Laryngoscope最新文献_第4页

Predictors of No-Show in a Safety-Net Otolaryngology Clinic: A Repeated Measures Approach. 在一个安全网耳鼻喉科诊所没有出现的预测因素：重复测量方法。

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-26 DOI: 10.1002/lary.32150

Tiffany Husman, Omeed Miraftab-Salo, Alonn Ilan, Shauna Brodie, Alan Paciorek, Megan L Durr, Jolie Chang, Mary Jue Xu

{"title":"Predictors of No-Show in a Safety-Net Otolaryngology Clinic: A Repeated Measures Approach.","authors":"Tiffany Husman, Omeed Miraftab-Salo, Alonn Ilan, Shauna Brodie, Alan Paciorek, Megan L Durr, Jolie Chang, Mary Jue Xu","doi":"10.1002/lary.32150","DOIUrl":"https://doi.org/10.1002/lary.32150","url":null,"abstract":"Objective: Identify predictors of patient no-show at an urban safety-net otolaryngology outpatient clinic.Methods: Retrospective cohort study including all scheduled patients and appointments in 2023. Predictor variables included sociodemographic factors, primary diagnosis, insurance, and the neighborhood deprivation index (NDI) based on census tract information. The outcome was analyzed as a binary variable using univariate and multivariate mixed-effects logistic regression models.Results: Among 2339 patients and 4641 scheduled appointments, 1639 patients completed all scheduled visits and 700 (29.9%) missed at least 1 visit. Among all appointments, 18.4% were missed. The prior no-show rate was 9% (IQR 4%-18%), and days from scheduling to appointment was 42 days (IQR 19-75). Univariate analysis demonstrated significant sociodemographic factors associated with higher odds of missing an appointment, including NDI (OR 1.03, p = 0.001), male gender (OR 1.35, p = 0.004), Black/African American race (OR 1.49, p = 0.022), unemployment and disability status (OR 1.45, p = 0.007 and OR 2.12, p < 0.001 respectively), unstable/unknown housing (OR 3.66, p < 0.001), and sexual orientation as lesbian or gay (OR 1.93, p = 0.003). NDI remained a significant factor in multivariate analysis (OR 1.03, p = 0.001). Patient portal inactivation and lead time were significant intervenable factors in multivariate analysis (OR 1.23, p = 0.049 and OR 1.26, p < 0.001, respectively).Conclusion: NDI, patient portal activation, and time from appointment scheduling to visit are significant predictors of patient no-show. This study offers insights into potential interventions addressing specific barriers to improving patient no-show rates for an urban, safety-net outpatient population.Level of evidence: 3 (retrospective cohort study).","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712012","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}

引用次数: 0

Role of Social Determinants of Health in Accessing Gender-Affirming Facial Surgery. 健康的社会决定因素在接受性别确认面部手术中的作用。

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-25 DOI: 10.1002/lary.32129

Ivy Tran, Nina Patel, Rohith M Bhethanabotla, Aarti Agarwal, P Daniel Knott, Andrea M Park

{"title":"Role of Social Determinants of Health in Accessing Gender-Affirming Facial Surgery.","authors":"Ivy Tran, Nina Patel, Rohith M Bhethanabotla, Aarti Agarwal, P Daniel Knott, Andrea M Park","doi":"10.1002/lary.32129","DOIUrl":"https://doi.org/10.1002/lary.32129","url":null,"abstract":"Objectives: This study investigates the role of social determinants of health (SDOH) in accessing gender-affirming facial surgery (GFS) at a single tertiary care institution. By examining the demographic, socioeconomic, and health profiles of patients, this study seeks to characterize barriers in pursuing GFS and identify possible areas for growth in providing equitable care.Methods: A mixed-methods approach was employed, including a retrospective chart review of all previous GFS patients at a single institution and semi-structured interviews. Data collected in the chart review included demographic, surgical, and socioeconomic characteristics of the patient population. Two researchers performed inductive analysis of the interview transcripts to ensure cross-coder reliability and to identify key themes and subthemes.Results: A total of 142 patients met the inclusion criteria for chart review. Findings from the chart review indicated that this patient population predominantly identified as White (37.3%), female (92.3%), publicly insured (73.9%), and demonstrated a high prevalence of depression (55.6%), anxiety (43.7%), and PTSD (23.2%). Semi-structured interviews were conducted with 11 patients. Key barriers in pursuing GFS identified in the interviews included insurance coverage concerns, logistical hurdles in scheduling GFS, and social stigma, while protective factors included support from loved ones and trans-friendly healthcare providers.Conclusion: This study highlights the critical influence that SDOH have on GFS access, particularly emphasizing the need for more supportive healthcare policies, accessible mental health resources, and more comprehensive patient and provider education. Addressing these barriers driven by SDOH can improve GFS access for gender-diverse individuals.Level of evidence: Level 3.","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701982","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}

