzos, Nina Rafailia Karela, Manthia Papageorgakopoulou, Kyriacos Evangelou, Jameel Muzaffar, Wai Sum Cho","doi":"10.1002/ohn.1279","DOIUrl":"10.1002/ohn.1279","url":null,"abstract":"<p><strong>Objective: </strong>Spontaneous cerebrospinal fluid (sCSF) leaks of lateral skull base have little consensus on optimal management. We synthesized and evaluated current literature via systematic and meta-analysis to compare the success rates and complications of the different surgical techniques for middle cranial fossa (MCF) sCSF leak repair.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, and Cochrane Library.</p><p><strong>Review methods: </strong>Studies selected concerned surgical treatment of MCF sCSF leak. Data extracted included the following: study characteristics, patient characteristics, primary outcomes, and secondary outcomes.</p><p><strong>Results: </strong>From 297 repairs with a MCF approach, the complication rate was 16.2% (95% CI: 12.3%-21.1%, I<sup>2</sup> = 0%, P = .052), compared to transmastoid (TM) 12.2% (95% CI: 6.7%- 21.2%, I<sup>2</sup> = 0%) in 82 repairs and for combined approaches 11.9% (95% CI: 4.2%-29.6%, I<sup>2</sup> = 58%) in 98 repairs. The rate of recurrence with the MCF approach was 3.2% (95% CI: 1%-6.4%, I<sup>2</sup> = 10%, P = .21) in 297 repairs, in the TM group the rate was 8.6% (95% CI: 4.7%-15%, I<sup>2</sup> = 0%) in 125 procedures and 1.1% in the combined approaches group (0%-4.5%, I<sup>2</sup> = 0%) in 139 procedures. Analysis of reoperation rates revealed a proportion of 0.9% (95% CI: 0%-4.4%, I<sup>2</sup> = 51%) in 287 repairs via the MCF approach. Reoperation rate was 8.6% (95% CI: 4.7%- 15%, I<sup>2</sup> = 0%) in 125 repairs via TM and 1.1% (95% CI: 0%-4.5%, I<sup>2</sup> = 0%) in 139 combined approach repairs.</p><p><strong>Conclusion: </strong>There is no statistically significant difference in the outcomes of repair techniques. Decision making for the preferred approach will be dependent on the location, size and number of the defects, hearing status, and in consultation with the patient.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"27-39"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006789","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}
J B Eyring, Brandon M Hemeyer, Stephen Walker, Wesley P Allen, Shi Liang, Christopher Stewart, Jeremy D Meier, Reema Padia
{"title":"Button Battery Ingestion: Exploring Socioeconomic Risk Factors.","authors":"J B Eyring, Brandon M Hemeyer, Stephen Walker, Wesley P Allen, Shi Liang, Christopher Stewart, Jeremy D Meier, Reema Padia","doi":"10.1002/ohn.1206","DOIUrl":"10.1002/ohn.1206","url":null,"abstract":"<p><strong>Objective: </strong>Examine the demographic and social determinants of health linked to pediatric esophageal foreign body removals, with an emphasis on button battery ingestions.</p><p><strong>Study design: </strong>A retrospective chart review was performed on pediatric patients who underwent operative removal of a foreign body from the esophagus (Current Procedural Terminologies [CPTs] 43215, 43194).</p><p><strong>Setting: </strong>The study was conducted across four hospitals from November 2010 to December 2023.</p><p><strong>Methods: </strong>Data on patient demographics and social determinants of health were analyzed. Exclusions included nonaccidental ingestions, patients older than 18 years, and cases with missing social determinants of health data. The Agency for Healthcare Research and Quality (AHRQ) database was used to link patient data to socioeconomic indicators.</p><p><strong>Results: </strong>Of 825 cases, 50 were button battery ingestions. Age was comparable between button battery and nonbutton battery patients. Button battery patients were predominantly male. Socioeconomic analysis revealed that button battery patients were from households with higher median incomes, lower poverty rates, higher home values, and greater internet access. The incidence of button battery ingestion increased over the study period.</p><p><strong>Conclusion: </strong>This study highlights significant demographic and socioeconomic differences in pediatric foreign body ingestions compared to button battery ingestions. Male gender and higher socioeconomic status were notable risk factors for button battery ingestion. These findings support the need for educational and preventive strategies to address the risks associated with button battery ingestion.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"96-105"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586705","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":"Phenotyping and Endotyping Pediatric Chronic Rhinosinusitis.","authors":"Ella Morgan, Michael J Cunningham, Eelam A Adil","doi":"10.1002/ohn.1231","DOIUrl":"10.1002/ohn.1231","url":null,"abstract":"<p><strong>Objective: </strong>To differentiate pediatric chronic rhinosinusitis (CRS) into clinically relevant primary and secondary phenotypes based on clinical, radiographic, and laboratory findings.