Otolaryngology- Head and Neck Surgery最新文献

{"title":"Speech Performance Following Intraoperative Correction of Cochlear Implant Electrode Array Tip Fold-Overs.","authors":"Miriam R Smetak, Matthew A Shew, Jordan Varghese, Nedim Durakovic, Cameron C Wick, Craig A Buchman, Jacques A Herzog","doi":"10.1002/ohn.1199","DOIUrl":"10.1002/ohn.1199","url":null,"abstract":"<p><strong>Objective: </strong>Cochlear implant (CI) electrode array tip fold-overs occur at an increased rate with perimodiolar electrode arrays, necessitating removal and re-insertion. The degree to which an intra-operative correction of tip fold-over affects CI performance and hearing preservation has not been previously reported.</p><p><strong>Study design: </strong>Retrospective chart review of CI recipients receiving a slim perimodiolar electrode array from 2016 to 2023.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Methods: </strong>Low-frequency pure tone average (LFPTA) was defined as the average of thresholds at 125, 250, and 500 Hz. We defined hearing preservation candidacy as LFPTA < 60 dB HL preoperatively, and successful hearing preservation was defined as LFPTA < 80 dB HL at activation. Consonant-nucleus-consonant (CNC) word recognition and AzBio scores in quiet and in +10 dB signal-to-noise ratio (SNR) were collected preoperatively, and at 3- and 6-months postoperatively.</p><p><strong>Results: </strong>From 663 implants, 35 (5.3%) experienced tip fold-over that was identified and corrected intra-operatively. There was no significant difference in 3-month CNC scores between those with fold-overs (44.9%, SD 20.9%) and those without (46.2%, SD 21.0%; P = .98). Similarly, there was no difference in AzBio in quiet (53.1%, SD 21.7% vs 60.8%, SD 28.0%; P = .26) or in AzBio +10 dB SNR (19.1%, SD 23.7% vs 31.5%, SD 27.2%; P = .60). Of 19 hearing preservation candidates that experienced tip fold-over, 6 (31.6%) had preserved hearing at activation compared to 31 of 59 candidates (52.5%; P = .11) without fold-over.</p><p><strong>Conclusion: </strong>While tip fold-over remains a clinical concern, speech performance does not appear to be negatively affected if the fold-over is identified and corrected.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2046-2050"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573232","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 Importance of Newborn Genetic Screening for Early Identification of GJB2 and SLC26A4 Related Hearing Loss.","authors":"Emily R Wener, Sharon L Cushing, Blake C Papsin, Dimitrios J Stavropoulos, Roberto Mendoza-Londono, Nada Quercia, Karen A Gordon","doi":"10.1002/ohn.1188","DOIUrl":"10.1002/ohn.1188","url":null,"abstract":"<p><strong>Objective: </strong>To assess the added benefit of newborn genetic screening for GJB2 and SLC26A4 variants in conjunction with newborn hearing screening.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Children with known variants of GJB2 and SLC26A4 were identified from 485 children with hearing loss who underwent testing with Next Generation Sequencing (NGS) between January 2015 and February 2018, prior to expanded screening for genetic variants and congenital CMV. Children with two pathogenic or likely pathogenic variants of GJB2 or SLC26A4 were considered to have genetic hearing loss. NGS genetic data were compared to variants included in the expanded genetic screen for all newborns in Ontario and newborn hearing screening results.</p><p><strong>Setting: </strong>Canadian tertiary pediatric hospital.</p><p><strong>Results: </strong>Thirty-five children with GJB2 and SLC26A4-associated hearing loss were identified by NGS (n = 27 GJB2-HL; n = 8 SLC26A4-HL). Of these, 20 (57%) had been identified by newborn hearing screening (14/27 52% GJB2-HL; 6/8 75% SLC26A4-HL). Ten of the 20 (50%) would also have been identified by genetic screening if it had been available (9/14 64% GJB2-HL; 1/6 17% SLC26A4-HL). An additional 8 children with GJB2 or SLC26A4-associated hearing loss passed their newborn hearing screen but showed hearing loss later; three of these children (38%) would have been identified by newborn genetic screening (3/6 GJB2-HL; 0/2 SLC26A4-HL).</p><p><strong>Conclusion: </strong>Genetic and hearing screening modalities in Ontario's expanded newborn hearing screening program improve early identification of children with hearing loss including those at risk of being missed by hearing screening alone. This was most clear for children with GJB2-hearing loss.