引用次数: 0

Tongue Base Suspension Using a Y-Knot All-Suture Anchor System. 舌底悬挂采用y型结全缝合锚定系统。

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-25 DOI: 10.1002/lary.32139

Peng Yeh, Yi-Kai Chang, Tsung-Wei Huang

引用次数: 0

Can the Repetitive Saliva Swallow Test Predict Airway Invasion in All Cause Dysphagia? 重复唾液吞咽试验能否预测全因性吞咽困难的气道侵犯？

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-25 DOI: 10.1002/lary.32137

David Kiderman, Boaz Gantz, Shir Boaron-Sharafi, Yonatan Lahav, Raviv Allon, Yael Shapira-Galitz

{"title":"Can the Repetitive Saliva Swallow Test Predict Airway Invasion in All Cause Dysphagia?","authors":"David Kiderman, Boaz Gantz, Shir Boaron-Sharafi, Yonatan Lahav, Raviv Allon, Yael Shapira-Galitz","doi":"10.1002/lary.32137","DOIUrl":"https://doi.org/10.1002/lary.32137","url":null,"abstract":"Objectives: The repetitive saliva swallow test (RSST) is a simple, noninvasive screening tool for oropharyngeal dysphagia, validated to detect aspiration in individuals with neurogenic dysphagia. This study aims to evaluate the diagnostic properties of the RSST in predicting airway invasion in an all-cause dysphagia population using fiberoptic endoscopic evaluation of swallowing (FEES) as the gold standard.Methods: A retrospective review including 87 adult outpatients from a dysphagia clinic was conducted. Each patient underwent both RSST and FEES. The primary outcome measure was the RSST's diagnostic performance against FEES-determined airway invasion (penetration-aspiration scale, PAS ≥ 3).Results: The study cohort had a median RSST score of 5, and 32% demonstrated airway invasion on FEES. Higher RSST scores were associated with a lower likelihood of airway invasion (OR: 0.79, p = 0.03). On receiver operating characteristic curve analysis, RSST had an area under the curve of 0.64, with an optimal cutoff of ≤ 6 swallows, yielding 89% sensitivity and 34% specificity.Conclusion: The RSST demonstrates statistical compatibility for airway invasion screening in an all-cause dysphagia population. However, its high cutoff values hinder its clinical utility due to modest specificity.Level of evidence: Class III.","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701977","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}

引用次数: 0

Short- and Long-Term Risk of Meningitis Following Pediatric Endoscopic Transsphenoidal Surgery. 儿童经蝶腔内窥镜手术后发生脑膜炎的短期和长期风险。

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-24 DOI: 10.1002/lary.32133

Eelam A Adil, Charlotte Cox, Hae-Young Kim, Michael J Cunningham

{"title":"Short- and Long-Term Risk of Meningitis Following Pediatric Endoscopic Transsphenoidal Surgery.","authors":"Eelam A Adil, Charlotte Cox, Hae-Young Kim, Michael J Cunningham","doi":"10.1002/lary.32133","DOIUrl":"https://doi.org/10.1002/lary.32133","url":null,"abstract":"Objectives: To determine both the short- and long-term risks of meningitis in children and adolescents undergoing transsphenoidal skull base surgery.Study design: Retrospective analysis of the Pediatric Health Information System (PHIS) database over a 10-year period.Methods: The PHIS database was reviewed to identify individuals ≤ 18 years of age who underwent endoscopic transsphenoidal surgery from 2012 to 2022. Data regarding patient demographics, length of stay, and need for revision surgery was recorded. To assess both the short- and long-term risk of postoperative meningitis, a PHIS query was performed for all readmissions of the initial cohort between 2012 and 2024. Any readmission related to meningitis was reviewed and analyzed. Subgroup analysis was performed based on patient age at initial surgery, gender, geographic region, insurance carrier, and need for revision surgery.Results: Total of 476 patients (501 cases) with a mean age of 12.8 years (SD: 4.0 years) met inclusion criteria. Twenty-four patients (5.0%) developed meningitis, 13 (2.7%) during their initial hospitalization and 11 (2.3%) following discharge, the latter within a range of 0.4-38.9 months (mean 8.1 months). Length of stay was significantly higher in patients who developed meningitis. Younger age at the time of surgery was the only risk factor identified.Conclusion: The short-term risk of postoperative meningitis following pediatric transsphenoidal skull base surgery is similar to that of the adult population. The long-term risk is also low, with most cases occurring within 1 year of discharge. Patients < 12 years of age have the highest risk and warrant consideration of prophylactic antibiotics.Level of evidence: 4: ","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694215","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}

