Laryngoscope Investigative Otolaryngology最新文献

{"title":"3D reconstruction of vocal fold dynamics with laser high-speed videoendoscopy in children","authors":"Rita R. Patel PhD,&nbsp;Michael Döllinger PhD,&nbsp;Marion Semmler PhD","doi":"10.1002/lio2.70024","DOIUrl":"10.1002/lio2.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to evaluate three-dimensional vertical motion of the superior surface of the vocal folds in vivo in (a) typically developing children as a function of vocal frequency variations and (b) a child with vocal nodules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A custom developed laser endoscope coupled with high-speed videoendoscopy was used to obtain 3D parameters from 2 healthy children, one child with vocal nodules, and 23 vocally healthy adults (females = 11, males = 12). Parameters of amplitude (mm), maximum opening/closing velocity (mm/s), and mean opening/closing velocity (mm/s) were computed for the lateral and vertical vibratory motion along the anterior, middle, and posterior sections of the vocal folds were computed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We provide for the first time, absolute measurements of vertical amplitude and maximum/ mean velocity during the opening and closing phases, in vivo in children. Overall, the vertical motion was larger in vocally normal children compared with the lateral motion, especially along the visible posterior section of the vocal folds and during low pitch phonation. The opening phase dynamics were consistently large along the posterior section in the child with vocal nodules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study findings establish the feasibility of capturing 3D motion in a clinical setting and provide proof of concept for the application of the proposed 3D laser in the pediatric population. Future large sample size studies are needed to establish the diagnostic potential of examining the closing phase vertical motion to evaluate vibratory development in children with normal voice and investigating the opening phase vertical motion in children with nodules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510618","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":"Surgical resection and overall survival in cT4b sinonasal non-squamous cell carcinoma","authors":"Aman M. Patel BS,&nbsp;Afash Haleem BA,&nbsp;Lucy Revercomb BS,&nbsp;Jason A. Brant MD,&nbsp;Michael A. Kohanski MD, PhD,&nbsp;Nithin D. Adappa MD,&nbsp;James N. Palmer MD,&nbsp;Jennifer E. Douglas MD,&nbsp;Ryan M. Carey MD","doi":"10.1002/lio2.70025","DOIUrl":"10.1002/lio2.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Surgical resection is associated with higher overall survival (OS) than definitive radiotherapy (RT) or chemoradiotherapy (CRT) in cT4b sinonasal squamous cell carcinoma (SCC). Our study investigates the survival benefit of surgical resection in cT4b sinonasal non-SCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2004 to 2019 National Cancer Database was queried for patients with cT4b sinonasal non-SCC undergoing definitive treatment with (1) surgical resection + additional therapy (RT, chemotherapy, or both), (2) RT alone, or (3) CRT. Surgical resection + additional therapy and definitive RT/CRT were compared with Kaplan–Meier and multivariable Cox regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 629 patients satisfying inclusion criteria, 513 (81.6%) underwent surgical resection + additional therapy and 116 (18.4%) underwent definitive RT/CRT. The most frequent histologic types were undifferentiated carcinoma (23.7%), adenoid cystic carcinoma (22.6%), and adenocarcinoma (20.7%). Few patients presented with clinical nodal metastasis (15.7%). There were 4 (0.8%) mortalities within 90 days of surgical resection. Patients undergoing surgical resection with positive surgical margins had higher 5-year OS than those undergoing definitive RT/CRT (56.3% vs. 39.4%, <i>p</i> = .039) and similar 5-year OS as those with negative margins (56.3% vs. 63.9%, <i>p</i> = .059). Patients undergoing neoadjuvant chemotherapy had similar 5-year OS as those undergoing definitive RT/CRT (60.9% vs. 39.5%, <i>p</i> = .053). Age at diagnosis, tumor diameter, and surgical resection + additional therapy (aHR 0.64, 95% CI 0.45–0.91) were associated with OS (<i>p</i> &lt; .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Surgical resection + additional therapy was associated with higher OS than definitive RT/CRT in cT4b sinonasal non-SCC. Surgical resection may benefit select patient with cT4b sinonasal non-SCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510620","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":"Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer","authors":"Osama A. Hamdi MD,&nbsp;Deepa Danan MD,&nbsp;Amber Denner MD,&nbsp;Jeffrey R. Bellinger MD,&nbsp;Noah Thornton BS,&nbsp;David C. Shonka MD,&nbsp;Jonathan C. Garneau MD,&nbsp;Katherine Fedder MD,&nbsp;Mark J. Jameson MD, PhD,&nbsp;Eric M. Dowling MD","doi":"10.1002/lio2.70021","DOIUrl":"https://doi.org/10.1002/lio2.