Laryngoscope Investigative Otolaryngology最新文献

{"title":"Establishment of a survival rabbit model for laryngotracheal stenosis: A prospective randomized study","authors":"Wei Chen MD,&nbsp;Qingyu Wang MM,&nbsp;Hongming Xu MD,&nbsp;Yuhui Xie MM,&nbsp;Lina Zhang MM,&nbsp;Yao Li PhD,&nbsp;Guofeng Yan PhD,&nbsp;Yiwen Ding PhD,&nbsp;Shunkai Lu MM,&nbsp;Zhibo Xie MD,&nbsp;Jiarui Chen MD,&nbsp;Mengrou Xu MD,&nbsp;Xiaoben Liang MD,&nbsp;Juan Chen PhD,&nbsp;Penghuai Fu PhD,&nbsp;Xiaoyan Li MD, PhD,&nbsp;Liming Peng PhD","doi":"10.1002/lio2.70047","DOIUrl":"https://doi.org/10.1002/lio2.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop a reproducible survival rabbit model for laryngotracheal stenosis (LTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventy New Zealand white (NZW) rabbits were randomly divided into experimental groups (<i>n</i> = 30) and a control group (<i>n</i> = 40). In experimental groups, a nylon brush was inserted retrograde from the tracheotomy through the subglottis and rotated until a full layer circumferential mucosal injury to cartilage exposure, assisted by fiberoptic laryngoscopy (FOL) visualization. Experimental group 1 (<i>n</i> = 10), rotated 10 times; group 2 (<i>n</i> = 20), rotated 20 times. The control group underwent tracheotomy only without nylon brush scraping. The rabbits underwent FOL at 1st, 4th, 8th, and 12th week postinjury respectively to observe the formation of LTS. They were euthanized and the larynxes and tracheas were subjected to gross and histopathological examination at 12 weeks postinjury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The control group all survived, while five cases in experimental groups died from LTS and/or mucous plug. Histological observation showed that the control group had intact laryngotracheal mucosal epithelium without any stenosis; the experimental groups showed proliferation of fibroblasts and thickening of collagen fibers. The mean stenosis in control group was 9.31 ± 0.98%, while that in experimental group 1 was 32.78 ± 7.07% and 58.25 ± 8.96% in experimental group 2. The difference between the three groups was statistically significant (<i>χ</i>² = 47.98, <i>p</i> &lt; .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We successfully developed a reproducible survival rabbit model for LTS using a nylon brush through FOL visualization combined with tracheostomy. This model can provide a mature and stable animal model for the exploration of wound-healing pathophysiology and the effect of interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of evidence</h3>\u0000 \u0000 <p>NA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herpes simplex virus presenting as an oropharyngeal mass","authors":"Evgeniya Molotkova BS,&nbsp;Anna C. Buhle BS,&nbsp;Patrick S. Rush DO,&nbsp;James E. McLean MD,&nbsp;Patrick S. Carpenter MD","doi":"10.1002/lio2.70042","DOIUrl":"https://doi.org/10.1002/lio2.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective(s)</h3>\u0000 \u0000 <p>Present a clinically challenging case of an immunocompetent 74-year-old male who presented with marked dyspnea and hemoptysis. After the airway was secured, direct laryngoscopy revealed a large, fungating, hemorrhagic mass of the left lateral pharyngeal wall and surrounding structures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Chart review of a single patient. This patient provided consent for his case materials and images to be used for educational purposes and publication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The clinical appearance of the mass was suspicious for an aggressive neoplasm. Initial biopsy of the mass was nonspecific, revealing necrosis and inflammation, but was negative for malignancy. Due to concern for bacterial supraglottitis, empiric treatment with antibiotics was initiated. Cultures were positive for <i>Fusobacterium necrophorum</i>. Repeat biopsy samples showed signs of underlying human simplex virus (HSV) infection, which was confirmed with polymerase chain reaction (PCR) testing. After addition of acyclovir, the patient began to improve clinically and was eventually decannulated. There was complete resolution of the mass at his 1-month follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HSV supraglottitis is a rare, rapidly progressive, and highly morbid condition. Lack of overt patient risk factors, frequently inconclusive biopsies, and clinical appearance mimicking other etiologies make diagnosis challenging. Superimposed bacterial infection is even less common and may contribute to increased disease severity and progression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worse survival and higher rates of relapse in U.S. Armenians with papillary thyroid cancer","authors":"Karen Tsai MD,&nbsp;Katerina Arca MS,&nbsp;Philip H. G. Ituarte PhD,&nbsp;Thomas Gernon MD,&nbsp;Behrouz Salehian MD,&nbsp;Diana Bell MD,&nbsp;Ellie Maghami MD","doi":"10.1002/lio2.70052","DOIUrl":"https://doi.org/10.1002/lio2.