Annals of Otology Rhinology and Laryngology最新文献

{"title":"Tracheobronchial Foreign Body Extraction in a Preterm Infant via Choledochoscope: A Case Report and Literature Review.","authors":"Ratko Prstačić, Miram Pasini, Nada Sindičić Dessardo, Mateja Đenović, Ruža Grizelj","doi":"10.1177/00034894251336540","DOIUrl":"10.1177/00034894251336540","url":null,"abstract":"<p><strong>Objectives: </strong>Tracheobronchial foreign body (TFB) extraction in premature neonates poses unique challenges due to their delicate respiratory system, making the TBF extraction a critical and high-stakes intervention. TFBs in this patient population are mostly iatrogenic. There are only a few reports in the literature describing the management of TFBs in premature neonates. To the best of our knowledge, this represents the first report using a flexible choledochoscope for TFB extraction.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on a case of a preterm infant who underwent successful extraction of a tracheobronchial foreign body.</p><p><strong>Results: </strong>A premature neonate born at 25 weeks 2/7 days gestation with a birth weight of 780 g was intubated after delivery. Following extubation to non-invasive ventilation, a control chest radiograph revealed atelectasis of the right lower lobe and a TFB of tubular structure measuring 20 mm × 1.5 mm in the right main bronchus. Diagnostic flexible bronchoscopy was performed and extraction with graspers via rigid bronchoscope was attempted but failed. Subsequently, a bedside procedure in the Neonatal intensive care unit (NICU) was performed using a 7.5 Fr flexible choledochoscope through the endotracheal tube (ETT). TFB was successfully extracted with graspers and upon extraction, it was confirmed to be the distal 2 cm segment of the closed-circuit endotracheal suction system. The infant made full recovery.</p><p><strong>Conclusion: </strong>We report a method that provides a safe means of TFB extraction with a successful outcome. The insights gathered from this review are intended to contribute valuable knowledge that can enhance the management of TFBs in preterm infants.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"620-622"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Selection for Efficacious Mandibular Advancement Device Therapy in Obstructive Sleep Apnea: An Institutional Outcomes Analysis.","authors":"Nainika Nanda, Aaron Robertson, David C Upton","doi":"10.1177/00034894251334725","DOIUrl":"10.1177/00034894251334725","url":null,"abstract":"<p><strong>Introduction: </strong>Mandibular advancement devices (MADs) are a treatment option for obstructive sleep apnea/hypopnea syndrome (OSAHS); however, the ideal patient selection criteria continue to be refined.</p><p><strong>Objectives: </strong>To determine the overall efficacy of a custom titratable MAD in treating a subset of OSAHS patients. A secondary objective was to determine predictive factors affecting treatment outcome for MAD therapy.</p><p><strong>Methods: </strong>Retrospective analysis of a single otolaryngologist's (DCU) experience in 86 patients with Friedman Stages 2 to 4 treated with a MAD (Thornton Adjustable Positioner) at an academic medical center.</p><p><strong>Results: </strong>Therapeutic success as measured by type 3 home apnea test (HSAT) before and after proper MAD titration was defined as a 50% reduction in initial AHI or reduction of AHI to a mild severity below 15 events/hour. The 50% AHI reduction rate after MAD titration was 64% and the overall success rate inclusive of patients with reduction below 15 events/hour was 72.1%. MAD therapy significantly reduced the mean AHI (-10.4 ± 12.6), <i>P</i> < .001) and improved the minimum oxygen saturation (1.88 ± 5.79, <i>P</i> = .003). Significant reduction of OSAHS severity was seen across all treatment groups regardless of initial OSAHS severity: mild (55.9%), moderate (85%), severe (75%; <i>P</i> < .001 for all 3 groups). High BMI, advanced age, concentric velopharyngeal collapse pattern, prior pharyngeal surgery, and male sex were not statistically significant predictors of ineffectiveness.</p><p><strong>Conclusions: </strong>MAD therapy for OSAHS in patients with Friedman Stages 2 to 4 is an effective treatment in 72% of cases and should be considered as an initial treatment option within this subset of patients, inclusive of those with initially severe, moderate, and mild OSAHS.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"575-582"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Hybrid Simulation Model for Septoplasty Training.","authors":"Jenny Kim, Terral Patel, Vanessa Helou, Noel Jabbour","doi":"10.1177/00034894251339556","DOIUrl":"10.1177/00034894251339556","url":null,"abstract":"<p><strong>Objectives: </strong>To develop, describe, and validate a novel hybrid training model for endoscopic septoplasty that combines pig ears with a 3D-printed model.