Otolaryngology- Head and Neck Surgery最新文献

{"title":"Facial Feminization Surgery and Mental Health Resource Utilization: A Retrospective Institutional Review.","authors":"Pauline P Huynh, Andrew Kleinberger, Kathleyn Brandstetter, David W Chou, Alice R Pressman, Charles Shih","doi":"10.1002/ohn.1172","DOIUrl":"10.1002/ohn.1172","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the effects of facial feminization surgery (FFS) on mental health resource utilization among patients with gender dysphoria within an integrated multicenter health care system.</p><p><strong>Study design: </strong>A retrospective database review.</p><p><strong>Setting: </strong>An equal-access, integrated health care system.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical records of Kaiser Permanente Northern California patients who underwent FFS from 2016 to 2021 on utilization of mental health services in a large integrated health care system. Full FFS was defined as all 3 facial thirds. We compared average quarterly utilization for 12 to 24 months before FFS with quarterly utilization during 12 to 24 months of follow-up. Patients who did not have continuous coverage for at least 12 months before and 12 months after FFS were excluded.</p><p><strong>Results: </strong>A total of 699 FFS cases were performed between 2016 and 2021, of which 478 cases were included (35.6 ± 12.3 years old, 207 [43.3%] had full FFS). Wilcoxon matched-pairs signed-rank tests comparing pre-FFS and post-FFS utilization counts showed statistically significant reductions in the number of mental health-associated visits. Age and comorbid mental health diagnoses were significant predictors of mental health resource utilization in the pre-FFS period. A comorbid mood or anxiety disorder was a predictor of changes in resource utilization following FFS.</p><p><strong>Conclusion: </strong>To our knowledge, this endeavor is the first utilization study of FFS conducted in the United States. FFS was associated with significantly lower utilization of mental health services in the 12-month post-FFS period compared to the 12-month pre-FFS period.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1585-1593"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493229","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":"Clinical and Electromyographic Characteristics of Pediatric Laryngeal Dyskinesia.","authors":"Nasser W Alobida, Ameen Binnasser, Aleksandra King, Andre Isaac, Hamdy El-Hakim","doi":"10.1002/ohn.1133","DOIUrl":"10.1002/ohn.1133","url":null,"abstract":"<p><strong>Objective: </strong>To report the clinical and laryngeal electromyographic (LEMG) parameters of children with laryngeal dyskinesia (LD) and its prevalence among laryngeal mobility disorder (LMD) requiring full airway examination.</p><p><strong>Study design: </strong>Retrospective uncontrolled study.</p><p><strong>Setting: </strong>Tertiary pediatric center.</p><p><strong>Methods: </strong>Eligible children (<17 years old) were stridulous patients suspected of LMD (16 years period). We included those diagnosed with LD according to previously described criteria by Denoyelle et al, followed up for at least 3 months, who were assessed endoscopically and LEMG.</p><p><strong>Primary outcome: </strong>LEMG scores, and the prevalence of LD in all LMD who required airway exam under anesthesia.</p><p><strong>Secondary outcomes: </strong>clinical resolution, McGill scores, and instrumental swallowing test.</p><p><strong>Results: </strong>A total of 44 patients (<17 years) were identified. Of these, 29 were included (25 boys; median age: 9.83 months [0.42-116.58]). LD constituted 18.58% of all patients during the study period. Asymmetry of movement and LEMG between the 2 sides was noted (the right side was more affected). Seventeen had swallowing difficulties (13 abnormal instrumental tests), and 27 snored (mean McGill score 3). The median follow up was 49.96 months (range: 5.25-243.25). Symptoms improved in all patients, but one, by the last follow-up date.</p><p><strong>Conclusion: </strong>LD is prevalent among LMD and is mostly self-limiting. We noted asymmetry of LEMG grades between the 2 sides of the larynx, male predominance, and functional deficits in sleep and swallowing. The diagnosis requires a complete endoscopic exam with LEMG. Conflating this entity with bilateral laryngeal paralysis has likely impacted the documented epidemiology and natural history.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1741-1747"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952691","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":"Implementation Mapping to Identify Strategies to Increase Timely Postoperative Radiotherapy Initiation for Head/Neck Cancer.","authors":"Laila A Gharzai, Jaymie Bromfield, Michelle Kwan, Alexis Larson, Janine A Kingsbury, Adil Akthar, Gaurava Agarwal, Julia H Vermylen, Sara Becker, Kelli Scott, Amelia E Van Pelt, Katelyn O Stepan","doi":"10.1002/ohn.1268","DOIUrl":"https://doi.org/10.1002/ohn.1268","url":null,"abstract":"<p><strong>Objective: </strong>Timely initiation of postoperative radiotherapy (PORT) for head and neck squamous cell carcinoma (HNSCC) is associated with improved survival, but rates of timely PORT initiation are low. To support uptake in a tertiary academic center, we aimed to identify implementation determinants (eg, barriers and facilitators) to timely PORT initiation and to design context-specific implementation strategies.