Laryngoscope最新文献

{"title":"What is the Optimal Timing for Elective Otolaryngologic Surgery After Stroke?","authors":"Jordan Rubenstein, Isaac L Alter, Anil K Lalwani","doi":"10.1002/lary.32029","DOIUrl":"https://doi.org/10.1002/lary.32029","url":null,"abstract":"","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048651","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":"Inconsistent Associations of Modified Frailty Index-5 With Adverse Head and Neck Reconstruction Outcomes.","authors":"Doruk Orgun, Caroline C Bay, Kristine M Carbullido, Aaron M Wieland, Brett F Michelotti, Samuel O Poore","doi":"10.1002/lary.32008","DOIUrl":"https://doi.org/10.1002/lary.32008","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the consistency of associations between modified frailty index-5 (mFI-5) and postoperative adverse outcomes in head and neck cancer (HNC) reconstruction.</p><p><strong>Methods: </strong>American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2017 to 2022 was utilized to identify HNC patients undergoing locoregional or microvascular free tissue transfers. Kaplan-Meier estimates and multivariable Cox regression analyses were utilized to compare risk of infections, bleeding, readmissions, reoperations, major adverse cardiovascular events (MACE), and mortality within the first postoperative month for each mFI-5 score with mFI-5 = 0 as reference. Further analyses investigated associations between individual mFI-5 components and the outcomes of interest.</p><p><strong>Results: </strong>We included 5,573 patients (median age: 64; 31.5% female), 63% (n = 3,519) of whom underwent microvascular free tissue transfers. Unadjusted univariate analyses associated higher mFI-5 scores with longer hospital stays. In locoregional tissue transfers, adjusted hazard ratios (aHRs) for reoperation were 1.37 (p = 0.03) for mFI-5 = 1 and 2.19 (p = 0.03) for mFI-5 ≥ 3. In microvascular free tissue transfers, aHRs for MACE were 1.93 (p = 0.04) for mFI-5 = 2 and 6.53 (p < 0.001) for mFI-5 ≥ 3, while aHRs for mortality was 3.88 (p = 0.04) for mFI-5 ≥ 3. No associations were observed between increasing mFI-5 scores and increased relative risk of infection, bleeding, or readmission. Individual component analysis associated congestive heart failure with aHRs of 3.92 (1.84-8.35; p < 0.001) for MACE and 5.30 (2.03-13.88; p < 0.001) for mortality. Additionally, COPD was associated with an aHR of 1.39 (1.16-1.67; p < 0.001) for infections.</p><p><strong>Conclusion: </strong>The associations of higher mFI-5 scores with postoperative adverse outcomes following oncoplastic head and neck reconstruction were inconsistent and possibly driven by individual effects of its components.</p><p><strong>Level of evidence: </strong>Level III (three) Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054119","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":"Are More Adults Bleeding After Tonsillectomy Than in the Past?","authors":"Deepthi Akella, Chloe Cottone, Maya Raghavan, Gaayathri Varavenkataraman, Chennai A Marcus, Dylan Z Erwin, Michele M Carr","doi":"10.1002/lary.32016","DOIUrl":"https://doi.org/10.1002/lary.32016","url":null,"abstract":"<p><strong>Objective: </strong>Post-tonsillectomy hemorrhage (PTH) rates have increased in children over the last decade. This study aimed to determine whether PTH incidence in adults had also increased over the last 15 years.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>TriNetX database.</p><p><strong>Methods: </strong>A search was conducted using TriNetX for patients 18 years and older within the US Collaborative Network who had undergone tonsillectomy (CPT codes 42821 or 42826) and yielded 72,232 subjects. PTH diagnoses were identified using ICD-10 codes J95.830 or K91.840, and those who returned to the operating room (RTOR) to control PTH were identified using CPT 42962. PTH events that occurred and analgesics given following 14 days of tonsillectomy were tabulated annually from 2008 to 2022. Mann-Kendall test for monotonic trend examined significant trends in PTH and analgesic use.</p><p><strong>Results: </strong>Mean age at tonsillectomy was 32.8 years (SD = 13.8). 4.1% were diagnosed with PTH in 2008, compared with 6.2% by 2022 (p = 0.0030). In 2008, 0.7% required RTOR to control PTH, compared with 2.4% in 2022 (p < 0.0001). Use of codeine decreased from 6.9% in 2008 to 2.5% in 2022 (p = 0.0022). Use of ibuprofen, acetaminophen, ketorolac, and oxycodone increased from 1.6% to 23.4% (p = 0.0005), 36.1% to 78.6% (p < 0.0001), 1.5% to 11.9% (p < 0.0001), and 20.6% to 63.6% (p < 0.0001), respectively. No change was detected in use of hydrocodone.