</p><p><strong>Methods: </strong>The pig ear was chosen for its similarity to the human septum and wide availability. A frame for the nasal septum substitute was designed to mimic the appearance of a human nose, securely anchor the septum, and create a bend to simulate a deviated septum. The external nose was 3D-printed using polylactic acid (PLA) filament. The model underwent validation with a group of 13 junior and 7 senior trainees who performed endoscopic septoplasties on the simulator and completed a subjective assessment tool; recordings of their procedures were also analyzed and graded in a blind manner.</p><p><strong>Results: </strong>Overall, residents agreed that the simulator is a good training tool for knowledge of the steps of a septoplasty (mean = 4.67 ± 0.59), as well as for the skills required of the procedure (mean rating = 4.61 ± 0.50). Residents also agreed that the simulator had adequately realistic characteristics and features (mean = 4.13 ± 0.81). Junior residents more strongly agreed than the senior residents that the simulator improved their knowledge of performing a septoplasty (4.50 ± 0.90 vs 3.40 ± 0.55, <i>P</i> < .01). Senior residents performed significantly better in all assessed domains and completed the procedure significantly faster than junior residents.</p><p><strong>Conclusion: </strong>This study describes the first endoscopic septoplasty simulator to combine a pig ear with a 3D-printed model. The model provides realistic tactile feedback of the human nasal septum while offering a precise, standardized, and reproducible construction at an affordable cost. Our findings support the validity of this simulator that can provide an opportunity for otolaryngology trainees to improve their septoplasty skills in a safe and effective manner.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"598-605"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury (AKI) After Pediatric Tonsillectomy: An Opportunity for Quality Improvement.","authors":"Avivah J Wang, Avani Vasireddy, Jeffrey Cheng","doi":"10.1177/00034894251330063","DOIUrl":"10.1177/00034894251330063","url":null,"abstract":"<p><strong>Purpose: </strong>There is emerging evidence showing even a single episode of transient acute kidney injury (AKI) in children can have negative long-term health consequences. AKI may be under-recognized in children undergoing tonsillectomy because of unique risk factors, such as recommended use of NSAIDs and restricted oral intake pre- and postoperatively.</p><p><strong>Methods: </strong>A consecutive case series with chart review was performed for patients under age 18 years at a single tertiary care institution who underwent tonsillectomy between July 1, 2013 and May 17, 2024, identified by CPT codes for tonsillectomy. ED visits within 30 days of surgery were documented. Serum creatinine values at ED visit were recorded, if available, and incidence of elevated serum creatinine and AKI were determined.</p><p><strong>Results: </strong>Charts of 3018 pediatric tonsillectomy patients were reviewed. About 295 (9.8% of 3018) had an ED visit within 30 days for any reason, of whom 110 (37.3% of 295) had a serum creatinine value at this ED visit. Of these, 13 (11.8% of 110) had elevated serum creatinine, and 8 (7.3% of 110) had AKI by standardized criteria. One patient had a follow-up serum creatinine performed within 1 year which showed resolution of AKI.</p><p><strong>Conclusion: </strong>Incidence of AKI following tonsillectomy has not been previously well recognized. Identification of previously unrecognized risks from post-tonsillectomy AKI represents an important potential area for quality improvement, including careful patient selection for use of non-steroidal anti-inflammatory drugs, close monitoring of those at higher risk for dehydration after surgery, and follow-up care for those diagnosed with AKI.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"556-560"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Local Corticosteroid on Electrical Impedances after Cochlear Implantation in children: A Prospective Double-Blind Randomized Clinical Trial.","authors":"Kharrat Ines, Hammami Bouthaina, Walha Omar, Ben Ayed Mariam, Zouche Imen, Achour Imen, Chaabouni Mohammed Amine, Charfeddine Ilhem","doi":"10.1177/00034894251339564","DOIUrl":"10.1177/00034894251339564","url":null,"abstract":"<p><strong>Objectives: </strong>The primary aim of this study is to determine the effects of associating local and systemic corticosteroids on electrical impedance of electrode contacts during the 6 months following cochlear implantation in children. We assessed the effect of this association along the electrode array to evaluate its impact on both basal and apical electrodes.