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Papillary thyroid cancer (PTC) is the most frequent subtype of thyroid cancer with overall favorable survival. Currently, little is known about the PTC experience within the United States (U.S.) Armenians. We performed the first study comparing clinicopathologic variables and clinical outcomes of U.S. Armenian PTC patients to a matched control group of non-Armenians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a single-center, retrospective, case–control study of adult Armenian PTC patients who received care at COH from 2005 to 2022. Armenian ethnicity was determined by surnames ending in “-ian” and “-yan”. We report and compare clinicopathologic presentation and disease outcomes with a gender- and age-matched control non-Armenian population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-eight Armenian patients comprised our study cohort. Positive margin status (<i>p</i> = .038), angioinvasion (<i>p</i> = .006), and extrathyroidal extension (<i>p</i> = .014) were more prevalent in the Armenian population. Higher rates of both persistent disease and death due to disease were seen in the Armenians regardless of age groupings. Multivariable analysis revealed significant impact of Armenian status on outcomes. Calculated 5- and 10- year disease-specific survival rates in the Armenian cohort were 88% and 73.2%, respectively, compared with 100% and 94.6% in the non-Armenian group (<i>p</i> &lt; .002). The 5- and 10- year progression-free survival was worse in the Armenian group at 61.8% and 50.1%, respectively, compared with 87.5% and 87.5% in the non-Armenian group (<i>p</i> &lt; .001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Armenian PTC patients displayed more aggressive disease than non-Armenians. In addition, Armenian PTC patients had higher incidence of disease relapse and worse clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>5</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between intratympanic injection of dexamethasone and methylprednisolone in idiopathic sudden sensorineural hearing loss: A randomized clinical trial","authors":"Kourosh Eftekharian MD, MPH,&nbsp;Elnaz Najafi MD,&nbsp;Maryam Amizadeh MD,&nbsp;Noosheen Mokari MS,&nbsp;Mohammad Faramarzi MD,&nbsp;Yalda Izadparast MD,&nbsp;Yalda Jabbari Moghadam MD,&nbsp;Ali Eftekharian MD","doi":"10.1002/lio2.70054","DOIUrl":"10.1002/lio2.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the hearing outcomes of patients with idiopathic sudden sensorineural hearing loss after intratympanic (IT) injection of methylprednisolone and dexamethasone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Randomized case-controlled clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventy-five patients diagnosed with idiopathic sensorineural hearing loss were randomly divided into two groups based on therapy. Both groups received oral prednisolone (10 mg/kg; maximum of 60 mg) for 10 days without tapering and received IT injections two times a week for 2 weeks (four injections in total). One group received an IT injection of a 40 mg/mL solution of methylprednisolone, and the other one, 4 mg/mL dexamethasone. Three comparisons between the initial and third-month hearing tests were made to assess the degree of hearing change: (1) pure tone improvement in each individual tone (0.5, 1, 2, 3, and 4 kHz); (2) word-recognition score improvement; and (3) complete, partial, and no recovery of hearing calculated (as defined by American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study was completed with 69 of the 75 patients—34 in the methylprednisolone group and 35 in the dexamethasone group. The groups' differences in frequency-specific hearing improvement were not statistically significant. There was no statistically significant difference in the word recognition score improvement between the two groups. Additionally, there was no discernible difference between the two groups' hearing recovery rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Methylprednisolone and dexamethasone IT injection therapy had similar hearing outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of evidence</h3>\u0000 \u0000 <p>2.