Auris Nasus Larynx最新文献

{"title":"Diagnosis and treatment of patulous Eustachian tube","authors":"Ryoukichi Ikeda","doi":"10.1016/j.anl.2024.09.007","DOIUrl":"10.1016/j.anl.2024.09.007","url":null,"abstract":"<div><div>Symptoms of patulous Eustachian Tube (PET) were first described by Jago in 1858 and reported by Schwartze in 1864, recognizing PET as a clinical entity. This review summarizes the causes, epidemiology, diagnosis, and treatment of PET, with a particular emphasis on diagnosis and treatment, detailing the diagnostic criteria and silicone plug (Kobayashi plug) surgery proposed or developed in Japan. PET is often linked to weight loss from chronic illnesses, dieting, anorexia nervosa, hemodialysis, and bariatric surgery. It is also associated with pregnancy, oral contraceptive use, nasopharyngeal and muscular atrophy or scarring, and neuromuscular diseases. Interestingly, many PET cases lack an identifiable cause. The prevalence of PET ranges from 0.3 % to 7.0 %, with a higher incidence in females and typically occurring in adolescents and adults. Diagnosis relies on a combination of clinical history, physical examination, ET function test, and imaging. The Japan Otological Society (JOS) proposed standardized diagnostic criteria, where a “definite PET” diagnosis requires all three criteria (aural symptoms, tubal obstruction procedures, and objective findings), while “possible PET” requires two. Treatment includes conservative and surgical interventions. For persistent and severe cases that do not improve with conservative treatments, surgical options are explored. These surgical procedures are classified by the type of intervention, which includes tympanic membrane manipulation (such as tympanostomy tube insertion and mass loading of the tympanic membrane), plug surgery, ET injection, shim surgery, tuboplasty, and ET closure. The Kobayashi plug, a 23 mm long silicone plug, is specifically designed for PET treatment. Indications for its use include “definite PET,” a PHI-10 score of 26 or higher, and lack of improvement after six months of conservative treatment. Preoperative evaluations include CT scans to assess ET patency and confirm the bony portion. Surgery, mostly performed under local anesthesia, involves inserting the plug into the ET via a myringotomy, ensuring the correct size and position with endoscopic guidance. In conclusion, PET is a challenging condition with diverse etiologies and symptoms. Effective management requires a comprehensive diagnostic approach and tailored treatment plans, with the Kobayashi plug offering a promising solution for refractory cases. Further research and advancements in diagnostic techniques and therapeutic interventions will continue to enhance the management of PET.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 947-955"},"PeriodicalIF":1.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378597","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":"Endoscopic surgical management of juvenile nasopharyngeal angiofibroma: Correlating tumour characteristics, risk of hemorrhage, and recurrence","authors":"Alfredo García-Fernández,&nbsp;María Fernández-Rueda,&nbsp;Esther García-González,&nbsp;Nieves Mata-Castro","doi":"10.1016/j.anl.2024.09.004","DOIUrl":"10.1016/j.anl.2024.09.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Juvenile nasopharyngeal angiofibroma is an uncommon tumour primarily seen in young males. It is characterized by its vascular nature and aggressive growth pattern, presenting a significant surgical challenge. Endoscopic sinonasal surgery has become the treatment of choice, reducing both morbidity and blood loss, as well as recurrence rates. This study aims to present the clinical characteristics and surgical outcomes of patients with juvenile nasopharyngeal angiofibroma treated exclusively with endoscopic surgery at our centre.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on cases of juvenile nasopharyngeal angiofibroma treated with endoscopic surgery at a single centre between 2013 and 2023.</div></div><div><h3>Results</h3><div>A total of 21 patients were included in the study, with a mean age of 17.7 years. 57.14 % of the patients presented with an advanced stage (Stage ≥ IIc Radkowsky). The median volume was 79.2 cm³. Pre-surgical embolization was performed in all cases. 7 patients (33.3 %) required blood transfusion. The need for blood transfusion was associated with greater tumour volume (<em>p</em> = 0.0028), intracranial extension (<em>p</em> = 0.025), extension to the infratemporal fossa (<em>p</em> = 0.024), and orbital extension (<em>p</em> = 0.026). There were 2 cases (9.5 %) of tumour recurrence/persistence, both classified as stage IIIb. Tumour persistence/recurrence was more common in patients with intracranial extension (<em>p</em> = 0.045).