</p><p><strong>Methods: </strong>In 2 different patient groups, the evolution of electrical impedances was investigated during 6 months post-implantation. Children in Group 1 received systemic corticosteroids (1 ml injection of 4 mg/ml Dexamethasone (DXM) intravenously 12 hours before the procedure followed by an injection of 1 ml of 4 mg/ml de DXM during the induction of anesthesia). Group 2 received the same systemic corticosteroids with local corticosteroid (intratympanic injection [ITI] of Methylprednisolone (MP) 40 mg/1 ml given at the start of the procedure). Impedances were assessed perioperatively, on the third post-operative day, at 1 week, 1 month, 2 months, 3 months, and 6 months after implantation. We compared the mean impedance values and the average impedance at the apical and basal electrodes between both groups.</p><p><strong>Results: </strong>Impedances in Group 1 were significantly higher than those in Group 2, both perioperatively (<i>P</i> = .037) and on the third post-operative day (<i>P</i> = .027). Starting from the first week and throughout the 6 months post-implantation, the difference between both groups was not significant. When comparing impedances at the apical and basal electrodes between both groups, the mean impedance at the basal electrodes was significantly higher in Group 1 compared to Group 2 at 1 month (<i>P</i> = .042).</p><p><strong>Conclusion: </strong>The association of intratympanic and intravenous corticosteroids results in significantly reduced impedances during the early postoperative period. The basal electrodes have a more pronounced effect from this association. Based on these findings, this protocol is effective in lowering impedances in the short term but not in the medium term following cochlear implantation.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"588-597"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Sucralfate in Post-Tonsillectomy Pain in Children: A Scoping Review.","authors":"Erin E Briggs, Lauren R McCray, Jaimin J Patel, Shaun A Nguyen, Noah P Parker","doi":"10.1177/00034894251336517","DOIUrl":"10.1177/00034894251336517","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this scoping review is to investigate the efficacy of sucralfate on postoperative pain following oropharyngeal surgery in the pediatric population using pain scales, analgesic use, diet toleration, and bleeding. Furthermore, we wanted to highlight the clinical importance of the limitations in the current literature.</p><p><strong>Review methods: </strong>The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. Results of included studies and a narrative summary of our findings are presented through descriptive statistics (frequency [%] for categorical variables and mean [range] for continuous variables with 95% confidence intervals [CI]).</p><p><strong>Results: </strong>Of the 195 abstracts identified, 3 studies (N = 241) pertaining to sucralfate and post-operative pain in the pediatric population were included. Sucralfate group had a mean age of 6.13 (range = 3-12) versus 6.82 (range = 3-12) for control group. Sucralfate group had statistically significant reduction in pain scores than control group. Analgesic use was consistently lower in the sucralfate group compared to the control group. Two studies also showed a difference in diet tolerance between the 2 groups.</p><p><strong>Conclusions: </strong>Tonsillectomy is one of the most frequently performed procedures on children and the procedure results in an extended and painful recovery. The literature shows promising results of sucralfate in the reduction of post-tonsillectomy pain in the pediatric population; however, the literature is limited, and further investigation is warranted.</p><p><strong>Level of evidence: </strong>2.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"549-555"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sialosis (Sialadenosis): A Sialographic Study with Clinical Correlates.","authors":"Piper A Wenzel, Evgeniya Molotkova, Joan Maley, Kailey Henkle, Benjamin Fick, Ryan Thorpe, Henry Hoffman","doi":"10.1177/00034894251337823","DOIUrl":"10.1177/00034894251337823","url":null,"abstract":"<p><strong>Objective: </strong>Characterize radiographic findings and co-existing pathologic processes in the parotid glands of patients with swelling or pain identified on radiographic review to be consistent with sialosis (sialadenosis) employing dynamic infusion digital sialography correlated with computed tomography (CT).