Auris Nasus Larynx最新文献

{"title":"An autopsy case of pulmonary tumor thrombotic microangiopathy that developed during chemotherapy for salivary duct carcinoma of the parotid gland","authors":"Mai Itoyama ,&nbsp;Akihiro Ohara ,&nbsp;Kazuki Yokoyama ,&nbsp;Shun Yamamoto ,&nbsp;Ken Kato ,&nbsp;Yuichiro Tada ,&nbsp;Ayumi Sugitani ,&nbsp;Hirokazu Sugino ,&nbsp;Yasushi Yatabe ,&nbsp;Masahiko Kusumoto ,&nbsp;Kenichi Nakamura ,&nbsp;Yoshitaka Honma","doi":"10.1016/j.anl.2024.07.002","DOIUrl":"10.1016/j.anl.2024.07.002","url":null,"abstract":"<div><p>Pulmonary tumor thrombotic microangiopathy (PTTM) is a rapidly progressive cancer-related disease with a dismal clinical course. The patient in this report was a 43-year-old man with metastatic salivary duct carcinoma arising from the parotid gland. Combined androgen blockade therapy was administered started as first-line treatment, but failed after 5 months, followed by docetaxel plus carboplatin therapy as second-line treatment, which failed after 3 months. Genomic profiling revealed a BRAF V600E mutation, and combined BRAF and MEK inhibitor therapy was started as third-line treatment. The cancer remained stable during the first 10 months of third-line treatment, but treatment was subsequently discontinued due to the onset of symptoms of fatigue, myalgia and arthritis. Twenty days after the onset of these symptoms and interruption of third-line treatment, the patient was urgently admitted to hospital with respiratory distress and severe thrombocytopenia. CT images at the time of admission led our radiologist to the possibility of PTTM, but the patient died the day after admission and autopsy findings indicated that PTTM was the cause of death. This report describes a very informative case of PTTM with sequential imaging and detailed autopsy findings were available and provides a literature review.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 5","pages":"Pages 829-833"},"PeriodicalIF":1.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762940","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":"Exploring factors influencing the hearing test and hearing aid adoption among Japanese older adults: Implications of recognizing the hearing loss–dementia relationship","authors":"Ichiro Fukumasu ,&nbsp;Yuko Kataoka ,&nbsp;Takahiro Tabuchi ,&nbsp;Kentaro Egusa ,&nbsp;Mizuo Ando","doi":"10.1016/j.anl.2024.07.001","DOIUrl":"https://doi.org/10.1016/j.anl.2024.07.001","url":null,"abstract":"<div><h3>Objective</h3><p>The hearing aid adoption rate among older adults in Japan is lower than that in other developed countries. Herein, a survey was conducted to identify this bottleneck and develop countermeasures. This study aimed to examine whether raising awareness of the relationship between hearing loss and dementia is significant for hearing tests and adopting hearing aids.</p></div><div><h3>Methods</h3><p>A questionnaire was administered to participants aged 65 or older who visited a general hospital to determine the background factors (1) for a recent history of hearing tests, (2) for the desire to visit an otolaryngologist and have a hearing test, (3) for recognizing the hearing loss–dementia relationship, and (4) for adopting hearing aids.</p></div><div><h3>Results</h3><p>A total of 517 patients (mean age, 78.06; SD 6.97), representing 2.4% of the region's older-adult population, participated in the survey. A history of hearing tests within five years was significantly associated with recognizing the hearing loss–dementia relationship (adjusted OR 2.36, 95% CI 1.49–3.72). The desire to visit an otolaryngologist or have a hearing test was significantly associated with recognizing the hearing loss–dementia relationship (adjusted OR 1.70, 95% CI 1.02–2.85). Moreover, 39.3% were aware of the hearing loss–dementia relationship. The significant associated factors were being female (OR 2.50, 95% CI 1.64–3.81) and having interpersonal hobbies (OR 1.66, 95% CI 1.11–2.49). The significant background factors for adopting hearing aids were older age (OR 6.95, 95% CI 1.90–25.40), self-reported severe hearing impairment (OR 5.49, 95% CI 2.55–11.80), and living alone (OR 2.63, 95% CI 1.18–5.89). Recognizing the hearing loss–dementia relationship was not a significant factor.</p></div><div><h3>Conclusion</h3><p>Raising awareness of the hearing loss–dementia relationship was not associated with adopting hearing aids for self-reported hearing impairments. However, it may be associated with otolaryngology visits and hearing tests. Thus, steps like hearing screening for older adults are also essential.