Laryngoscope最新文献

{"title":"Factors Influencing the Delay in Head and Neck Cancer Diagnosis in Lebanon.","authors":"Nader G Zalaquett, Jad Hosri, Zachary Elwell, Zeina Semaan, Annemarie Daou, Omar Aboul Hosn, Bassem Youssef, Marc Mourad, Arafat Tfayli","doi":"10.1002/lary.32470","DOIUrl":"https://doi.org/10.1002/lary.32470","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate factors affecting the delay in head and neck cancer (HNC) diagnosis in Lebanon.</p><p><strong>Methods: </strong>Patients with HNC presenting between August 1, 2023, and August 1, 2024, to the American University of Beirut Medical Center (AUBMC) were recruited. A questionnaire was administered to characterize the demographic, socioeconomic, and clinical factors affecting their cancer diagnosis, and their charts were reviewed retrospectively for their cancer demographics and to account for any discrepancies.</p><p><strong>Results: </strong>A total of 78 participants were analyzed: 34 with early-stage (Stages 1 and 2) and 44 with late-stage (Stages 3 and 4) HNC. Late-stage participants had a significantly lower rate of university education (43.2% vs. 70.6%; p = 0.016), private insurance (27.3% vs. 64.7%; p = 0.001), and regular dental check-ups (29.5% vs. 52.9%; p = 0.036). They also reported more financial issues (52.3% vs. 26.5%; p = 0.022) and lack of awareness (65.9% vs. 29.4%; p = 0.001). Late-stage patients traveled longer distances for care (p = 0.043) and had issues with transport (38.6% vs. 8.8%; p = 0.003). Presentation (Type 1 delay) and referral (Type 2 delay) delays were significantly longer for late-stage HNC patients (median: 45 vs. 14 days, p < 0.001; 14 vs. 8.5 days, p < 0.001, respectively). Diagnosis delays were similar between groups (median: 7.00 days), but with a statistically significant mean difference (6.21 vs. 7.74 days).</p><p><strong>Conclusions: </strong>This study highlights the need to address patient awareness and healthcare barriers to improve timely HNC diagnosis. Enhancing symptom awareness and referral efficiency can significantly reduce diagnostic delays and associated morbidity in Lebanon.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776760","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":"Pathological Grading Determines the Clinical Efficacy of Outpatient KTP Laser Treatment for Vocal Fold Leukoplakia.","authors":"Dan Li, Zhiyan Lu, Siyi Chen, Harry Hoang, Jingru Ma, Chao Xue, Yi Fang, Yinying Chu, Lingjie Wu, Wenjing Mao, Xiufa Wu, Rui Fang, Jun Shao, Chunsheng Wei, Peijie He","doi":"10.1002/lary.32479","DOIUrl":"https://doi.org/10.1002/lary.32479","url":null,"abstract":"<p><strong>Objective: </strong>Vocal fold leukoplakia is commonly managed with outpatient potassium titanyl phosphate (KTP) laser therapy; however, limited data exist on the impact of different pathological grades on long-term efficacy. This study retrospectively analyzed the treatment outcomes, identified prognostic factors, and provided insights to improve disease characterization and clinical management.</p><p><strong>Study design: </strong>Retrospective study (2017-2024).</p><p><strong>Methods: </strong>Ninety two patients with vocal fold leukoplakia treated in Fudan Eye and ENT hospital (FD-EENT) were included. The mean follow-up period after the last treatment was 20.53 ± 17.32 months. Disease control was assessed by lesion regression using ImageJ analysis. Acoustic outcomes were evaluated using the Voice Handicap Index-30 (VHI-30), GRBAS scale, and other acoustic parameters.</p><p><strong>Results: </strong>Patients underwent a mean of 1.6 treatment sessions. Following the last treatment, the lesion regression rates were 90.1% for no dysplasia, 81.75% for mild dysplasia, and 86.83% for moderate dysplasia, compared to 51.0% for severe dysplasia and 32.9% for carcinoma in situ (CIS). Patients with pathological grades of severe dysplasia and CIS showed significantly poorer treatment outcomes than those with milder dysplasia (***p = 0.0001).</p><p><strong>Conclusion: </strong>Outpatient KTP laser effectively controls disease progression in vocal fold leukoplakia, with efficacy linked to the degree of dysplasia. KTP laser is an effective treatment for milder pathological dysplasia, but its efficacy diminishes in more severe stages. The treatment should be carefully considered for patients with severe dysplasia and CIS, with close follow-up, and biopsy should be performed to monitor malignant transformation and prevent delayed treatment.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776764","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":"Discordance Between Subjective Visual Vertical and Vestibular Evoked Myogenic Potentials in Stroke.","authors":"Seo-Young Choi, Youn-Jin Park, Suk-Min Lee, Hyun Sung Kim, Jae-Hwan Choi, Kwang-Dong Choi","doi":"10.1002/lary.70018","DOIUrl":"https://doi.org/10.1002/lary.70018","url":null,"abstract":"<p><strong>Background: </strong>While there has been a significant correlation between subjective visual vertical (SVV) and ocular vestibular myogenic potentials (oVEMPs) tests in acute vestibular neuritis (AVN), the association between these two tests in central vestibular lesions remains uncertain.