</p><p><strong>Methods: </strong>Retrospective chart review of a consecutive series of 578 sialograms performed by the senior investigator over a 16-year period identified 39 patients with 1 or both parotid gland sialograms recorded as \"sialosis\" by radiologists' interpretation. After inclusion and exclusion criteria were applied, 20 patients remained for evaluation. A review of sialograms was conducted by a senior radiologist to identify co-existing pathologies (ex: stricture, sialectasis, sialolith) as well as characterize an overall aggregate impression and specific findings of ductal curvature, splaying, and truncation on a numerical scale from 1 (absent finding) to 10 (severely abnormal). Two normal sialograms served as controls. The density of each gland was assessed through CT measurement of Hounsfield units (HU). Variables collected included sex, age, symptoms, BMI, alcohol use, and comorbidities.</p><p><strong>Results: </strong>Twenty patients with a total of 27 glands classified as \"sialosis\" on sialography and 2 patients with normal sialography findings were evaluated. Indications for sialography included pain (90%), fluctuation in swelling of the parotid gland(s) (65%), or xerostomia (35%). Sialographic analysis identified 7 glands (26%) with sialosis to have an additional co-existing pathology (2 with strictures, 5 with sialectasis). Consistent features in glands with sialosis included ductal curvature, splaying, and truncation. CT analysis of glands with sialosis identified a median HU measurement of -36 compared to +30 for glands identified as normal (<i>P</i> = .03).</p><p><strong>Conclusion: </strong>Sialography is useful in selected patients to evaluate for co-existing pathologies contributing to salivary symptoms. Sialography additionally demonstrates consistent findings (ductal curvature, splaying, and truncation) associated with sialosis that correlate with fat infiltration identified on CT imaging.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"613-619"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Sociodemographics in Follow-Up Post-Tympanostomy Tube Placement.","authors":"Grant E Gochman, Veronica Drozdowski-Nuccio, Richard D Hubbell","doi":"10.1177/00034894251333653","DOIUrl":"10.1177/00034894251333653","url":null,"abstract":"<p><strong>Objective: </strong>To determine if disparities exist in patient follow-up post-bilateral myringotomy with tympanostomy tube placement.</p><p><strong>Introduction: </strong>Bilateral myringotomy with tympanostomy tube placement (BMT) is the most common surgery performed in children in the U.S. The current literature suggests there are no demographic differences in treatment of otitis media, however these studies have limited data on postoperative follow-up. This study aims to assess socioeconomic and other factors that affect follow-up after BMT.</p><p><strong>Methods: </strong>A retrospective chart review of pediatric patients seen at a tertiary medical center who underwent BMT was conducted. Demographic, medical, and socioeconomic information was collected. Fisher's exact test was used to estimate association between follow-up with all nominal responses. Logistic regression was used to estimate association between follow-up with quantitative responses.</p><p><strong>Results: </strong>A total of 750 patients (62.1% male) were included with 37.7% of patients identifying as non-Caucasian and 30.6% as Hispanic. The mean (SD) age at time of surgery was 5.1 (4.4) years. Patients undergoing a concurrent tonsillectomy and adenoidectomy (T&A) were less likely to follow-up than those with BMT alone. This was true even after adjusting for age and distance from medical center (OR = 0.46, 95% CI = 0.27-0.79; <i>P</i> = .01). Race, type of insurance, medical-comorbidities, indication for surgery, and distance from clinic did not affect rate of follow-up (<i>P</i> > .05). Those who underwent multiple BMTs and those with developmental delay may also be less likely to follow-up, although this finding did not meet statistical significance (<i>P</i> < .1).</p><p><strong>Discussion: </strong>Our study demonstrates socioeconomic variables, indication for surgery, and co-morbidities were not statistically significant factors in determining rates of follow-up after BMT. Interestingly, concurrent T&A was associated with lower rates of follow-up. Findings in this study suggest large medical centers with diverse patient populations see similar rates of follow-up post-BMT across a variety of variables.