引用次数: 0

Complication Trajectories in Total Pharyngolaryngectomy: Comprehensive Complication Index Analysis. 全咽切除术并发症轨迹：综合并发症指数分析。

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-22 DOI: 10.1002/lary.32149

Takeaki Hidaka, Shimpei Miyamoto, Yutaka Fukunaga, Azusa Oshima, Takeshi Shinozaki, Kazuto Matsuura, Takuya Higashino

{"title":"Complication Trajectories in Total Pharyngolaryngectomy: Comprehensive Complication Index Analysis.","authors":"Takeaki Hidaka, Shimpei Miyamoto, Yutaka Fukunaga, Azusa Oshima, Takeshi Shinozaki, Kazuto Matsuura, Takuya Higashino","doi":"10.1002/lary.32149","DOIUrl":"https://doi.org/10.1002/lary.32149","url":null,"abstract":"Background: Understanding the trajectory of complications following total pharyngolaryngectomy (TPL) with free jejunal transfer (FJT) is crucial for enhancing patient management and improving surgical outcomes. However, the traditional Clavien-Dindo classification captures only the highest grade of complication and is unable to capture the progression of complications, limiting its utility for longitudinal assessments. This study utilized the comprehensive complication index (CCI) to provide a continuous evaluation of complications over time.Methods: This retrospective observational study included patients who underwent TPL with FJT between 2018 and 2023. Daily postoperative complications were tracked using the CCI, calculated from postoperative day 1 to day 30. A group-based trajectory model was employed to classify patterns of change in daily CCI. The predictive power of early CCI for a subsequent serious complication course was evaluated using receiver operating characteristic curve analysis.Results: The trajectory modeling for a total of 161 eligible patients identified three distinct complication trajectories: no complication (n = 80), moderate (n = 66), and severe (n = 15). Initial CCI values were predictive of the severe complication course: a cutoff value of 8.7 for the CCI on postoperative day 2 provided an area under the curve of 0.926 with 86.7% sensitivity and 93.8% specificity.Conclusions: Complication trajectories after TPL with FJT can be effectively categorized using the CCI, providing insights beyond the traditional grading systems. Early identification of the severe complication course allows for targeted interventions that may improve patient outcomes.Level of evidence: 3: ","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677349","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}

引用次数: 0

Utility of Existing Patient-Reported Outcome Measures for Identifying Non-Rhinogenic Facial Pain. 现有患者报告的结果测量在识别非鼻源性面部疼痛中的应用。

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-22 DOI: 10.1002/lary.32147

David W Jang, Hui-Jie Lee, Ralph Abi Hachem, Bradley J Goldstein, David L Witsell, Frederick Godley, Timothy Collins, Theresa Coles