</p><p><strong>Conclusion: </strong>Post-tonsillectomy analgesia in adults has changed significantly over the last 15 years. Our study highlights a concurrent increase in PTH which bears more investigation.</p><p><strong>Level of evidence: </strong>3 Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054098","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":"Resolution of Iatrogenic Spinal Accessory Neuropathy Following Delayed Surgical Intervention.","authors":"Yihuai Qu, Payam Entezami, Taylor B Cave, Laura E Klusovsky, Brent A Chang","doi":"10.1002/lary.32012","DOIUrl":"https://doi.org/10.1002/lary.32012","url":null,"abstract":"<p><p>We present an interesting case of a 74-year-old female who presented with spinal accessory neuropathy following an ipsilateral right-sided carotid endarterectomy 6 months after the initial injury. Subsequent surgical exploration revealed a surgical clip that had been placed directly across the spinal accessory nerve. Clip removal and neurolysis was subsequently performed, leaving the nerve intact. After surgical intervention, she immediately demonstrated increased bilateral shoulder shrug motion and continues to improve her function with physical therapy. This case demonstrates a fascinating case of cranial nerve recovery after delayed intervention in the context of existing literature. Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054126","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":"Association of Menopause and Rhinitis Among Adult Women in the United States: Findings from the All of Us Research Program.","authors":"Richard G Chiu, Kamal Eldeirawi, Anthony I Dick, Sharmilee M Nyenhuis, Thasarat Sutabutr Vajaranant, Rachel Caskey, Victoria S Lee","doi":"10.1002/lary.32015","DOIUrl":"10.1002/lary.32015","url":null,"abstract":"<p><strong>Objective: </strong>The inflammatory role of female hormones has been garnering increased attention in the literature. Studies suggest a link between estrogen and inflammatory conditions of the airways and nasal mucosa. However, there remains a paucity of literature regarding the associations of hormones with rhinitis. Given the profound hormonal changes that occur during menopause, we sought to better understand the association between menopause and rhinitis.</p><p><strong>Methods: </strong>Data from the All of Us Research Program regarding rhinitis diagnoses, menopause status, demographic variables, socioeconomic status, and comorbidities were extracted for female participants aged 40-60. Crude odds ratios (cORs) and 95% confidence intervals (CIs) were calculated for unadjusted associations between menopause and rhinitis. Variables were then included in multivariable logistic regression models, with separate models for allergic rhinitis (AR) and nonallergic rhinitis (NAR) as the outcome variables. Adjusted odds ratios (aOR) and 95% CI were calculated.</p><p><strong>Results: </strong>We identified 40,875 female participants aged 40-60 without any missing data. Compared with participants without rhinitis, a greater proportion of those with AR (51.6% vs. 55.6%; cOR: 1.18; 95% CI: 1.11-1.25) and NAR (51.6% vs. 58.9%; cOR: 1.34; 95% CI: 1.11-1.63) had experienced menopause. However, after controlling for covariates, menopause was associated with a decreased odds of AR (aOR: 0.89; 95% CI: 0.82-0.96) and not associated with NAR (aOR: 0.98; 95% CI: 0.77-1.24).</p><p><strong>Conclusion: </strong>Menopause was independently associated with a decreased odds of AR but was not associated with NAR. Research should aim to further examine these relationships and hormonal mechanisms underlying the observed protective associations.</p><p><strong>Level of evidence: </strong>3 Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034738","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":"Usage of Milan System in Risk Stratification of Submandibular Gland Fine Needle Aspiration Cytology.","authors":"Wan Xin Yew, Kevin C C Choy, Manish M Bundele, Ernest W Fu, Hao Li, Ming Yann Lim, Yijin Jereme Gan","doi":"10.1002/lary.32019","DOIUrl":"https://doi.org/10.1002/lary.32019","url":null,"abstract":"<p><strong>Objectives: </strong>The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) categorizes fine needle aspiration and cytology (FNAC) results into 6 tiers and assigns a risk of malignancy (ROM) to each category. Its utility in submandibular gland lesions remains unclear. Our article aims to study (1) the utility of the MSRSGC in classifying FNAC of submandibular gland masses, (2) describe the demographics and incidence of submandibular gland malignancy in our population, and (3) analyze the accuracy of FNAC in diagnosis of benign and malignant submandibular gland tumors.