</p><p><strong>Study design: </strong>Retrospective chart review of patients with CRS who underwent endoscopic sinus surgery over a 5-year period.</p><p><strong>Setting: </strong>Tertiary referral children's hospital.</p><p><strong>Methods: </strong>Relevant medical and surgical history inclusive of disease onset, clinical and radiographic findings, laboratory data, and operative culture results was recorded. Data analysis resulted, where appropriate, in phenotype and endotype characterization.</p><p><strong>Results: </strong>In total, 94 patients, aged 6.8 to 22.0 years, with a mean age of 15.4 years, satisfied the inclusion criteria. Eosinophilic CRS was the most common primary phenotype (n = 19, 20.2%), and this group was the most likely to have recurrent disease requiring revision surgery. Additional primary phenotypes identified included allergic fungal rhinosinsusitis (n = 10, 10.6%) and central compartment atopic disease (n = 2, 2.1%). CRS associated with cystic fibrosis was the most common secondary CRS category (n = 13, 13.8%). Based on available data, over one-third of patients (n = 36, 38.2%) could not be categorized into a specific phenotype based on current clinical and radiologic criteria.</p><p><strong>Conclusion: </strong>A phenotype and endotype-based classification system for CRS is evolving for the adult population. This study highlights that such a classification system is possible in the pediatric and adolescent age group, facilitating targeted biologic therapies at the underlying inflammatory mechanism. Further investigation is clearly required given an etiologic source of paranasal sinus inflammation could not be identified in approximately one-third of patients.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"243-250"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662736","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}
Wen-Hsuan Tseng, Ming-Sui Lee, Shung-Cyuan Hong, Tzu-Yu Hsiao, Tsung-Lin Yang
{"title":"Application of an AI-Based Model for Non-Invasive Sonographic Assessment for Injection Laryngoplasty.","authors":"Wen-Hsuan Tseng, Ming-Sui Lee, Shung-Cyuan Hong, Tzu-Yu Hsiao, Tsung-Lin Yang","doi":"10.1002/ohn.1215","DOIUrl":"10.1002/ohn.1215","url":null,"abstract":"<p><strong>Objective: </strong>Hyaluronic acid (HA) can be degraded over time. However, the persistence of the effects after injection laryngoplasty (IL) for unilateral vocal fold paralysis (UVFP) has been observed. The relation between HA residue and clinical voice outcomes is undetermined. We aimed to develop a non-invasive method with clinical applicability for objective evaluation of the temporal change in HA volume using artificial intelligence-based ultrasonographic assessment. Furthermore, the volume outcome and its relation to voice outcomes were investigated.</p><p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Setting: </strong>A voice clinic at a tertiary medical center.</p><p><strong>Methods: </strong>Adult patients who underwent HA IL for UVFP were recruited. The Voice Handicap Index-10 questionnaire, the grade, roughness, breathiness, asthenia, strain scale, and the normalized glottal gap were evaluated before IL. Patients received ultrasonography for the identification of HA and estimation of volume based on Temporal Convolutional Segmentation Network, and also voice outcome assessments at 2 weeks, and 2 and 6 months after IL.</p><p><strong>Results: </strong>Contours of HA were well-described, and volumes were estimated accordingly. Clinical voice outcomes were significantly improved postoperatively and remained stationary. Contrarily, residual HA volume decreased significantly across time points (1.21 ± 0.53 at 2 weeks, 0.63 ± 0.35 at 2 months, P < .001; 0.32 ± 0.25 at 6 months, P < .001). Simple linear regression showed no significant relationship between the remaining volume at 2 months and patient age or duration of symptoms (P = .67).</p><p><strong>Conclusion: </strong>Volume change of injected HA over time was estimated non-invasively. The prolonged voice improvement, longer than HA longevity, was demonstrated objectively. The knowledge on HA longevity and duration of benefit provides perspectives beneficial to counseling patients and future treatment planning.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"144-153"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674429","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}
Praneet C Kaki, Neel R Sangal, Doreen Lam, Ryan M Carey, Karthik Rajasekaran, Ara Chalian, Robert M Brody, Gregory S Weinstein, Steven B Cannady