{"title":"Utility of Existing Patient-Reported Outcome Measures for Identifying Non-Rhinogenic Facial Pain.","authors":"David W Jang, Hui-Jie Lee, Ralph Abi Hachem, Bradley J Goldstein, David L Witsell, Frederick Godley, Timothy Collins, Theresa Coles","doi":"10.1002/lary.32147","DOIUrl":"https://doi.org/10.1002/lary.32147","url":null,"abstract":"Objective: Facial pain/pressure is often non-rhinogenic and migraine-related in etiology. However, this is frequently misdiagnosed as sinusitis, leading to inappropriate antibiotic utilization and unnecessary procedures. We assessed the utility of the 3-Item Identify Migraine (ID Migraine) and the 22-Item Sinonasal Outcomes Test (SNOT-22) in differentiating rhinogenic vs. non-rhinogenic facial pain/pressure (NRFP).Methods: Patients presenting to the rhinology clinic with a complaint of facial pain/pressure completed the ID Migraine and SNOT-22. A diagnosis of CRS or NRFP was given based on imaging criteria. Receiver Operating Characteristics (ROC) were determined to evaluate the ability of the PROMs to identify NRFP.Results: Of the 251 patients enrolled, 114 had CRS and 137 had NRFP. Mean (SD) age was 50 (16), and 69.3% (n = 174) were women. The ID Migraine had a positive predictive value of 0.66 (95% CI: 0.57 to 0.74) and a negative predictive value of 0.57 (95% CI: 0.48 to 0.66), with an AUC of 0.64 (95% CI: 0.58 to 0.71). The SNOT-22 had an AUC of 0.64 (95% CI: 0.58 to 0.71) using the combined five domain scores, with the function domain score having the highest AUC at 0.60 (95% CI: 0.53 to 0.67).Conclusion: Existing PROMs have limitations when used to identify NRFP in patients presenting with facial pain/pressure. A screening questionnaire developed and validated specifically for this purpose would assist clinicians in early diagnosis and appropriate management of these patients. Given the high incidence of NRFP, this measure could significantly improve healthcare efficiency.Level of evidence: 4: ","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677353","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}

引用次数: 0

Is Prophylactic Perioperative Antibiotic Indicated in Cochlear Implantation? 人工耳蜗植入术围手术期是否需要预防性抗生素？

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-22 DOI: 10.1002/lary.32142

Alexa J Kacin, Greg Licameli, Sukgi S Choi

引用次数: 0

Practice Trends in Laryngology: Neuromodulators for Treatment of Chronic Cough. 喉科实践趋势：治疗慢性咳嗽的神经调节剂。

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-21 DOI: 10.1002/lary.32109

Christopher D Dwyer, Michael M Johns, Jennifer J Shin, Thomas L Carroll

{"title":"Practice Trends in Laryngology: Neuromodulators for Treatment of Chronic Cough.","authors":"Christopher D Dwyer, Michael M Johns, Jennifer J Shin, Thomas L Carroll","doi":"10.1002/lary.32109","DOIUrl":"https://doi.org/10.1002/lary.32109","url":null,"abstract":"Objectives: Assess practice trends among laryngologists within the United States surrounding neuromodulator use for chronic cough treatment.Methods: Anonymous 29-item survey comprised of a mixture of multiple choice, Likert scale, and free-text answers was electronically distributed to practicing laryngologists in the United States.Results: Eighty-five laryngologists from 26 states responded. The majority (96.5%) prescribe neuromodulators for chronic cough and are the preferred first-line treatment for refractory explained chronic cough (37.8%) and unexplained chronic cough (50.6%). Gabapentin (97.6%), amitriptyline (91.5%), and tramadol (73.2%) are the most used. The preferred first-line drugs were also gabapentin (45.1%), amitriptyline (39.0%), and tramadol (11.0%). Most wait 3-6 months before making changes when a neuromodulator is successful, then wean to the lowest possible cough-controlling dose (68.3%) or taper off completely (24.4%). When a neuromodulator fails: 43.9% wean and try another neuromodulator; others shift to a superior laryngeal nerve (SLN) block (24.4%). When cough recurs almost immediately after weaning an effective neuromodulator, most will re-initiate it again (97.6% likely or highly likely). If the cough recurs in the future, typical practice includes reinitiating the same prior effective neuromodulator at its previously tolerated effective dose (40.5%) or re-titrating to the new effective dose needed (51.9%).Conclusions: Laryngologists routinely prescribe neuromodulators for unexplained and refractory chronic cough. Gabapentin and amitriptyline are the preferred first-line agents, generally titrated to maximal effect, balancing against side effects. A low threshold to reinitiate previously effective neuromodulators exists when cough recurs. If an initial neuromodulator is unsuccessful, either a different neuromodulator or a SLN block is considered.Level of evidence: 5: ","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674673","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}

引用次数: 0

Are Prophylactic Postoperative Antibiotics Indicated for Uncomplicated Endoscopic Skull Base Surgery? 不复杂的内窥镜颅底手术是否需要术后预防性抗生素？

IF 2.2 3区医学

Laryngoscope Pub Date : 2025-03-21 DOI: 10.1002/lary.32151

Matthew J Kabalan, Troy D Woodard

引用次数: 0