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity is a risk factor for prolonged mechanical ventilation after tracheotomy","authors":"Jacqueline Tucker BS,&nbsp;Nicole Ruszkay MD,&nbsp;Sara Sandifer BS,&nbsp;Tonya S. King PhD,&nbsp;Neerav Goyal MD MPH FACS,&nbsp;David Goldenberg MD FACS,&nbsp;John P. Gniady MD FACS","doi":"10.1002/lio2.70038","DOIUrl":"10.1002/lio2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare patient outcomes across body mass index (BMI) subgroups in the setting of recent tracheotomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective chart review included patients over 18 years old who underwent tracheotomy placement between February 2017 and March 2020. Patients were divided into five groups based on BMI: underweight, normal weight, overweight, obese, and morbidly obese. Data were collected from the electronic medical record (EMR). Statistical analyses were completed via Kruskal–Wallis, Chi-square, log-rank tests, and Cox proportional hazards regression. If significant differences were found between groups, then subsequent pairwise comparisons of BMI were completed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 391 patients included in the study. There were significant differences in length of stay (<i>p</i> = .015) and duration of mechanical ventilation (<i>p</i> &lt; .001) among the groups. This was mainly driven by comparisons between the normal weight and obese groups, with patients of normal weight having shorter hospital stays and shorter ventilation durations. With each increasing BMI category from normal weight, a greater proportion of patients were ventilator-dependent at the time of discharge (<i>p</i> &lt; .001). Interestingly, after adjustment for comorbidities, the rate of tracheotomy change was 0.86 times lower for every increase in BMI category (95% CI 0.77–0.96). There was a significant difference among the BMI groups with respect to time to tracheotomy collar placement according to both the log-rank test (<i>p</i> &lt; .001) and the Cox model with adjustment for the presence of heart failure (<i>p</i> = .011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients undergoing tracheotomy, obese and morbidly obese patients have increased lengths of hospital stays. Additionally, they are dependent on ventilators for longer and are more likely to be ventilator-dependent at the time of discharge. It is important to understand how BMI impacts the hospital course for patients undergoing tracheotomy so that patients and their families can be better informed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level 3.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a mobile application for gender-affirming voice training: A community-engaged approach","authors":"Isaac L. Alter AB,&nbsp;Keith A. Chadwick MD, MS,&nbsp;Katerina Andreadis MS,&nbsp;Rachel Coleman MS, CCC-SLP,&nbsp;Mary Pitti MS, CCC-SLP,&nbsp;Jerel M. Ezell PhD, MPH,&nbsp;Anaïs Rameau MD, MS, MPhil","doi":"10.1002/lio2.70043","DOIUrl":"10.1002/lio2.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To date, there has yet to be a rigorous exploration of voice and communication modification training (VCMT) among transgender and gender-nonconforming (TGNC) individuals using digital technology. We sought to evaluate and describe the iterative process of app development using a community-based approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An interprofessional team of voice health care professionals, application developers, designers, and TGNC community members was assembled to conceive the functionality, content, and design of a mobile app to support VCMT for TGNC people. Six TGNC individuals, identified primarily by word of mouth, joined the development team as a Community Advisory Board (CAB). The CAB provided input on app content development, design choices, and user experience, with collaboration across disciplines and integration of TGNC community members throughout app development; the applicability of CBPR principles was evaluated throughout the development process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Iterative cycles of content creation and feedback produced multiple substantial changes during the app's development, including added functionality, improved inclusivity and accessibility, and design and branding enhancements. Several successful outcomes from our approach were identified, including the recruitment of dedicated CAB members and interprofessional collaboration that included community members. Challenges included integration of multiple different approaches and levels of expertise, navigating TGNC individuals' participation without exploitation, and creating high-quality content on a limited budget.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our process demonstrates the value of including a CAB in the design of a digital VCMT platform, and suggests a potential for community-based participatory research (CBPR) in laryngology and speech language pathology, where uptake of this framework has remained limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level 5.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meniere's disease: Structural considerations in early cochlea hydrops","authors":"Daniel J. Pender MSE, MD, FACS","doi":"10.1002/lio2.70041","DOIUrl":"10.1002/lio2.