</p><p><strong>Methods: </strong>We created an implementation blueprint through a sequential mixed-methods study where we (1) identified determinants by fielding a 15-item survey based on the Theoretical Domains Framework (TDF), (2) prioritized determinants through focus groups with relevant stakeholders, (3) mapped barriers to implementation strategies using the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) matching tool, and (4) operationalized strategies using the Action, Actor, Context, Target, Time (AACTT) framework.</p><p><strong>Results: </strong>Twenty-three participants from three departments (61% Radiation Oncology, 35% Otolaryngology, 4% Medical Oncology) in a variety of roles (35% physicians, 39% nurses or advanced practice providers, 22% radiation therapists or dosimetrists, and 4% research coordinators) completed surveys. Participants identified 10 determinants affecting timely PORT initiation. After strategy selection and operationalization by focus group participants (n = 13), three ERIC strategies were selected for clinical implementation: remind clinicians, conduct educational meetings, and facilitate relay of clinical data to providers.</p><p><strong>Discussion: </strong>This work developed a menu of implementation strategies for future deployment to support timely PORT initiation. Codesign centered the voice of frontline workers, increasing the likelihood of successful implementation.</p><p><strong>Implications for practice: </strong>The systematic approaches to development can serve as a model for process improvement in other contexts.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040763","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":"Pediatric Sharp Foreign Body Aspiration: Revealing Unexpected Risk Factors.","authors":"Alicia Belaiche, Trevor A Lewis, Jakob Pugi, Mariya Bogatchenko, Liane B Johnson, Trina C Rosaasen, Lily H P Nguyen","doi":"10.1002/ohn.1275","DOIUrl":"https://doi.org/10.1002/ohn.1275","url":null,"abstract":"<p><strong>Objective: </strong>Characterize the demographic and clinical features of pediatric sharp foreign body aspiration (FBA).</p><p><strong>Study design: </strong>Twenty-four-year retrospective chart review.</p><p><strong>Setting: </strong>Four tertiary-care centers across four Canadian provinces.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on pediatric patients who underwent rigid bronchoscopy for sharp FBA below the vocal cords at the McGill University, McMaster University, University of Alberta, and Dalhousie health centers from January 1, 2000, to November 30, 2023.</p><p><strong>Results: </strong>In total, 48 patients (27 males and 21 females, mean age of 10.1 years) met the inclusion criteria. Thumbtacks were the most common aspirated objects (66.7%). The mean age for thumbtack aspiration was 11.6 years, which was significantly higher than the 7.0-year mean for other sharp FBAs (P = .0263). Subgroup analysis of patients who resided in an Indigenous territory had a significantly greater rate of thumbtack aspiration (89.3%, P = .0001). Sharp FBA presented with typical symptoms of FBA with the addition of a higher incidence of chest pain (27.1%) and hemoptysis (18.8%), and it was characterized by a higher incidence of radiopaque FBs on chest radiography (89.6%). Most complications, including postoperative atelectasis (27.1%), pneumothorax (4.2%), perforation (2.1%), and vocal cord hematoma (2.1%), were observed with thumbtacks.</p><p><strong>Conclusion: </strong>This is the largest pediatric study on sharp FBA in America, addressing a significant gap in the literature. Considering the trends and patient demographics identified in this study and in the literature globally, geographical or cultural variations may influence the nature of sharp FBA in pediatric populations. Insights from this study can inform future prevention programs.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024277","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":"Predictive Factors of Free Flap Volume Evolution in Head and Neck Reconstruction.","authors":"Quentin Hennocq, Jean-Baptiste Caruhel, Mourad Benassarou, Jebrane Bouaoud, André Chaine, Angélique Girod, Nicolas Graillon, Sylvie Testelin, Mélika Amor-Sahli, Jean-Philippe Foy, Chloé Bertolus","doi":"10.1002/ohn.1284","DOIUrl":"https://doi.org/10.1002/ohn.1284","url":null,"abstract":"<p><strong>Objective: </strong>The aim of our study was to determine the factors influencing the evolution of the total volume and bone volume of free flaps commonly used in head and neck surgery, with a 30-month prospective study, to establish volume change predictions and thus propose a degree of overcorrection to be expected before reconstruction.