</p><p><strong>Methods: </strong>We prospectively recruited 58 patients with acute stroke involving the posterior circulation territory (PCS) between 2019 and 2022. For comparison, 32 patients with AVN served as a control. We evaluated sustained utricular function through SVV tests and transient utricular function through bone-conducted (BC) oVEMPs tests during the acute stage.</p><p><strong>Results: </strong>The incidence of abnormal BC oVEMPs (91% vs. 35%, p < 0.01) and SVV tests (94% vs. 76%, p = 0.034) was significantly higher in AVN than PCS. The BC oVEMPs asymmetry ratio was considerably greater in AVN than in PCS (median [interquartile range, IQR]: 51.3% [34.5-61.2] vs. 9.5% [4.7-27.1], p < 0.01), while there was no significant difference in SVV tilt between the two groups (11.6° [7.5-17.7] vs. 8.1° [3.5-14.0], p = 0.320). The cut-off point of BC oVEMPs asymmetry ratio for differentiation of AVN was 31.7% with a sensitivity of 81.3%, a specificity of 84.5%, and Youden index of 0.65. The frequency of discordance between SVV and BC oVEMPs tests was more common in PCS than AVN (43% vs. 9%, p < 0.01).</p><p><strong>Conclusion: </strong>Our results show that discordance between SVV and BC oVEMPs tests in acute vestibular syndrome may indicate a central pathology. In the brainstem and cerebellum, the anatomical pathways responsible for verticality perception are more extensive than the central graviceptive projections arising from the utricle.</p><p><strong>Level of evidence: </strong>n/a.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776758","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":"Innovative Technique: Fixation of Receiver Stimulator of Cochlear Implant.","authors":"Milind V Kirtane, Sangeeta P Varty, Bhawana Dangol, Gabriela C Hawkes","doi":"10.1002/lary.70014","DOIUrl":"https://doi.org/10.1002/lary.70014","url":null,"abstract":"<p><p>This is an innovative and easy technique for fixation of the receiver stimulator of a cochlear implant. This novel method prevents migration of the device and avoids dural complications.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776762","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":"Effect of Spanish Language Concordant Care on Shared Decision-Making in Pediatric Otolaryngology.","authors":"Caleb M Allred, Sanjay R Parikh, Xing Wang, Juliana Bonilla-Velez","doi":"10.1002/lary.32466","DOIUrl":"https://doi.org/10.1002/lary.32466","url":null,"abstract":"<p><strong>Objective: </strong>Shared decision-making allows patients and physicians to make choices together by incorporating clinical expertise and patient preference. We sought to describe preferences in medical decision-making and the degree of shared decision-making among Spanish-speaking caregivers receiving pediatric Otolaryngology care. We hypothesized that language-concordant encounters would have higher shared decision-making scores.</p><p><strong>Methods: </strong>Cross-sectional study of Spanish-speaking caregivers at a tertiary regional pediatric academic center undergoing consultation with pediatric otolaryngology (May 2022-February 2024). Care was provided in either a language-concordant setting or a language-discordant setting. Following patient encounters in which a decision was made, Spanish-speaking caregivers completed the Control Preferences Scale to determine their preferred roles in medical decision-making (active, active-collaborative, collaborative, passive-collaborative, or passive) and the Shared Decision-Making Questionnaire (scored 0-100) to assess perceived decision-making. Fisher's exact test, Kruskal-Wallis test, and the Mann-Whitney U test were used for analysis, as appropriate.</p><p><strong>Results: </strong>One-hundred-fifty-six caregivers were enrolled. The mean age of the caregivers was 38.14 years (SD = 7.38) and most participants were mothers. The active-collaborative medical decision-making role was the most favored (41.4%) while 7.1% preferred a completely active and 14.3% a completely passive role. Language-concordant encounters had higher scores on the Shared Decision-Making Questionnaire (median [IQR]: 100 [88.89, 100.00]) than language-discordant encounters (median [IQR]: 94.44 [82.22, 100.00]; p = 0.003).</p><p><strong>Conclusion: </strong>More shared decision-making was observed among Spanish-speaking caregivers receiving language-concordant care compared to language-discordant care, many of whom preferred an active-collaborative decision-making style. Language-concordant care appears to facilitate an environment for shared decision-making to thrive during surgical consultation in pediatric otolaryngology.</p><p><strong>Level of evidence: </strong>This is a level III study due to the cross-sectional design in conjunction with the use of validated tools and a focus on comparative analysis within the study population.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776759","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":"Long-Term Occlusal Outcomes for Conservative Management in Patients With Robin Sequence.","authors":"Benjamin Palatnik, Daniel Sampson, Robert Tibesar, Brianne Roby","doi":"10.1002/lary.70013","DOIUrl":"https://doi.org/10.1002/lary.70013","url":null,"abstract":"<p><strong>Introduction: </strong>Robin sequence (RS), the triad of micrognathia, glossoptosis, and airway obstruction, is treated with conservative management in milder cases with the expectation that mandibular growth will normalize over time. Mandibular distraction osteogenesis (MDO) is a surgical intervention utilized in more severe cases. We aim to identify the long-term outcomes in conservatively managed RS patients to identify differences in mandibular growth and structural airway pathology.