</div></div><div><h3>Conclusion</h3><div>Exclusive endoscopic resection of these tumours, regardless of volume and extension, does not increase the risk of blood loss or recurrence. Advanced-stage tumours, especially those with intracranial extension, present a higher risk of bleeding and tumour persistence. In these cases, the low morbidity of the endoscopic approach becomes more evident.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 940-946"},"PeriodicalIF":1.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328234","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":"Detailed characterization of auditory neuropathy in Perrault syndrome with TWNK variants","authors":"Marie N Shimanuki ,&nbsp;Makoto Hosoya ,&nbsp;Takanori Nishiyama ,&nbsp;Takeshi Wakabayashi ,&nbsp;Masafumi Ueno ,&nbsp;Hiroyuki Ozawa ,&nbsp;Hideki Mutai ,&nbsp;Kiyomitsu Nara ,&nbsp;Tatsuo Matsunaga ,&nbsp;Naoki Oishi","doi":"10.1016/j.anl.2024.09.005","DOIUrl":"10.1016/j.anl.2024.09.005","url":null,"abstract":"<div><div>Perrault syndrome is an autosomal recessive condition characterized by hearing loss and ovarian failure. Hearing loss in Perrault syndrome has been reported as sensorineural; however, only two cases in a single report have comprehensively investigated hearing in Perrault syndrome with <em>TWNK</em> variant, and the association between this variant and auditory neuropathy has not been established. The proband presented with hearing difficulties and primary amenorrhea. Hearing tests revealed mild hearing loss. Maximum speech intelligibility score was 95 % with normal otoacoustic emission. However, no auditory brainstem responses were observed, leading to the diagnosis of auditory neuropathy. Genetic tests identified compound heterozygous variants of <em>TWNK</em> (p.Ile253Met and p.Arg391His), which lead to the genetic diagnosis of Perrault syndrome. Electrocochleography suggests a decreased cochlear nerve function. The patient's sister was also subsequently genetically diagnosed with Perrault syndrome upon identification of the same <em>TWNK</em> variant and had auditory neuropathy with low-tone hearing loss on pure-tone audiometry. These cases highlight the importance of detailed hearing tests, including auditory brainstem response and genetic tests in patients with Perrault syndrome, even in cases of mild hearing loss, for accurate diagnosis and appropriate management.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 933-939"},"PeriodicalIF":1.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative assessment of hyperactive delirium risk after head and neck surgery with free tissue transfer reconstruction","authors":"Takayuki Imai ,&nbsp;Teiko Takasago ,&nbsp;Ayako Nakanome ,&nbsp;Shinkichi Morita ,&nbsp;Yuya Miyakura ,&nbsp;Kento Sasaki ,&nbsp;Kazue Ito ,&nbsp;Takahiro Goto ,&nbsp;Yukinori Asada","doi":"10.1016/j.anl.2024.09.001","DOIUrl":"10.1016/j.anl.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>Hyperactive delirium with agitation following head and neck surgeries with free tissue transfer reconstruction (HNS-FTTR) represents a critical and potentially life-threatening postoperative complication. Although preoperative risk assessment is important, no established risk screening tool has been developed to accurately predict its occurrence.</p></div><div><h3>Methods</h3><p>In this retrospective observational study, we examined 192 consecutive patients who underwent HNS-FTTR between August 2019 and January 2024. We assessed the effectiveness of the existing delirium risk screening system, the DELirium Team Approach program which includes factors such as age ≥ 70 years, presence of brain disorders, dementia, alcohol consumption habits, a history of delirium, and use of benzodiazepines. Additionally, we explored the association between each risk factor and the onset of delirium.</p></div><div><h3>Results</h3><p>Delirium occurred in 43 patients (22.4 %). The risk screening tool effectively predicted the occurrence of hyperactive delirium after HNS-FTTR (OR: 8.316; 95 % CI: 2.205–36.060; <em>p</em> = 0.004), with a sensitivity of 95.3 % and a specificity of 28.9 %. Multivariate analysis revealed age ≥ 70 years (OR: 2.179; 95 % CI: 1.058–4.662; <em>p</em> = 0.0383) and alcohol consumption habits (OR: 2.554; 95 % CI: 1.260–5.268; <em>p</em> = 0.0098) as significant independent risk factors.</p></div><div><h3>Conclusion</h3><p>Our findings suggest that the risk screening system evaluated in this study appears to be sensitive, simple, and effective for the preoperative prediction of hyperactive postoperative delirium following HNS-FTTR.