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2082-2089"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Adverse Outcomes After Myringotomy or Tube Placement in Head and Neck Cancer.","authors":"Krithika Kuppusamy, Carly Y Yang, Kevin Wong, Douglas C Bigelow, Michael J Ruckenstein, Steven J Eliades, Jason A Brant, Tiffany Hwa","doi":"10.1002/ohn.1186","DOIUrl":"10.1002/ohn.1186","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate rates of adverse outcomes among patients with a history of head and neck cancer undergoing myringotomy with or without tube placement for middle ear effusion.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Academic medical center.</p><p><strong>Methods: </strong>Retrospective chart review was performed on patients undergoing myringotomy with or without tube placement for middle ear effusion between 2018 and 2022. Data reviewed included demographics, cancer history, audiometry, and clinical course.</p><p><strong>Results: </strong>In total, 578 patients (736 ears) had a mean follow-up of 36.6 months: 84 (14.53%) were in the cancer cohort. On average, cancer patients were older (62.6 vs 59.3 years, P < .05) but had similar rates of overall adverse outcomes (44.05% vs 44.13%, P = 1.0). Rates of persistent perforation were higher among cancer patients (14.29% vs 2.43%, P < .001); there was no significant difference in rates of recurrent effusion (5.95% vs 4.66%; P = .81). Postpropensity score matching, perforation rates reached statistical significance (14.29% vs 1.22%, P < .01). There was no difference in rate of adverse events for overall events (44.05% vs 47.56%, P = .77) or recurrent effusion (5.95% vs 1.22%, P = .22).</p><p><strong>Conclusion: </strong>Patients with a history of head and neck cancer or radiation have a three-to-five-fold risk of persistent tympanic membrane perforation after myringotomy with or without tube placement and a higher rate of recurrent effusion that is not significant. In multivariate analysis, perforation risk was revealed to be multifactorial.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1971-1979"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Backscattered Ultrasonographic Imaging of the Tongue and Outcome in Hypoglossal Nerve Stimulation.","authors":"Samuel Tschopp, Vlado Janjic, Yili Lee, Argon Chen, Pei-Yu Chao, Marco Caversaccio, Urs Borner, Kurt Tschopp","doi":"10.1002/ohn.1251","DOIUrl":"10.1002/ohn.1251","url":null,"abstract":"<p><strong>Objective: </strong>Hypoglossal nerve stimulation (HNS) is an increasingly used therapy. However, not all patients undergoing HNS implantation benefit from the treatment, making an improved patient selection a priority. This study investigates whether backscattered ultrasonographic imaging (BUI) can predict the response to HNS therapy.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Secondary and tertiary hospital.</p><p><strong>Methods: </strong>In this multicenter cross-sectional study, we recruited patients who had undergone HNS implantation during their scheduled follow-up consultation. HNS therapy parameters were collected. Standardized submental ultrasonographic examination and home sleep apnea testing were performed. The primary outcome was assessing the response to HNS therapy using ultrasonographic features and preoperative patient characteristics.</p><p><strong>Results: </strong>In total, 62 participants, 49 male, with a median (interquartile range [IQR]) age of 62 (55-67) and a median (IQR) body mass index of 27.6 (25.2-29.7). The follow-up was a median (IQR) of 19.5 (4.8-41.4) months after implantation. The apnea-hypopnea index (AHI) was preoperatively 40.5 (29.8-58.0) and reduced at follow-up to 21.0 (11.0-35.3). In total, 42% were responders to HNS. Preoperative AHI (34.8/hour vs 49.3/hour, r = 0.44) was significantly higher in nonresponders than in responders. The average prediction accuracy of HNS therapy based on baseline AHI alone was 71%. A lower backscatter signal, indicating less fat deposition in the tissue, was observed in the responder group. When the baseline AHI and backscatter signal were combined, the prediction accuracy of response to the HNS reached 78%.</p><p><strong>Conclusion: </strong>The combination of tissue composition analyzed using the backscattered signal and the preoperative AHI is highly predictive for determining the HNS treatment response.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT06154577.