</p><p><strong>Methods: </strong>A retrospective review of patients with RS at a tertiary pediatric hospital was conducted from 2002 to 2022. History and physical exam were reviewed to assess for dental occlusion, surgical history, and syndromic status. Both persistent micrognathia (Class II occlusion) and persistent malocclusion (Class II or Class III occlusion) required documentation after skeletal maturity. RS patients who had not yet achieved skeletal maturity were eliminated.</p><p><strong>Results: </strong>Fifty eight RS patients were included from 2281 records retrieved (44.9% CM, 55.1% (+) MDO). Conservatively managed patients frequently demonstrated malocclusion (76.9%) and crossbite (27.8%) to a lesser extent, with future surgery documented in 3.85% of cases. (+) MDO patients showed similar rates of malocclusion (59.4%) and crossbite (34.5%), with increased rates of future surgery (25%). Among (+) MDO patients, micrognathia persisted in syndromic patients (66.7%, n = 5) more often than in non-syndromic patients (52.9% n = 8).</p><p><strong>Conclusions: </strong>Most RS patients retained micrognathia beyond skeletal maturity, conflicting with the self-correction model. Further studies should track RS patients treated conservatively to understand the rate of adult orthognathic surgery, assessing the varied distractor protocols and modalities currently available.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776763","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":"In Response to Systemic Effects and Absorption of Subepithelial Dexamethasone Vocal Fold Injections.","authors":"M Alwan, D J Phyland, J A Smith, P M Paddle","doi":"10.1002/lary.70015","DOIUrl":"https://doi.org/10.1002/lary.70015","url":null,"abstract":"","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776761","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":"In Response to Reduced Mortality With Treatment of Anxiety and Depression Among Head and Neck Cancer Survivors.","authors":"Tyler J Gallagher, Niels C Kokot","doi":"10.1002/lary.32467","DOIUrl":"https://doi.org/10.1002/lary.32467","url":null,"abstract":"","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769216","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":"Management of Postoperative Pain in Septorhinoplasty: A Systematic Review.","authors":"Caitlin M Coviello, Uma R Ramesh, Beatriz Varman, Krista L Olson, Sunthosh K Sivam","doi":"10.1002/lary.32433","DOIUrl":"https://doi.org/10.1002/lary.32433","url":null,"abstract":"<p><strong>Objective: </strong>Septorhinoplasties are a common surgery. Effectively managing postoperative pain and identifying opioid reduction techniques is of critical importance. This systematic review characterizes the literature regarding the management of postoperative pain with opioid-based and opioid alternative therapies in patients undergoing septorhinoplasty.</p><p><strong>Data sources: </strong>Medline (Ovid), Embase (Elsevier), Cochrane Library (Wiley), and Web of Science (Clarivate).</p><p><strong>Review methods: </strong>A literature search was conducted using multiple medical subject headings (MeSH) and keywords with adherence to preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Full-text analysis was performed by two independent reviewers using the Critical Appraisal Skills Program (CASP) and National Institute for Health and Clinical Excellence (NICE) validated quality assessment tools.</p><p><strong>Results: </strong>A total of 2503 articles were identified, and 14 studies met inclusion criteria. In the five opioid-based studies, patients were prescribed 10-60 opioid tablets, with consumption of 4.9-14.7 opioid tablets. Six pharmacologic opioid alternative therapy studies included sphenopalatine ganglion block, gabapentin, and nonsteroidal anti-inflammatory drugs (NSAIDs), all of which demonstrated either equivalent or improved pain control compared to opioid medications. Three nonpharmacologic opioid alternative studies were included, and one showed that vibration therapy reduced pain scores.</p><p><strong>Conclusion: </strong>While studies examining postoperative pain control in septorhinoplasty are heterogeneous, our findings suggest that opioids are prescribed in excess of exhibited need. Areas of consideration for opioid alternative multimodal pain control include gabapentin, celecoxib, ibuprofen, or other NSAID therapies, and local anesthetic blocks. Additional studies are needed to further examine minimizing opioids in postoperative pain control.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769217","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":"In Reference to \"Postoperative Implementation of Virtual Reality and Wearable Devices\".","authors":"Ken Chen, Yaoshu Teng","doi":"10.1002/lary.70001","DOIUrl":"https://doi.org/10.1002/lary.70001","url":null,"abstract":"","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769215","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}