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 929-932"},"PeriodicalIF":1.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274648","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 machine learning models to predict papillary carcinoma in thyroid nodules: The role of immunological, radiologic, cytologic and radiomic features","authors":"Luca Canali ,&nbsp;Francesca Gaino ,&nbsp;Andrea Costantino ,&nbsp;Mathilda Guizzardi ,&nbsp;Giorgia Carnicelli ,&nbsp;Federica Gullà ,&nbsp;Elena Russo ,&nbsp;Giuseppe Spriano ,&nbsp;Caterina Giannitto ,&nbsp;Giuseppe Mercante","doi":"10.1016/j.anl.2024.09.002","DOIUrl":"10.1016/j.anl.2024.09.002","url":null,"abstract":"<div><h3>Objective</h3><p>Approximately 30 % of thyroid nodules yield an indeterminate diagnosis through conventional diagnostic strategies. The aim of this study was to develop machine learning (ML) models capable of identifying papillary thyroid carcinomas using preoperative variables.</p></div><div><h3>Methods</h3><p>Patients with thyroid nodules undergoing thyroid surgery were enrolled in a retrospective monocentric study. Six 2-class supervised ML models were developed to predict papillary thyroid carcinoma, by sequentially incorporating clinical-immunological, ultrasonographic, cytological, and radiomic variables.</p></div><div><h3>Results</h3><p>Out of 186 patients, 92 nodules (49.5 %) were papillary thyroid carcinomas in the histological report. The Area Under the Curve (AUC) ranged from 0.41 to 0.61 using only clinical-immunological variables. All ML models exhibited an increased performance when ultrasound variables were included (AUC: 0.95–0.97). The addition of cytological (AUC: 0.86–0.97) and radiomic (AUC: 0.88–0.97) variables did not further improve ML models’ performance.</p></div><div><h3>Conclusion</h3><p>ML algorithms demonstrated low accuracy when trained with clinical-immunological data. However, the inclusion of radiological data significantly improved the models' performance, while cytopathological and radiomics data did not further improve the accuracy.</p></div><div><h3>Level of evidence</h3><p>Level 4.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 922-928"},"PeriodicalIF":1.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274649","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":"Assessing volume growth of paranasal sinuses and nasal cavity in children using three-dimensional imaging software","authors":"Kaoru Yamakawa ,&nbsp;Hironobu Nishijima ,&nbsp;Megumi Koizumi ,&nbsp;Kenji Kondo","doi":"10.1016/j.anl.2024.08.007","DOIUrl":"10.1016/j.anl.2024.08.007","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the accurate volume changes in the paranasal sinus and nasal cavity with age development, using three-dimensional (3D) imaging software</p></div><div><h3>Methods</h3><p>Paranasal sinus and nasal cavity volumes from computed tomography (CT) images in patients aged 0–24 years were measured using a 3D model to examine age-related changes. Paranasal sinus and nasal cavity growth were compared between age groups. Additionally, the correlation between body height and paranasal sinus growth was examined.</p></div><div><h3>Results</h3><p>A total of 139 CT scans from 137 patients were analyzed. Volume growth of maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavity was observed until 18, 16, 20, 20, and 22 years, respectively. Maxillary sinus rapidly grew at 2–8 and 9–12 years, ethmoid sinus 2–8 and 13–16 years, sphenoid sinus 5–8 years, frontal sinus 2–10 years, and nasal cavity 7–12 years. The median volume after growth completion for maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavities was 21,937 mm³, 4868 mm³, 5870 mm³, 3172 mm³, and 15,555 mm³, respectively. The left-right difference in the nasal cavity volume increased with age. Sinus and nasal cavity growth completion was delayed by 2–4 years compared to general height growth.</p></div><div><h3>Conclusion</h3><p>Growth of the ethmoid, maxillary, sphenoid, frontal sinus, and nasal cavity was completed in approximately 20 years. Compared to the results shown in reports based primarily on 2D measurements, the ethmoid and sphenoid sinuses and nasal cavity were found to continue to grow until older age than previously thought.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 917-921"},"PeriodicalIF":1.