</p><p><strong>Methods: </strong>In this retrospective case series, the FNAC results of 92 patients who underwent pre-operative FNAC and excision of submandibular gland between May 2008 and December 2023 were reviewed and assigned to a MSRSGC category, and ROM was calculated based on histological diagnosis.</p><p><strong>Results: </strong>20/92 (21.7%) submandibular gland excisions with pre-operative FNAC were malignant. ROM is as follows: non-diagnostic 7.1%, non-neoplastic 12.5%, atypia of undetermined significance 35.3%, benign neoplasm 3.3%, salivary gland neoplasm of uncertain malignant potential 35%, suspicious for malignancy 100%, and malignant 100%.</p><p><strong>Conclusion: </strong>Our study validates the usage of the MSRSGC in the work up of submandibular gland tumors.</p><p><strong>Level of evidence: </strong>4 Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034740","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":"Does Cerebrospinal Fluid Leak in Pituitary Surgery Affect Patient Reported Quality of Life?","authors":"Camille Duggal, Sarah Detombe, Ashton Lefteris, Stan Van Uum, Leigh Sowerby, Neil Duggal, Brian Rotenberg","doi":"10.1002/lary.32007","DOIUrl":"https://doi.org/10.1002/lary.32007","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic techniques allow for improved visualization and tumor debulking of pituitary adenomas. More thorough tumor resection, however, can be associated with higher rates of CSF leaks. We set out to determine if CSF leaks influenced patient perceived quality of life outcomes.</p><p><strong>Methods: </strong>This retrospective study included 152 patients who underwent endoscopic pituitary tumor resection over a 10-year period. QoL was assessed using the SF-36 questionnaire and completed before surgery, 6 weeks and 6 months post-operatively. Statistical analysis was conducted using a equivalence test and a two-way mixed model ANOVA to assess intraoperative CSF leak, postoperative CSF leak, redo surgery, and the use of a lumbar drain.</p><p><strong>Results: </strong>Of the 152 patients, 98 had a potential intraoperative CSF leak. Intra- and postoperative CSF leaks did not significantly impact patient reported QoL outcomes at 6 months following surgery. There was clinical equivalence in mental scores as early as 6 weeks and 6 months for physical scores. There was no statistically significant difference in physical (p-value = 0.975) and mental (p = 0.204) scores for patients who experienced a postoperative CSF leak. There was no statistically significant difference in QoL in the mental and physical scores for patients that received a lumbar drain (physical score p = 0.832; mental score p = 0.915) or redo surgery (physical score p = 0.830; mental score p = 0.204).</p><p><strong>Conclusion: </strong>This article demonstrates that CSF leaks do not impact patient-reported QoL outcomes at 6 months post-surgery. This will allow surgeons to better provide insight and counsel patients regarding the relevance of CSF leaks in the setting of pituitary procedures.</p><p><strong>Level of evidence: </strong>III Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014888","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":"A Rare Sequela of Untreated Streptococcus Pharyngitis: A Case Report.","authors":"Meredith L Hiltbrand, Emily Cushing","doi":"10.1002/lary.32011","DOIUrl":"https://doi.org/10.1002/lary.32011","url":null,"abstract":"<p><p>Pharyngitis is commonly caused by the gram positive bacteria, streptococcus. Given the potential morbid complications of untreated streptococcal pharyngitis, antibiotics are critical. One of the rarer complications is pulmonary-renal syndrome (PRS), defined as rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage. PRS is associated with high rates of morbidity and mortality, making swift diagnosis and treatment imperative for survival. More common causes of PRS are tied to autoimmune diseases. This case describes a novel progression of PRS caused by streptococcus. A 26-year-old male with no significant medical history presented to our emergency department with streptococcal group A-positive sore throat. After discontinuing amoxicillin due to pruritus, the patient returned one month later with persisting hematuria and dysuria, diagnosed with post-streptococcal glomerulonephritis. Despite receiving another antibiotic prescription, it was not filled. He returned six days later with worsening symptoms, leading to ICU admission due to hemoptysis requiring subsequent intubation. Diffuse alveolar hemorrhage was confirmed with bronchial washings. Negative autoimmune laboratory results and clinical symptoms suggest streptococcal pharyngitis induced pulmonary-renal syndrome. Although only the sixth case of streptococcal induced PRS, it is imperative to consider when treating patients with diffuse alveolar hemorrhage, due to its possible mortality. Prompt recognition and treatment with pulse steroids and plasmapheresis is crucial for PRS resolution. Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014347","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":"The Impact of Financial Coverage on Hearing Aid Utilization Rates Within the Military Health System.","authors":"James J Pierre, Alex W Yang, Charles A Riley, Anthony M Tolisano","doi":"10.1002/lary.32013","DOIUrl":"https://doi.org/10.1002/lary.32013","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate hearing aid utilization rates among populations with varying hearing aid insurance benefits.</p><p><strong>Methods: </strong>A retrospective cohort study was performed. A total of 377 patients were included in the study after being identified through consecutive, hearing loss-related otology clinic visits. With respect to hearing aid benefits, patients were separated into full, partial, and no coverage populations. Chart reviews identified if a patient underwent hearing aid evaluation and fitting. Audiometric data were collected. Chi-square tests of independence and two-sided Z-tests were used for statistical analysis. ANOVA single-factor analysis testing was used to analyze pure tone averages (PTA) and word recognition scores (WRS) data.</p><p><strong>Results: </strong>The 377 patients who met criteria included: full insurance coverage (n = 210, mean age = 45 years), partial coverage (n = 82, mean age = 65 years), and no coverage (n = 85, mean age = 54 years). The full- and partial-coverage populations each had significantly higher hearing aid utilization rates (78% and 79%, respectively) than the no-coverage population (49%, p < 0.001). No statistical difference in mean PTA or WRS was noted among the three coverage categories.</p><p><strong>Conclusion: </strong>Patients with at least partial financial coverage are more likely to acquire hearing aids than those without despite similar degrees of hearing loss. This implies that the out-of-pocket cost of hearing aids is a primary impediment to hearing aid adoption and provides a useful road map for public and private insurers considering hearing aid coverage.</p><p><strong>Level of evidence: </strong>Level III (retrospective cohort study) Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014911","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":"Complications After Transoral Surgery for Oropharyngeal Cancer: An ACS-NSQIP Database Study.","authors":"Stephanie Wong, Liyang Tang, Daniel Kwon, Mark Swanson, Niels C Kokot, Uttam K Sinha, Albert Y Han","doi":"10.1002/lary.32014","DOIUrl":"https://doi.org/10.1002/lary.32014","url":null,"abstract":"<p><strong>Objective: </strong>Prior studies have highlighted the risk of perioperative mortality due to catastrophic bleeding in patients receiving transoral surgery (TOS) for oropharyngeal squamous cell carcinoma (OPSCC). Although the 30-day mortality and morbidity remain low, understanding the risk factors associated with complications is still required. The goal of this study is to identify risk factors associated with complications after TOS for OPSCC using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.</p><p><strong>Methods: </strong>A multi-institutional retrospective cohort analysis of the ACS-NSQIP database identified 3,489 patients undergoing TOS for OPSCC between 2010 and 2021. Preoperative risk factors were collected. The primary outcomes were 30-day readmission, reoperation, hemorrhage, and death. Univariate and multivariate analysis was used to identify preoperative risk factors associated with the primary outcomes.</p><p><strong>Results: </strong>The mean age was 60.6 years, and 81.5% were male. There were 24 deaths (0.7% 30-day mortality rate). The rates of readmission and reoperation were 8.9% and 5.8%, respectively. Smoking (OR = 1.440, 95% CI = 1.097-1.890) and CHF (OR = 3.525, 95% CI = 1.320-9.414) were associated with readmission. Diabetes and ASA 3+ increased the risk of both reoperation (diabetes: OR = 2.679, 95% CI = 1.110-6.468, ASA: OR = 1.701, 95% CI = 1.233-2.346) and hemorrhage (diabetes: OR = 3.488, 95% CI = 1.020-11.926, ASA: OR = 2.290, 95% CI = 1.394-3.764).</p><p><strong>Conclusion: </strong>This study redemonstrated the safety of TOS for OPSCC, with low 30-day readmission and reoperation rates. Smoking, diabetes, CHF, and ASA 3+ were important preoperative risk factors for complications.</p><p><strong>Level of evidence: 3: </strong>Laryngoscope, 2025.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014879","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}