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"569-574"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological Efficacy and Postoperative Outcomes of Low Grade Mucoepidermoid Carcinoma Treated With Partial Parotidectomy.","authors":"Hawa M Ali, Katelyn S Rourk, Jamie O Byrne, Kendall K Tasche, Daniel L Price, Kathryn M Van Abel, Linda X Yin, Eric J Moore","doi":"10.1177/00034894251335405","DOIUrl":"10.1177/00034894251335405","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of extent of parotidectomy on surgical and oncologic outcomes in low grade mucoepidermoid carcinoma (LGMEC).</p><p><strong>Methods: </strong>A retrospective chart review of all patients undergoing primary surgical treatment for LGMEC from 2000 to 2022 was conducted. Clinical features collected included demographics, facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence.</p><p><strong>Results: </strong>58 patients were included; 10 patients underwent partial parotidectomy (PP), 38 underwent superficial parotidectomy (SP), and 10 underwent near-total/total parotidectomy. PP and SP patients had smaller tumors and more superficial tumors compared to near-total/total parotidectomy group (<i>P</i> = .03). PP and SP were more likely to have negative margins and less locoregional disease compared to near-total/total parotidectomy patients (<i>P</i> < .01). Near-total/total parotidectomy were more likely to undergo facial nerve resection (20% vs 0% for PP & SP respectively) (<i>P</i> = .05). Immediate postoperative facial nerve function was significantly better among PP patients (73% HB I) compared to SP (44% HB I) and near-total/total parotidectomy patients (0% HB I) (<i>P</i> < .01). Most patients regained their facial nerve function although only 40% of the near-total/total parotidectomy patients had a HB I at the time of last follow up (<i>P</i> < .01). Patients were followed for a median of 6.2 years, during which only 1 patient (total parotidectomy) had a recurrence.</p><p><strong>Conclusions: </strong>PP offers a safe and effective approach for small LGMEC tumors, ensuring better facial nerve function postoperatively with minimal complications compared to more extensive surgery.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"606-612"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Computed Tomography Imaging Grading Scale for Pneumolabyrinth.","authors":"Shirley Xiaosu Liu, Andrew A McCall, Jennifer Anderson, Philip Perez, Barry Hirsch, Marion Hughes, Keerthi Arani, Katie Traylor, Barton F Branstetter","doi":"10.1177/00034894251332083","DOIUrl":"10.1177/00034894251332083","url":null,"abstract":"<p><strong>Objective: </strong>To develop a reliable prognostic grading scale for pneumolabyrinth detected on CT.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Tertiary care institution.</p><p><strong>Participants: </strong>A total of 39 patients with pneumolabyrinth identified through CT imaging from 2010 to 2019 were included. The main outcome measures involved reviewing clinical outcomes and radiographic features. The extent of pneumolabyrinth was assessed and graded as low, intermediate, or high risk for permanent hearing loss, by expert radiologists.</p><p><strong>Main outcomes and measures: </strong>The primary outcome of the study was the association between the extent of pneumolabyrinth, as graded by a novel prognostic scale (low, intermediate, or high risk), and the likelihood of permanent hearing loss. Hearing outcomes and vestibular symptoms were assessed through retrospective chart review, while the grading of pneumolabyrinth extent was based on expert radiologic evaluations of CT imaging. The hypothesis regarding the predictive utility of the grading scale was formulated after data collection. Reliability of the grading scale was measured using Cohen's kappa and Fleiss' kappa.</p><p><strong>Results: </strong>The patient cohort had a median age of 30 years (range = 8-84 years), 33% of whom were female. Trauma, predominantly temporal bone fractures (87.5%), was the most common cause. The grading scale demonstrated excellent intra-rater reliability (Cohen's kappa = .95) and substantial inter-rater reliability (Fleiss' kappa = .729). High risk pneumolabyrinth cases had a higher rate of profound hearing loss (90.9%) compared low or intermediate risk cases (46.2%, <i>P</i> = .0136). Dizziness was not associated with pneumolabyrinth grade, but correlated with involvement of semicircular canals (72.7%) compared to patients with pneumolabyrinth limited to vestibule and/or cochlea (31.3%, <i>P</i> = .008). Presence of pneumolabyrinth isolated to the vestibular labyrinth was significantly associated with dizziness symptoms (<i>P</i> = .047).</p><p><strong>Conclusion: </strong>Our novel grading scale reliably predicted clinical outcomes, providing prognostic utility in hearing status and potential guidance in surgical approach.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"561-568"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}