</p><p><strong>Study design: </strong>We prospectively included all consecutive free flap.</p><p><strong>Setting: </strong>Our maxillofacial surgery department between August 2021 and January 2024.</p><p><strong>Methods: </strong>We collected information on preoperative, per-operative, and postoperative factors, on patients, surgical techniques, and adjuvant treatments. We measured on each postoperative imaging the overall flap volume and bone volume if applicable. Multivariate mixed models were then used to select clinical parameters associated with volume loss.</p><p><strong>Results: </strong>We included 166 flaps, performed on 155 patients. The mean age was 60.1 ± 15.1 years. A total of 634 imagings were segmented (487 computed tomography [CT] scans, 77%; 147 magnetic resonance imagings [MRIs], 23%). The use of the superior thyroid or lingual veins for venous anastomosis, such as the use of small couplers, resulted in negative volume changes. Predicted bone volumes decreased by 23% at 30 months for deep circumflex iliac artery (DCIA) free flaps, 19% for fibula free flap (FFF), and 38% for scapular system free flap (SFF).</p><p><strong>Conclusion: </strong>These findings allow us to envisage a volume overcorrection of around 60% for fasciocutaneous or osteocutaneous flaps, and 75% for muscle or osteomuscular flaps. The choice of vein and microsurgical technique seems to have more impact on the evolution of free flap volume than patient characteristics or adjuvant treatments.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985996","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":"https://doi.org/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%, I² = 0%, P = .052), compared to transmastoid (TM) 12.2% (95% CI: 6.7%- 21.2%, I² = 0%) in 82 repairs and for combined approaches 11.9% (95% CI: 4.2%-29.6%, I² = 58%) in 98 repairs. The rate of recurrence with the MCF approach was 3.2% (95% CI: 1%-6.4%, I² = 10%, P = .21) in 297 repairs, in the TM group the rate was 8.6% (95% CI: 4.7%-15%, I² = 0%) in 125 procedures and 1.1% in the combined approaches group (0%-4.5%, I² = 0%) in 139 procedures. Analysis of reoperation rates revealed a proportion of 0.9% (95% CI: 0%-4.4%, I² = 51%) in 287 repairs via the MCF approach. Reoperation rate was 8.6% (95% CI: 4.7%- 15%, I² = 0%) in 125 repairs via TM and 1.1% (95% CI: 0%-4.5%, I² = 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":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","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}

{"title":"Tracheostomy Tube Change Versus PEEP Titration on Tracheostomy-Dependent Infants With Airway Malacia and Ventilator Instability.","authors":"Harrison M Thompson, Mikayla Hubbard, Johnny Krasinkiewicz, Sarah E Bauer, Diane W Chen","doi":"10.1002/ohn.1278","DOIUrl":"https://doi.org/10.1002/ohn.1278","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of positive end-expiratory pressure (PEEP) titrations or tracheostomy size change (trach change) on ventilation stability in infants with tracheobronchomalacia.</p><p><strong>Study design: </strong>A retrospective chart review.</p><p><strong>Setting: </strong>Tertiary care children's hospital from 2015 to 2023.</p><p><strong>Methods: </strong>A retrospective chart review on ventilator and tracheostomy-dependent patients <1 year of age. Demographics, bronchoscopic findings, and ventilator outcomes within 14 days were recorded. Analysis was performed with chi-square, Fisher's exact, binomial regression analysis, and two-tailed t tests.</p><p><strong>Results: </strong>Of 71 patients (66% male, median 6.1 months old [interquartile range, IQR, 4.6-7.3]) who underwent 74 initial bronchoscopies, the PEEP titration cohort (n = 37) experienced an improvement (narrower) in 24-hour mean ventilatory ranges (peak inspiratory pressure [PIP] 5.6 pre vs 2.9 post, P = .01; fraction of inspired oxygen [FiO₂] range 5% vs 3%, P = .04), whereas the trach change cohort did not (PEEP 5.9 vs 5.6, P = .8; FiO₂ 10% vs 5%, P = .07). In patients with airway malacia, the PEEP titration cohort had improved PIP ranges postintervention (5.5 vs 3.0, P = .02), whereas the trach change cohort did not (4.4 vs 6.6, P = .13). In patients without airway malacia, trach change correlated with improved PIP (8.4 vs 3.8, P = .04). Repeat bronchoscopy after initial intervention was significantly more common after trach change compared to PEEP titration (22% vs 3%, P = .01).</p><p><strong>Conclusion: </strong>PEEP titration was associated with improved PIP and FiO₂ ventilatory outcomes with a lower rate of repeat bronchoscopy compared to trach change, suggesting trach change alone may have little impact with greater subsequent interventional needs compared to PEEP titration.