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2134-2140"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicidal Ideation, Behaviors, and Deaths in People With Ménière's Disease: A Systematic Review.","authors":"Lauren R McCray, Hannah G Farmer, Shaun A Nguyen, Jeffrey P Staab, Jacqueline P Nguyen, Jonathan Kil, Habib G Rizk","doi":"10.1002/ohn.1216","DOIUrl":"10.1002/ohn.1216","url":null,"abstract":"<p><strong>Objective: </strong>To assess relations between Ménière's disease and suicidality, measured by suicidal ideation, suicidal behaviors, and death by suicide.</p><p><strong>Data sources: </strong>CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS databases were searched from inception through July 2, 2024.</p><p><strong>Review methods: </strong>Observational studies related to suicidality in patients with Ménière's disease were included. Non-English language papers, editorials, and studies on vestibular disorders not specified as Ménière's disease were excluded. The Risk Of Bias In Nonrandomized Studies-of Exposure tool was used for cohort and qualitative studies, and the Joanna Briggs Institute critical appraisal checklist was used for case-control studies.</p><p><strong>Results: </strong>Four studies (n = 168,566) were included in our review. Two cohort studies found significantly increased adjusted hazard ratios of 2.1 (95% CI: 2.0-2.2) for death by suicide and 7.6 (95% CI: 4.4-13.3) for suicidal behaviors, respectively, in patients with Ménière's disease compared to the control population after their diagnosis. However, a case-control study found no significant difference in the prevalence of suicidal ideation or behaviors prior to the date of diagnosis in patients with Ménière's disease compared to the control population (0.9% vs 0.8%; P = .44). In addition, one patient with Ménière's disease expressed suicidal ideation in the qualitative study.</p><p><strong>Conclusion: </strong>Patients may experience variable responses to Ménière's disease. Thus, otolaryngologists should be mindful of the potential for suicidality in patients with Ménière's disease.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1866-1873"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586470","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":"Speech Delay and Hearing Rehabilitation Disparities in Children With Hearing Loss.","authors":"Lacey C Magee, Malek Bouzaher, Mihika Thapliyal, Yi-Chun Liu, Samantha Anne","doi":"10.1002/ohn.1204","DOIUrl":"10.1002/ohn.1204","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the influence of race and insurance type on speech delay rates and hearing rehabilitation access in children with bilateral hearing loss (HL).</p><p><strong>Study design: </strong>Retrospective cross-sectional study of pediatric patients with bilateral HL who received cochlear implants (CIs) or hearing aids (HAs).</p><p><strong>Setting: </strong>This study used the national Pediatric Health Information System (PHIS) database to identify patients with HL across 52 tertiary care pediatric hospitals in the United States.</p><p><strong>Methods: </strong>Data collected included demographics, CI/HA use, speech delay/disorders, and type of insurance coverage.</p><p><strong>Results: </strong>This study identified 18,422 patients with bilateral HL (40.1% female, 66.3% white, 66.3% on public insurance), with an average age of 5.21 ± 4.37 years. Patients with private insurance were more likely to be white than non-white (48.9% vs 27.5%, P < .001), more likely to receive CI (18.0% vs 14.7%, P < .001), more likely to receive HA (21.3% vs 17.9%, P <.001), and less likely to have speech delay diagnoses (74.9% vs 81.0%, P < .001) compared to patients with public insurance. Compared to non-white patients, white patients were more likely to have CI (16.8% vs 14.7%, P < .001), more likely to have HA (20.6% vs 17.0%, P < .001), and less likely to have speech delay diagnoses (81.1% vs 77.2%, P < .001). When adjusting for other variables, these associations with insurance type and race were still observed.</p><p><strong>Conclusion: </strong>Disparities seen amongst different races and income groups can be observed at the population level and highlight an opportunity for policy interventions to secure equitable access for children with pediatric HL.