{"title":"Functional Outcomes of Free Flap Reconstruction After TORS in Early-Stage HPV-Positive Oropharyngeal Cancer.","authors":"Praneet C Kaki, Neel R Sangal, Doreen Lam, Ryan M Carey, Karthik Rajasekaran, Ara Chalian, Robert M Brody, Gregory S Weinstein, Steven B Cannady","doi":"10.1002/ohn.1221","DOIUrl":"10.1002/ohn.1221","url":null,"abstract":"<p><strong>Objective: </strong>In the unique clinical context of a retropharyngeal carotid artery (RPC), free flap reconstruction (FFR) may be used for small pathologic tumor (pT)1-2 human papillomavirus (HPV)+ oropharyngeal squamous cell carcinoma (OPSCC) tumors to provide vessel coverage, providing a unique case-control study model. This study aims to elucidate the impact of FFR on functional outcomes following transoral robotic surgery (TORS).</p><p><strong>Study design: </strong>Retrospective review of electronic medical records between 2010 and 2022.</p><p><strong>Setting: </strong>Single-institution tertiary care center.</p><p><strong>Methods: </strong>Cohorts were defined as FFR (with RPC) and no FFR (nFFR). A 1:2 propensity score match (PSM) was performed. The functional oral intake scale (FOIS) was used to characterize swallowing outcomes. Statistical analysis was performed in R-Studio.</p><p><strong>Results: </strong>Post-PSM, 93 patients met inclusion criteria (59.8 years, 92% white, 88% male). In total, 31 (33%) underwent FFR, 77 (83%) had pT2 tumors, and 87 (93%) underwent adjuvant treatment. The FFR cohort saw increased return to the operating room (FFR 19% vs nFFR 3.3%, P < .001) and mean hospital stay (7.2 ± 2.2 vs 4.9 ± 3.1 days, P = .02). Median preoperative FOIS was similar between groups (FFR: 7.00 [interquartile range (IQR) 6.00-7.00] vs nFFR: 7.0 [7.00-7.00], P = .2) with comparable decline at first follow-up. The nFFR cohort had higher FOIS at 3 and 6 months (5.00 [5.00-6.00] vs 6.00 [5.00-7.00], P = .04). FOIS was similar after 1 year (6.00 [5.00-7.00] vs 6.00 [6.00-7.00], P = .3).</p><p><strong>Conclusion: </strong>FFR achieved comparable functional outcomes to nFFR at 1 year. FFR is a viable reconstructive option for pT1-2 tumors for which TORS that are amenable to surgical resection via TORS despite an anatomic barrier such as RPC.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"40-48"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605974","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}
Eleonora M C Trecca, Vito Carlo Alberto Caponio, Mario Turri-Zanoni, Antonella Miriam di Lullo, Michele Gaffuri, Jérôme R Lechien, Antonino Maniaci, Giuseppe Maruccio, Marella Reale, Irene Claudia Visconti, Virginia Dallari
{"title":"Comparative Analysis of Information Quality in Pediatric Otorhinolaryngology: Clinicians, Residents, and Large Language Models.","authors":"Eleonora M C Trecca, Vito Carlo Alberto Caponio, Mario Turri-Zanoni, Antonella Miriam di Lullo, Michele Gaffuri, Jérôme R Lechien, Antonino Maniaci, Giuseppe Maruccio, Marella Reale, Irene Claudia Visconti, Virginia Dallari","doi":"10.1002/ohn.1225","DOIUrl":"10.1002/ohn.1225","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric otorhinolaryngology (ORL) addresses complex conditions in children, requiring a tailored approach for patients and families. With artificial intelligence (AI) gaining traction in medical applications, this study evaluates the quality of information provided by large language models (LLMs) in comparison to clinicians, identifying strengths and limitations in the field of pediatric ORL.</p><p><strong>Study design: </strong>Comparative blinded study.</p><p><strong>Setting: </strong>Controlled research environment using LLMs.</p><p><strong>Methods: </strong>Fifty-four items of increasing difficulty, namely 18 theoretical questions, 18 clinical scenarios, and 18 patient questions, were posed to ChatGPT-3.5, -4.0, -4o, Claude-3, Gemini, Perplexity, Copilot, a second-year resident, and an expert in the field of pediatric ORL. The Quality Analysis of Medical Artificial Intelligence (QAMAI) tool was used for blinded evaluation of the quality of medical information by a panel of expert members from the Young Otolaryngologists Group of the Italian Society of ORL and the International Federation of ORL Societies.</p><p><strong>Results: </strong>LLMs performed comparably to specialist in theoretical and standardized clinical scenarios, with Bing Copilot achieving the highest QAMAI scores. However, AI responses lacked transparency in citing reliable sources and were less effective in addressing patient-centered questions. Poor interrater agreement among reviewers highlighted challenges in distinguishing human-generated from AI-generated responses. Rhinology topics received the highest scores, whereas laryngology and patient-centered questions showed lower agreement and performance.</p><p><strong>Conclusion: </strong>LLMs show promise as supportive resources in pediatric ORL, particularly in theoretical learning and standardized cases. However, significant limitations remain, including source transparency and contextual communication in patient interactions. Human oversight is essential to mitigate risks. Future developments should focus on refining AI capabilities for evidence-based and empathetic communication to support both clinicians and families.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"228-236"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658095","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}