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Recent literature studying the impact of blood transfusion on outcomes in patients with head and neck cancer (HNC) have shown that blood transfusions are associated with increased risk of death and higher wound infection rates. The purpose of this study was to implement a lower transfusion threshold while comparing outcomes of free flap patients following initiation of a new transfusion guideline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study of all patients at a tertiary care academic center who underwent free tissue transfer after HNC resection between July 17, 2007 and June 7, 2021. Transfusion criteria were adjusted in 2014; the hematocrit threshold to transfuse was incrementally reduced from 30% in 2007 to 21% in 2017. The main outcomes of interest were overall survival (OS) and recurrence free survival (RFS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 346 patients met the criteria for inclusion in the study. Groups 1 (less strict protocol – 30%) and 2 (stricter protocol – 21%) consisted of 171 and 175 patients, respectively. Fewer units of packed red cells were transfused per patient in group 2 (0.26 vs. 2.87 in group 1, <i>p</i> &lt; .001). Group 1 was associated with worse OS (<i>p</i> = .01; hazard ratio [HR] = 1.7) and RFS (<i>p</i> &lt; .001; HR = 2.5). Comparing only patients with SCC between the two groups also demonstrated poorer OS (<i>p</i> = .01; HR = 1.8) and RFS (<i>p</i> = .006; HR = 2.1) in group 1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In HNC patients undergoing free tissue transfer, stricter transfusion criteria with threshold hematocrit of 21% was associated with improved OS, RFS, and complication rates with no negative impact on free flap survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451155","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":"The pathophysiology of dysphagia post-lung transplant: A systematic review","authors":"Sana Smaoui PhD,&nbsp;Elly Cummins,&nbsp;Maryah Mena,&nbsp;Summer Scott,&nbsp;Rodrigo Tobar-Fredes","doi":"10.1002/lio2.70022","DOIUrl":"https://doi.org/10.1002/lio2.70022","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One major consequence of lung transplantation is the development of oropharyngeal dysphagia. This systematic review aims to appraise and synthesize the available evidence of the use of instrumental assessments to outline the characteristics of post-lung transplant dysphagia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Following the identification of appropriate search terms for the question, a literature search was conducted in PubMed, Scopus, and the Health and Medical Collection of Proquest Research Library and included records between inception and September 14, 2023. Search strategies included the use of text words and subject headings (e.g., MeSH and Index terms) related to (1) dysphagia or swallowing (swallow*, deglutition disorder*), (2) lung transplant (lung transplant*, post-operative, post-lung), and (3) complications (adverse effects, *complications, treatment outcome).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The literature search strategy yielded a total of 883 studies from the electronic database search, with no additional records identified through other sources. After the removal of duplicates (&lt;i&gt;n&lt;/i&gt; = 96), a total of 787 studies were screened through title and abstracts which eliminated 775 studies. Six studies were ultimately included in the systematic review. The selected articles included patients who underwent lung transplantation and all but one study utilized a retrospective design. A lack of transparency regarding instrumental evaluation protocols (videofluoroscopic [VFSS] and Flexible Endoscopic Evaluation of Swallowing [FEES]) including the number and bolus types used during the instrumental evaluations appeared as a theme in the studies included. The Penetration-Aspiration Scale (PAS) was systematically utilized to measure dysphagia safety outcome. Handling of the PAS scale was not consistent across studies, however penetration or aspiration ranged from 52.4% up to 100%. Additionally, silent aspiration rates ranged from 14.2% to 61.9%.