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0385814624001019/pdfft?md5=9d396d83f90b70804b09a5fdee6ee79b&pid=1-s2.0-S0385814624001019-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National epidemiological survey on pharyngeal, laryngeal, and tracheal stenosis in Japan: A National survey on airway stenosis","authors":"Yo Kishimoto ,&nbsp;Kayoko Mizuno ,&nbsp;Yoshitaka Kawai ,&nbsp;Keisuke Mizuno ,&nbsp;Hideki Hirabayashi ,&nbsp;Kinya Furukawa ,&nbsp;Noriko Morimoto ,&nbsp;Kosaku Maeda ,&nbsp;Koichi Kaneko ,&nbsp;Koichi Omori","doi":"10.1016/j.anl.2024.08.008","DOIUrl":"10.1016/j.anl.2024.08.008","url":null,"abstract":"<div><h3>Objective</h3><p>Airway stenosis impairs the quality of life of patients. However, the epidemiology and pathophysiology of airway stenosis remain underexplored owing to its rarity. Airway stenosis may go undetected for a long period without accurate diagnosis or treatment owing to the lack of established treatment guidelines. Thus, clinical information must be accumulated and analyzed to generate evidence-based treatment strategies for this rare entity.</p></div><div><h3>Methods</h3><p>A retrospective nationwide epidemiological survey was conducted targeting patients with pharyngeal, laryngeal, or tracheal stenosis in Japan. The initial survey was conducted across 1393 facilities between 2013 and 2017 to evaluate the treatment of airway stenosis. The clinical information of the patients was collected via a secondary survey.</p></div><div><h3>Results</h3><p>The primary survey revealed that airway stenosis was treated at only 43 % of the facilities over the 5-year period. The secondary survey revealed that 284 cases were registered across 57 facilities. The number of patients with acquired stenosis exceeded that of those with congenital stenosis. The larynx or cervical trachea was the most common site of stenosis, and intubation or tracheostomy was the most common cause of stenosis. Approximately 76 % of patients underwent surgical treatment, and tracheostomy was the most common procedure. Stenosis persisted in &gt; 70 % of patients at the last visit.</p></div><div><h3>Conclusions</h3><p>This study clarified the clinical background of patients with pharyngeal, laryngeal, and tracheal stenosis in Japan and the surgical treatment received. The findings of this study confirmed the rarity of airway stenosis and the difficulty in treating this entity.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 911-916"},"PeriodicalIF":1.6,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167457","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 clinical manifestation and treatment of Meniere's Disease from the viewpoint of the water homeostasis of the inner ear","authors":"Taizo Takeda ,&nbsp;Setsuko Takeda ,&nbsp;Akinobu Kakigi","doi":"10.1016/j.anl.2024.08.002","DOIUrl":"10.1016/j.anl.2024.08.002","url":null,"abstract":"<div><p>Endolymphatic hydrops, a pathological feature of Ménière's disease, has been experimentally and clinically confirmed to be influenced by the blood circulation of vasopressin (VP). VP is a well-known hormonal regulator of water homeostasis. In addition, VP is influenced by various environmental changes, dehydration, fluctuation of atmospheric pressure, pregnancy, and other factors. Furthermore, VP is a key regulator of the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is a major neuroendocrine system that controls reactions to emotional and physical stresses, as well as the sleep/wake cycle (circadian rhythm). Therefore, VP is susceptible to change via the HPA axis.</p><p>This review considers possible mechanisms of the formation of endolymphatic hydrops from the perspective of the vasopressin-aquaporin 2 system.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 905-910"},"PeriodicalIF":1.6,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142152045","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":"Open-type cholesteatoma is the predictive factor for residual disease in congenital cholesteatoma treated with TEES","authors":"Toshinori Kubota,&nbsp;Tsukasa Ito,&nbsp;Takatoshi Furukawa,&nbsp;Hirooki Matsui,&nbsp;Takanari Goto,&nbsp;Chikako Shinkawa,&nbsp;Seiji Kakehata","doi":"10.1016/j.anl.2024.08.004","DOIUrl":"10.1016/j.anl.2024.08.004","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the predictive factors for residual disease occurring after surgical removal of congenital cholesteatomas and whether these predictive factors differ between microscopic ear surgery (MES) using data from the literature and transcanal endoscopic ear surgery (TEES) using data from our own institution.</p></div><div><h3>Methods</h3><p>Twenty-three patients with a congenital cholesteatoma who underwent surgical treatment at Yamagata University Hospital between December 2011 and December 2017 were retrospectively investigated. We divide TEES into three different approaches: non-powered TEES, powered TEES and dual MES/TEES. Main outcome measures were Potsic stage, closed or open congenital cholesteatoma type, TEES surgical approach, appearance of residual disease, tympanoplasty type and hearing outcome.