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2098-2104"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermediate Grade Salivary Gland Mucoepidermoid Carcinoma: Is Neck Dissection Indicated?","authors":"Jake Langlie, Nicholas DiStefano, Carmen Gomez-Fernandez, Jaylou Velez-Torres, Jason Leibowitz, David Arnold, Donald Weed, Francisco J Civantos","doi":"10.1002/ohn.1202","DOIUrl":"10.1002/ohn.1202","url":null,"abstract":"<p><strong>Objective: </strong>NCCN guidelines recommend a neck dissection addressing at least levels II-IV for high-grade mucoepidermoid carcinoma (MEC) and close observation of the lymphatic basins for low-grade MEC. However, no guidelines exist for intermediate-grade MEC with clinically and radiologically uninvolved cervical lymph nodes.</p><p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>Patients with intermediate-grade MEC with a clinically N0 neck from our tertiary academic institution from 2015 to 2023.</p><p><strong>Methods: </strong>Evaluation for histologic lymphatic metastases was performed when surgeons elected to perform neck dissection. For patients who did not receive a neck dissection, review of medical records to document the results of clinical observation, and specifically regional lymphatic recurrence, on long-term follow-up.</p><p><strong>Results: </strong>Thirty-five patients with N0 intermediate grade MEC were included, composed of 26 patients who underwent primary tumor resection and neck dissection and 9 patients who received resection of the primary tumor without neck dissection. One out of 26 patients receiving neck dissection was found to have lymphatic metastasis. Watchful waiting of 9 patients demonstrated no recurrence at a mean follow up of 40 months. Thus, 1 out of 35 patients (2.9% [95% confidence interval: 2.7%-3.1%]) had documented metastatic disease in the lymphatics.</p><p><strong>Conclusions: </strong>For patients presenting with intermediate-grade MEC, there was a low chance (2.9%) of positive histologic or clinical lymphatic metastases in the neck. Given this low risk, we believe the potential benefit of neck dissection may be outweighed by the potential morbidity. Careful consideration of the clinical behavior of the lesion could be considered along with a more selective approach toward elective lymphadenectomy in intermediate-grade MEC.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1988-1994"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Pediatric Acute Upper Airway Pathology During Local Wildfires and Increased PM 2.5 Burden.","authors":"Patrick Kiessling, Kara Meister, Douglas Sidell, Moira O'Bryan, Elizabeth Erickson-DiRenzo, Karthik Balakrishnan","doi":"10.1002/ohn.1191","DOIUrl":"10.1002/ohn.1191","url":null,"abstract":"<p><strong>Objective: </strong>As wildfires worldwide increase in severity and frequency, fine particulate matter (PM 2.5), generated as a component of wildfire smoke, increasingly impacts air quality. Children are particularly vulnerable to poor air quality in numerous ways, including inhalation of more air in proportion to their body size than adults. Though its adverse impacts on the lower airway are well demonstrated, the clinical effects of PM 2.5 on the pediatric upper airway are poorly understood and warrant investigation.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary academic medical center.</p><p><strong>Methods: </strong>From 2014 to 2023, patient presentations to a pediatric emergency department in Northern California during exposure periods of elevated PM 2.5 burden associated with nearby wildfires were identified. Patient diagnoses, presenting symptoms, and management were analyzed. Comparison group patients were evaluated during date-matched control periods with confirmed normal air quality. Chi-squared analyses determined significance.</p><p><strong>Results: </strong>During periods of increased wildfire-generated PM 2.5 burden, a significantly greater proportion of pediatric patients presented to the emergency department with upper airway pathology compared to matched control periods of healthy air quality. Further, a significantly greater proportion of patients were diagnosed with croup during wildfires. Of patients presenting with upper airway pathology, a significantly greater proportion experienced dysphonia during wildfires and had a negative strep test.</p><p><strong>Conclusion: </strong>Wildfire-generated PM 2.5 may contribute to increased rates of croup presentations, and PM 2.5 may disproportionately affect the larynx in the pediatric upper airway. Larger population-based studies and preclinical models may clarify these clinical manifestations of a growing public health threat.