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This review sought to describe the post-operative swallowing function and its physiological parameters following lung transplantation. We examined the results reported and the methods utilized in obtaining these results in the existing literature. Limited reporting practices for physiological parameters were found, however the airway invasion was reported in all studies with variation in degrees of swallowing safety related deficits, with PAS being the most widely used scale to describe airway i","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449189","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":"Perilymphatic enhancement and endolymphatic hydrops: MRI findings and clinical associations","authors":"Masumi Kobayashi MD PhD,&nbsp;Tadao Yoshida MD PhD,&nbsp;Yukari Fukunaga,&nbsp;Daisuke Hara,&nbsp;Shinji Naganawa MD PhD,&nbsp;Michihiko Sone MD PhD","doi":"10.1002/lio2.1312","DOIUrl":"https://doi.org/10.1002/lio2.1312","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In this study, we aimed to summarize magnetic resonance imaging (MRI) findings of perilymphatic enhancement (PE) and endolymphatic hydrops (EH) of the inner ear, which are associated with vestibular and cochlear symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data on ears with definite Meniere's disease (MD), sensorineural hearing loss (SNHL), vertigo, and listening difficulties (LiD) from 508 ears of 254 patients who underwent contrast-enhanced 3-Tesla MRI between April 2021 and March 2023. We evaluated the degree of endolymphatic hydrops (EH), signal intensity ratios (SIRs) between the basal turns of the cochlea and cerebellum, and hearing levels for all ears. Ears with definite MD were also assessed for changes in vestibular and cochlear symptoms within 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ears with definite MD exhibited significantly higher percentages of EH in both the vestibule and cochlea compared with ears with other diseases. Furthermore, ears with MD or sensorineural hearing loss (SNHL) had significantly higher SIRs of PE compared with ears with other diseases or asymptomatic ears. Among patients with definite MD, those experiencing hearing fluctuations or vertigo attacks within the last 6 months had significantly higher SIRs of PE compared with those who did not experience any symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Significant EH in the vestibule and cochlea was a major finding for the imaging diagnosis of definite MD. A high SIR of PE was a good indicator for assessing MD activity, reflecting vestibular and cochlear symptoms and fluctuations.</p>\u0000 \u0000 <p>Level of Evidence: 4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.1312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142429919","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":"Reply to “Letter to the Editor: Salivary gland ultrasound elastography requires interpretation of ‘normal’”","authors":"Chia-Fan Chang MD,&nbsp;Hsin-Kai Wang MD","doi":"10.1002/lio2.70015","DOIUrl":"10.1002/lio2.70015","url":null,"abstract":"<p>Shear wave elastography (SWE) is an innovative imaging technique that quantifies tissue stiffness, thus enabling objective assessment of this biomechanical feature. Since its initial application for the evaluation of liver cirrhosis, numerous research has shown that the shear wave velocity (SWV) of the liver is affected by multiple factors, including fibrosis, inflammation, congestion, and fatty change.<span>^{1, 2}</span> As a result, SWV is an output of the summation of all these pathological processes. This concept also applies to SWV of other organs and tissue, including the salivary gland.</p><p>Our study compared SWV in the salivary gland affected by sialolithiasis before and after treatment. A higher SWV before treatment was attributed to inflammation and swelling triggered by ductal obstruction. We appreciate Hoffman et al. for their comments, which specifically mention that fatty infiltration following chronic sialolithiasis may cause a decreased SWV, which might mask the effect of inflammation, fibrosis, and atrophy. No pathological specimen is available in our study cohort; therefore, we cannot clarify whether there was fatty infiltration of the gland in our patients. Sumi et al. found that fatty infiltration of the salivary gland affected by chronic sialolithiasis was more likely asymptomatic.<span>³</span> Our study enrolled patients with symptomatic sialolithiasis seeking treatment. In addition, the mean duration of SWV measurement before and after treatment of sialolithiasis was a relatively short interval of 1.55 months. Therefore, we proposed that inflammation and swelling were the dominant factors for elevated SWV before treatment and lowering of SWV after stone removal, regardless of fatty infiltration.</p><p>Several studies explored normal SWV and Young's modulus in the normal salivary gland. However, no widely accepted single value has been established so far, since normal SWV varies by age, ultrasound machine, and technique utilized to acquire SWV.