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037513","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 of Children With Tracheostomy Before and After Implementing Caregiver Simulation-Based Tracheostomy Education.","authors":"Mary Ellen Fain, Brittany A Truitt, Caroline C Ivie, Andrew Jergel, Rebecca L McCoy, Heather Brandt, Walter Reeder, Scott Gillespie, Dawn M Simon, Ajay S Kasi, Kara K Prickett","doi":"10.1002/ohn.1276","DOIUrl":"https://doi.org/10.1002/ohn.1276","url":null,"abstract":"<p><strong>Objective: </strong>Tracheostomy-related emergencies (TRE) such as decannulation, cannula obstruction, and hemorrhage contribute significantly to mortality, emergency department (ED) visits, and hospitalizations. High-fidelity simulation-based training (SBT) for family caregivers can improve their competence in TRE management. The aims of the study were to compare the frequency of ED visits, readmissions, and mortality in children with tracheostomy based on caregiver completion of SBT.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single-center academic children's hospital.</p><p><strong>Methods: </strong>Children who underwent tracheostomy from 2014 to 2020 were studied, with cohorts based on caregiver completion of SBT. Patients were followed for 1 year following hospital discharge after tracheostomy. The frequency and reasons for ED visits, readmissions, and mortality were evaluated.</p><p><strong>Results: </strong>Among the 158 patients who met inclusion criteria, the caregivers of 83 (53%) patients completed SBT. Overall mortality was significantly lower (P < .001) among patients whose caregivers completed SBT (2%) compared to patients whose caregivers did not complete SBT (17%). There was no significant difference in mortality due to tracheostomy-related causes based on caregiver completion of SBT (P > .99). There were no significant differences in the total ED visits (P = .44) and readmissions (P = .11), or tracheostomy-related ED visits (P = .61) and readmissions (P = .45) based on caregiver completion of SBT.</p><p><strong>Conclusion: </strong>Overall mortality was significantly lower among patients whose caregivers completed SBT. The frequency of ED visits, readmissions, and mortality due to tracheostomy-related causes did not differ between the groups. Although high-fidelity SBT may augment caregiver competence in TRE management, further study is needed to determine if SBT can measurably impact tracheostomy-related outcomes.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026519","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":"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":"https://doi.org/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":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-25","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":"Rigid Autofluorescence Imaging as a Tool for Identifying Cholesteatoma During Otologic Surgery: Initial Ex Vivo Findings.","authors":"Hylke F E van der Toom, Henriette S de Bruijn, Robert Jan Pauw, Senada Koljenović, Sjors Koppes, Dominic J Robinson, Stijn Keereweer","doi":"10.1002/ohn.1274","DOIUrl":"https://doi.org/10.1002/ohn.1274","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to determine whether rigid autofluorescence imaging can differentiate cholesteatoma from surrounding tissues to reduce residual disease after cholesteatoma surgery.</p><p><strong>Study design: </strong>Ex vivo proof-of-principle study.</p><p><strong>Setting: </strong>Erasmus University Medical Center, Rotterdam, the Netherlands.</p><p><strong>Methods: </strong>Autofluorescence signals of cholesteatoma, mucosa, and bone were measured using confocal microscopy to confirm distinguishable spectral differences. Subsequently, rigid autofluorescence imaging with specific filter settings (λ_e = 405 nm and λ_d > 570 nm) was applied to 14 resected surgical specimens to obtain signal intensity and tissue-specific fluorescence ratios.</p><p><strong>Results: </strong>Cholesteatoma matrix without keratin exhibited a significantly higher autofluorescence intensity compared to mucosa (P < .03), with a cholesteatoma-to-mucosa ratio of 2.15. Similarly, autofluorescence intensity was elevated in the matrix with keratin (ratio: 2.25, P = .03) and perimatrix with keratin (ratio: 2.29, P = .04) relative to mucosa. Perimatrix without keratin showed a nonsignificant trend (ratio: 1.85, P = .06). Although cholesteatoma and bone showed no significant difference, this is clinically less relevant as bone is easily identifiable during surgery.</p><p><strong>Conclusion: </strong>Rigid autofluorescence imaging demonstrates significant potential for improving cholesteatoma surgery by reliably differentiating cholesteatoma matrix, both with and without accumulated keratin, from mucosa, showing 2.25- and 2.15-fold higher signal intensities, respectively. This technique could assist otologic surgeons in achieving more complete resections, thereby reducing residual disease rates while preserving surrounding structures. Future research should focus on optimizing the technology for in vivo application, particularly for detecting small cholesteatoma fragments, and further evaluate factors influencing specificity and sensitivity in clinical practice.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998715","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}