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2072-2081"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal to Mean Airway Area Ratio of the Pharynx: A Novel Predictor of Pediatric Obstructive Sleep Apnea in Three-Dimensional Imaging.","authors":"Kun-Tai Kang, Yunn-Jy Chen, Wen-Chin Weng, Hung-Ta Hsiao, Pei-Lin Lee, Wei-Chung Hsu","doi":"10.1002/ohn.1234","DOIUrl":"10.1002/ohn.1234","url":null,"abstract":"<p><strong>Objective: </strong>Reliable variables for detecting pediatric obstructive sleep apnea (OSA) using three-dimensional (3D) imaging are currently lacking. This study aimed to develop a novel predictor of OSA in children.</p><p><strong>Study design: </strong>Prospective study.</p><p><strong>Setting: </strong>Tertiary care children's hospital.</p><p><strong>Methods: </strong>Pediatric patients (<18 years) with symptoms suggestive of OSA were enrolled. Polysomnography was used to categorize disease severities as primary snoring (apnea-hypopnea index, AHI < 1), mild OSA (AHI = 1-5), moderate OSA (AHI = 5-10), and severe OSA (AHI > 10). Cone-beam computed tomography was used to obtain 3D images. The minimal to mean airway area (AA) ratio was measured across the entire pharynx and its segment (nasopharynx, oropharynx, and hypopharynx).</p><p><strong>Results: </strong>The study included 104 children. For the entire pharynx, the minimal to mean AA ratio was 0.41, 0.36, 0.35, and 0.25 in the primary snoring, mild OSA, moderate OSA, and severe OSA groups, respectively (P = .001). Pearson's correlation revealed an inverse relationship between the minimal to mean AA ratio and OSA severity. The receiver operating characteristic curve identified the optimal cutoff point for predicting AHI ≥ 1 as 0.34 in the oropharynx (area under the curve [AUC] = 71%) and 0.39 in the entire pharynx (AUC = 67%). The minimal to mean AA ratio in the nasopharynx or hypopharynx indicated no significant difference between OSA severities.</p><p><strong>Conclusion: </strong>A minimal to mean airway AA ratio of less than one-third in the pharynx serves as a novel predictor of pediatric OSA in 3D imaging.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"2124-2133"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656875","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":"Outcomes and Complications of 2-Stage Versus 3-Stage Paramedian Forehead Flaps.","authors":"W Jack Palmer, Dev Amin, Praneet Kaki, Matt Davis, Eric Fei, Neha Garg, Daniel J Campbell, Dana Michlin, Khashayar Arianpour, Howard Krein, Ryan Heffelfinger","doi":"10.1002/ohn.1210","DOIUrl":"10.1002/ohn.1210","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore outcomes among 2-stage paramedian forehead flaps (PFFs), 3-stage PFFs, and PFFs undergoing accelerated pedicle takedown.</p><p><strong>Study design: </strong>A retrospective review.</p><p><strong>Setting: </strong>A tertiary care institution.</p><p><strong>Methods: </strong>Patients who underwent PFFs for nasal defects between 2017 and 2022 were identified. Demographic, clinical, and surgical characteristics were compared among groups. Surgical and cosmetic outcomes and revision procedures were evaluated.</p><p><strong>Results: </strong>Among 52 patients analyzed, 39 underwent 2-stage PFFs, and 13 underwent 3-stage PFFs. There were no significant differences in demographics, comorbidities, or surgical risk factors between groups. Three-stage PFF patients were more likely to have a cartilaginous defect. Postoperative dyspigmentation was seen more frequently in the 3-stage group; otherwise, there were no significant differences in outcomes. In a subanalysis of 29 patients requiring cartilage grafting, dyspigmentation was again seen more commonly in the 3-stage group; outcomes otherwise did not favor either group. Within the 2-stage group, 7 patients underwent accelerated pedicle takedown (≤21 days). No failures were seen with accelerated takedown, including among those who also received cartilage grafting. Overall, accelerated takedown was not associated with poorer surgical or cosmetic outcomes or an increased revision rate compared to standard takedown. Logistic regression did not identify any independent predictors of complication.</p><p><strong>Conclusion: </strong>Both 2- and 3-stage PFFs are effective tools in midface reconstruction, including when cartilage grafting is required. With 2-stage PFF, accelerated pedicle takedown is not associated with increased complications in appropriately selected patients.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1888-1896"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}