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Structural features of the human cochlea may control early lesion formation in endolymphatic hydrops. This process may hinge on three structural features: the flattened spiral shape of the human cochlea, the toroidal configuration of the distended cochlea duct, and the distensibility characteristics of Reissner's membrane. An analytical method is presented to assess the variation in hydropic distention that may occur in the several turns of the cochlea due to these structural features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A normal human cochlea is used to illustrate the method of analysis. Structural dimensions were taken from a mid-modiolar section. Reissner's membrane was projected to assume a spiral toroid shape as it distends. Peak membrane stress proclivities in each cochlea turn were calculated analytically. Membrane strain was assessed from a collagen model of Reissner's membrane. Sagittal membrane displacements were quantified geometrically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Stress levels in Reissner's membrane were projected to be the lowest in the lower basal turn and to increase progressively to a peak value in the apex. Strain in Reissner's membrane in the apical turn was projected to be substantially higher than in the lower turns. Sagittal displacement of Reissner's membrane was projected to be most pronounced in the apical turn in all the stages of early cochlea hydrops.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Structural features appear to underlie a differential susceptibility to hydrops in the human cochlea. The flattened spiral shape of the human cochlea coupled with the anticlastic configuration and the distensile characteristics of Reissner's membrane are projected to result in distinct histological stages as hydropic disease in the cochlea progresses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant otitis externa: What is the role of surgery?","authors":"Lisa Zhang MD,&nbsp;Joseph Bonanno BS,&nbsp;Woo Yul Byun MD,&nbsp;Yin Ren MD, PhD","doi":"10.1002/lio2.70029","DOIUrl":"10.1002/lio2.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Malignant otitis externa (MOE) is typically managed with long-term broad-spectrum antibiotics. The impact of surgical intervention on clinical outcomes is not well described. This study aims to compare clinical outcomes of MOE patients managed with or without surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design/Setting</h3>\u0000 \u0000 <p>Retrospective cohort, academic tertiary referral center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients diagnosed with MOE between January 2010 to September 2022 were included. Univariate analyses compared symptoms at initial presentation and long-term (≥1 year) outcomes between surgical and non-surgical patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 23 patients were included (78% male, mean age 69 ± 13 years, median follow-up 305 days). Most (<i>N</i> = 22, 96%) patients were diabetic. Seventeen (74%) underwent surgical intervention (76% tympanomastoidectomy, 24% external auditory canal debridement and biopsy). Poor facial nerve (FN) function at initial presentation (defined as House-Brackmann [HB] grade ≥3) significantly predicted undergoing surgical intervention (<i>p</i> = 0.02). Comparing surgically managed versus non-surgical patients at the time of presentation, there were no differences in the degree of hearing loss, severity of diabetes, rate of insulin dependence, incidence of immunosuppression, or the Charlson Comorbidity Index (all <i>p</i> &gt; 0.05). FN outcomes at long-term follow-up also did not significantly differ (p &gt; 0.05). No significant differences in the length of stay (9 vs. 6 days, <i>p</i> = 0.2), rate of readmission (31% vs. 17%, <i>p</i> = 0.5) or 5-year overall survival (53% vs. 66%, <i>p</i> = 0.6) were observed between surgical and non-surgical patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long-term outcomes for patients with MOE remain poor. Patients with poor FN function at presentation were more likely to undergo surgical intervention. Patient comorbidities, including the severity of diabetes, were not predictive of undergoing surgery. However, surgical intervention for MOE did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in our cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>III</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reference to Primary site surgical resection in cM1 oral cavity squamous cell carcinoma","authors":"Erkan Topkan MD,&nbsp;Efsun Somay PhD,&nbsp;Uğur Selek MD","doi":"10.1002/lio2.70053","DOIUrl":"10.1002/lio2.70053","url":null,"abstract":"&lt;p&gt;We applaud Patel and colleagues for their study investigating the impact of primary site surgical resection on overall survival (OS) in patients diagnosed with clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The study included 278 patients: 139 (50.0%), 80 (28.8%), 25 (9.0%), and 34 (12.2%) treated with chemotherapy (CT), chemoradiotherapy (CRT), surgical resection + adjuvant chemotherapy (S-CT), and surgical resection + adjuvant chemoradiotherapy (S-CRT), respectively. Respective 5-year OS rates were 9.4%, 15.2%, 8.3%, and 23.8% (&lt;i&gt;p&lt;/i&gt; &lt; .001), indicating that surgical resection was beneficial only when combined with CRT. While the present study provides valuable insights into the treatment outcomes of cM1 OCSCC patients, addressing two critical concerns would ensure a more comprehensive understanding of Patel and colleagues' findings.