<span>^{4, 5}</span> Alternatively, measurement of the contralateral gland offers us an objective standard to compare SWV between normal and diseased glands and assess the degree of recovery after treatment.</p><p>SWE is an effective tool for quantitative assessment of various salivary gland diseases. Hoffman et al. reminded us to be aware of the complexity hidden behind a simple number (SWV) so that we could interpret these data correctly.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394364","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":"Immunocytochemistry assessment of vocal fold regeneration after cell-based implant in rabbits","authors":"Larissa Nicolas BS,&nbsp;Hanna Mandl BS,&nbsp;Feng Schrader BS,&nbsp;Jennifer L. Long MD, PhD","doi":"10.1002/lio2.70007","DOIUrl":"10.1002/lio2.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Cell-based outer vocal fold replacement (COVR) offers a potential treatment for severe vocal fold scarring or cancer reconstruction. Previous work in rabbits using human adipose-derived stem cells (ASC) in fibrin suggested that a hybrid structure emerged within 2 months, containing both implanted and host cells. This project uses immunocytochemistry to better define the phenotypic fate of implanted cells and features of the extracellular environment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Immunocytochemistry was performed on sections collected from rabbits 2 months after COVR implantation or scar surgery. Cellular targets included human leukocyte antigen (HLA), CD31, and smooth muscle actin (SMA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>HLA was present in all implanted sections and was used to identify human cells. In adjacent sections, HLA-positive cells were identified expressing CD31. SMA was not identified in the same cells as HLA. These markers were also present in injured vocal folds not receiving COVR. SMA protein content did not differ according to treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implanted human ASC persist in rabbit vocal folds. Some appear to express CD31, an endothelial marker. Smooth muscle actin, a marker of myofibroblast phenotype, was present in all sections regardless of treatment, and was not identified in hASC. Host cells also infiltrate the structure, producing a hybrid host-graft vocal fold.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394362","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":"Salivary gland ultrasound elastography requires interpretation of “normal”","authors":"Henry T. Hoffman MD,&nbsp;Piper Wenzel BS,&nbsp;Johannes Zenk MD,&nbsp;Antonio Marcelino MD,&nbsp;Harry Quon MD","doi":"10.1002/lio2.70016","DOIUrl":"10.1002/lio2.70016","url":null,"abstract":"&lt;p&gt;Strong support has evolved for elastography as a supplement to salivary gland ultrasound assessment.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; We advocate for the clinical value of this tool but offer caution in considering “normal” shear wave velocity (also reported as Young's modulus) to consistently reflect normal gland function.&lt;/p&gt;&lt;p&gt;Standard ultrasound assessment of parotid tumors has been reported to identify malignancy with a 91% accuracy.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Jering et al. reported that additional evaluation with elastography improved the diagnostic accuracy by identifying malignant tumors to be associated with faster shear wave velocities and larger areas of stiff tissue than benign tumors.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Assessments of non-neoplastic salivary disorders with ultrasound elastography have reported the capacity to discriminate between normal salivary glands with slower shear wave velocity from those in patients with Sjogren's syndrome with faster shear wave velocity.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Dai et al. through a meta-analysis of 15 articles addressing primary Sjogren's syndrome (pSS) concluded that ultrasound elastography “d&lt;i&gt;emonstrates high accuracy in differentiating between pSS and healthy/disease control groups&lt;/i&gt;”.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Chang and Wang identified their experience with ultrasound shear wave elastography to characterize glands affected with sialolithiasis.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Sequential assessments identified changes to gland stiffness following treatment of obstructive sialadenitis to further support the clinical utility of shear wave elastography as was similarly reported by a group in Munich, Germany.