</p></div><div><h3>Results</h3><p>A logistic regression analysis was conducted on the Potsic stage, closed or open type, TEES surgical approach and age to obtain the odds ratio for residual disease. The chance of residual disease significantly increased in the presence of an open-type congenital cholesteatoma (odds ratio: 30.82; 95 % confidence interval: 1.456–652.3; <em>p</em> = 0.0277), but not for any of the other factors including Potsic stage. The timing of the confirmation of residual disease after ossicular chain reconstruction was analyzed using a Kaplan-Meier analysis. The residual disease rate was significantly higher with an open-type congenital cholesteatoma (log-rank test, <em>p</em> &lt; 0.05). In addition, all residual disease occurred within three years after surgery.</p></div><div><h3>Conclusions</h3><p>Our results showed that an open-type congenital cholesteatoma is the strongest predictive factor for residual disease when removing a congenital cholesteatoma by TEES.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 5","pages":"Pages 898-904"},"PeriodicalIF":1.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142097336","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":"Factors of postoperative recurrent laryngeal nerve paralysis and recovery of vocal cord movement in thyroid surgery","authors":"Kazufumi Obata,&nbsp;Makoto Kurose,&nbsp;Akito Kakiuchi,&nbsp;Kenichi Takano","doi":"10.1016/j.anl.2024.08.006","DOIUrl":"10.1016/j.anl.2024.08.006","url":null,"abstract":"<div><h3>Objective</h3><p>Postoperative recurrent laryngeal nerve paralysis is one of the complications of thyroid surgery, and the prevention and management of paralysis is an important issue for surgeons. In this study, in order to gain further understanding of recurrent laryngeal nerve paralysis after thyroid surgery, we analyzed and examined the usefulness of nerve stimulators for recurrent laryngeal nerve paralysis and the factors that may cause recurrent laryngeal nerve paralysis. Furthermore, in cases where transient recurrent laryngeal nerve paralysis occurred, we analyzed and examined the timing of improvement in vocal cord movement for each intraoperative finding and intraoperative operation that caused the paralysis.</p></div><div><h3>Methods</h3><p>At the Department of Otorhinolaryngology Head and Neck Surgery, Sapporo Medical University Hospital, between January 2012 and December 2021, the subjects were 543 thyroid surgery cases (692 nerves) without preoperative paralysis or cancer nerve invasion performed. The relationship between postoperative transient and permanent paralysis of the recurrent laryngeal nerve was evaluated using univariate and multivariate analysis. The factors evaluated were gender, age, BMI, total thyroidectomy, benignity, malignancy, Graves’ disease, using IIONM (intermittent intraoperative nerve monitoring), using CIONM (continuous intraoperative nerve monitoring), malignant tumor T3b or higher, with lateral neck dissection, and years of experience of the surgeon. Furthermore, by targeting 87 nerves with transient paralysis, surgical operations were divided into three groups: minor injury, major injury, and adhesion, and their relationship with the timing of postoperative vocal fold movement improvement was evaluated.</p></div><div><h3>Results</h3><p>Permanent paralysis of the recurrent laryngeal nerve occurred in 12 nerves (1.7 %), and transient paralysis occurred in 100 nerves (14.5 %). Univariate analysis showed no association with each factor, but multivariate analysis showed that transient paralysis was significantly lower in men and in patients using IIONM. The improvement time for vocal cord paralysis was 2.8 months in the minor injury group, 4.5 months in the major injury group, and 3.2 months in the adhesion group, indicating a statistically significant difference between the minor injury group and the major injury group.</p></div><div><h3>Conclusion</h3><p>This study suggests that the use of IIONM and gentle manipulation of women may prevent recurrent laryngeal nerve paralysis during thyroid surgery. In addition, understanding the period of nerve recovery for each operation for postoperative transient recurrent laryngeal nerve paralysis may contribute to patient explanations and determining the timing of therapeutic intervention for speech improvement surgery.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 5","pages":"Pages 892-897"},"PeriodicalIF":1.6,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087772","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}