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;First, the study findings indicated that despite a high incidence of positive surgical margins (a significant adverse prognostic factor) S-CRT was linked to significantly improved OS rates compared to the alternative strategies of CT, CRT, and S-CT. Nevertheless, the 5-year OS rates of 9.4% for CT and 8.3% S-CT groups are nearly equivalent and substantially inferior to the 15.2% observed in the CRT group, suggesting that the principal factor influencing outcomes is the incorporation of radiotherapy with CT, namely definitive CRT.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Although the authors provide no comparative patient and disease characteristics for all four treatment regimens, the notably superior outcomes achieved in the CRT groups were most likely despite the accumulation of unfavorable prognostic variables in these groups, as can be anticipated from tab. 1 of the original manuscript.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; For example, therapy in a nonacademic center, high-grade histology, T3-4 tumors, N1-3 disease, and pathologic extra-nodal extension all disadvantage the non-surgical groups.&lt;/p&gt;&lt;p&gt;And second, S-CRT resulted in the best 5-year OS rates (23.8%) even when compared to CRT (15.2%). However, it remains uncertain whether the two cohorts possessed comparable tumor and patient characteristics, including comorbidities that could serve as competing risk factors for mortality, mainly since OS is the designated primary endpoint rather than disease-specific survival.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, more precise comparative data are needed for definitive conclusions because selection biases favoring surgical groups are a common finding in retrospective studies. Due to the common occurrence of selection biases favoring surgical studies in retrospective studies.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Therefore, to prevent highly toxic and futile therapies, we recommend using propensity score matching methods to balance the confounding variables between groups until the results of well-designed, large-scale, randomized clinical trial data become avai","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic and microscopic video modules are effective for teaching middle ear anatomy","authors":"Leona J. Tu BS,&nbsp;Obinna I. Nwosu MD,&nbsp;Doug Chieffe MD,&nbsp;Elissa Daniel,&nbsp;Michael S. Cohen MD","doi":"10.1002/lio2.70044","DOIUrl":"10.1002/lio2.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the efficacy of video modules in improving trainees' objective knowledge of middle ear anatomy and to compare the efficacy of using the endoscope to the microscope in video modules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medical students and residents were recruited. Two videos reviewing middle ear anatomy were developed. One video was recorded using an endoscope and the other using a microscope. Subjects were randomly assigned to either the endoscopic or microscopic video module group. A 20-question knowledge assessment designed to assess understanding of anatomic concepts was administered to all subjects prior to the intervention. After completing the endoscopic or microscopic video modules, subjects were administered the same knowledge assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 62 subjects recruited, 32 were randomized to the endoscope group and 30 to the microscope group. Eleven subjects completed all components of the assessment in the endoscope group and nine in the microscope group. Subjects in the endoscope group demonstrated a mean 12.3% increase in assessment scores (SD 9.1%, <i>p</i> = .0008), compared to a mean 11.7% increase in assessment scores in the microscope group (SD 9.4%, <i>p</i> = .0002). When controlling for pretest scores, there was no significant difference in posttest performance between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Brief video modules effectively improved objective short-term knowledge of middle ear anatomy. Although both groups demonstrated a significant improvement in knowledge, there was no significant difference in the educational utility of endoscopic videos compared to microscopic videos. Further studies with larger sample sizes may help quantify which modalities are optimal for teaching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>NA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}