&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We concur with Chang and Wang's contention that the significant decrease in shear wave velocity they identified following stone removal does “&lt;i&gt;imply the diseased gland became softer after removal of sialolithiasis&lt;/i&gt;” but offer caution in their interpretation that softening and slower speed reflects “&lt;i&gt;recovery of salivary gland function&lt;/i&gt;.”&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Although others have similarly identified the value of elastography to “&lt;i&gt;indirectly reflect organ function&lt;/i&gt;,”&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; it is important to acknowledge that fatty replacement of diseased glands may dominate the exam to provide a normal shear wave analysis of a poorly functioning or nonfunctioning gland.&lt;/p&gt;&lt;p&gt;Takagi et al. employed MR analysis to identify fatty degeneration occurring within the salivary glands of patients with long-standing Sjogren's syndrome.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; Study of patients with post-irradiation xerostomia employing MRI and advanced CT imaging has also correlated poor salivary gland function associated with fat infiltration.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; An elegant study of surgically resected human breast tissue identified a broad range of viscoelastic properties within the tissue subject to elastography analysis.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; These investi","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394365","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":"Current approaches to facial nerve schwannoma surgery","authors":"Elena Hernandez-Montero MD, PhD,&nbsp;Luis Garcia-Ibañez MD,&nbsp;Sara Jubes MD,&nbsp;Jorge Salmeron MD,&nbsp;Emilio Garcia-Ibañez MD,&nbsp;Francisco Larrosa MD, PhD","doi":"10.1002/lio2.70019","DOIUrl":"10.1002/lio2.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Facial nerve schwannomas (FNSs) are exceedingly rare benign tumors. This study aims to report on a series of excised FNSs, providing clinical information and details on their surgical management, including novel approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed patients who underwent surgical excision of FNSs in a private otology clinic and public tertiary referral center. The main outcome measures were facial nerve function, complete tumor removal, postoperative complications, tumor recurrence, and hearing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen patients (10 men and 7 women) with a mean age of 44.23 years (SD, 12.21) underwent surgery during the study period. The most common symptom was facial nerve dysfunction (58.8%). Facial and otoneurologic symptoms (hearing loss, tinnitus, and vertigo) were observed in 88.8% and 77.7% of patients, respectively. The middle cranial fossa (MCF) was the most common approach (six patients, 35.2%), followed by translabyrinthine (TL), transmastoid (TM), and combined TM-MCF (three patients, 17.6% each). Exclusive endoscopic transcanal suprageniculate (ETS) and mastoid combined with cervical approaches were applied once in two patients, 5.8% each. Total tumor removal was achieved in all cases. No significant postoperative complications were observed. The mean follow-up period was 193.2 months (SD, 119.5) and no tumor recurrence was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides further evidence for the safety and efficacy of various surgical approaches for FNS, and incorporates the endoscopic transcanal approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394361","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":"Outpatient management of pediatric epistaxis: A cost analysis and clinical model","authors":"Joshua A. Lee MD,&nbsp;Christopher Puchi MD,&nbsp;Kathleen R. Billings MD,&nbsp;Jennifer M. Lavin MD, MS,&nbsp;Inbal Hazkani MD,&nbsp;Carole Glennon RN, MSN, CPN,&nbsp;Dana M. Thompson MD, MS, MBA,&nbsp;John Maddalozzo MD","doi":"10.1002/lio2.1310","DOIUrl":"10.1002/lio2.1310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective(s)</h3>\u0000 \u0000 <p>Pediatric epistaxis is a common, often non-operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 122 patients were included for analysis. Over a follow-up duration of 20.5 months (IQR 8–36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution (<i>n</i> = 122). Refractory epistaxis was associated with a family history of coagulopathy (<i>p</i> = .007), daily epistaxis episodes (<i>p</i> = .043), and anemia (<i>p</i> &lt;.001). Average direct hospital costs associated with nasal cautery were $187 for in-office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in-office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work-up was $576.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care.</p>\u0000 \u0000 <p><b>Level of Evidence</b>: 4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394363","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}