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 822-827"},"PeriodicalIF":1.6,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141606364","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":"Clinical practice guidelines for the diagnosis and management of acute sensorineural hearing loss","authors":"Ryosuke Kitoh ,&nbsp;Shin-ya Nishio ,&nbsp;Hiroaki Sato ,&nbsp;Tetsuo Ikezono ,&nbsp;Shinya Morita ,&nbsp;Tetsuro Wada ,&nbsp;Shin-ichi Usami ,&nbsp;Research Group on Intractable Hearing Disorders and Japan Audiological Society","doi":"10.1016/j.anl.2024.06.004","DOIUrl":"10.1016/j.anl.2024.06.004","url":null,"abstract":"<div><h3>Objective</h3><p>Acute sensorineural hearing loss represents a spectrum of conditions characterized by sudden onset hearing loss. The “Clinical Practice Guidelines for the Diagnosis and Management of Acute Sensorineural Hearing Loss” were issued as the first clinical practice guidelines in Japan outlining the standard diagnosis and treatment. The purpose of this article is to strengthen the guidelines by adding the scientific evidence including a systematic review of the latest publications, and to widely introduce the current treatment options based on the scientific evidence.</p></div><div><h3>Methods</h3><p>The clinical practice guidelines were completed by 1) retrospective data analysis (using nationwide survey data), 2) systematic literature review, and 3) selected clinical questions (CQs). Additional systematic review of each disease was performed to strengthen the scientific evidence of the diagnosis and treatment in the guidelines.</p></div><div><h3>Results</h3><p>Based on the nationwide survey results and the systematic literature review summary, the standard diagnosis flowchart and treatment options, including the CQs and recommendations, were determined.</p></div><div><h3>Conclusion</h3><p>The guidelines present a summary of the standard approaches for the diagnosis and treatment of acute sensorineural hearing loss. We hope that these guidelines will be used in medical practice and that they will initiate further research.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 811-821"},"PeriodicalIF":1.6,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0385814624000749/pdfft?md5=83274bd081734b1b54eb1933e303649a&pid=1-s2.0-S0385814624000749-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538989","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":"Can Hounsfield unit density value accurately predict prelaryngeal invasion in laryngeal carcinoma cases","authors":"Senem Kurt Dizdar ,&nbsp;Egehan Salepci ,&nbsp;Burçin Ağrıdağ ,&nbsp;Nurullah Seyhun ,&nbsp;Ali Gemalmaz ,&nbsp;Suat Turgut","doi":"10.1016/j.anl.2024.06.003","DOIUrl":"10.1016/j.anl.2024.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>The Hounsfield unit density value (HUDV) is a relative quantitative measurement of radio density used by radiologists in the interpretation of computed tomography (CT) images. Our aim is to investigate the role of HUDV in evaluating pre-epiglottic space (PES) involvement of laryngeal carcinoma.</p></div><div><h3>Methods</h3><p>Seventy-four patients treated for laryngeal carcinoma in our clinic between 2014 and 2019 were included in the study. The invasion status of PES was determined radiologically and pathologically. HUDV was measured with a circular selected region of interest, with a constant size of 10 mm² for PES. The relationship between patological PES invasion, radiological PES invasion, and HUDV was evaluated.</p></div><div><h3>Results</h3><p>Measuring HUDV to determine PES invasion (74.3 %) was significantly higher than​​ conventional CT evaluation (59.5 %) (<em>p</em> = 0.001). The agreement coefficient (kappa value) of the conventional CT evaluation and the HUDV regarding PES involvement was 0.673, which was interpreted as ‘good’.</p></div><div><h3>Conclusion</h3><p>HUDV could be used as an additional tool in diagnosing pre-epiglottic space invasion in laryngeal cancer.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 803-810"},"PeriodicalIF":1.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536041","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":"Intractable epistaxis requiring surgical exploration or arterial embolization; Associated comorbidities and locations of the bleeder","authors":"Hong-kwon Kil,&nbsp;Jae-Cheul Ahn","doi":"10.1016/j.anl.2024.06.001","DOIUrl":"10.1016/j.anl.2024.06.001","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to determine which comorbidities were associated with intractable epistaxis requiring electrocauterization or embolization, and to identify the location where intractable epistaxis frequently occurred.</p></div><div><h3>Methods</h3><p>The patients were divided into two groups: patients with epistaxis successfully controlled in outpatient department (OPD) and those with intractable epistaxis in OPD which was controlled by surgical exploration or arterial embolization (OP/EM). Evaluations of the bleeding locations, related vessels, and patient's comorbidities were conducted.</p></div><div><h3>Results</h3><p>A total of 41 patients from the OP/EM group and 725 patients from the OPD group were enrolled. The following comorbidities showed elevated risks of the intractable epistaxis (<em>p</em>&lt; 0.05) in multivariate analysis; hypertension (OR 1.089, 95% CI 1.049 - 1.132), dyslipidemia (1.132, 1.041 - 1.232), liver cirrhosis (1.272, 1.152 - 1.406), chronic obstructive pulmonary disease (1.234, 1.078 - 1.412) and asthma (1.205, 1.053 - 1.379). Inferior and middle turbinate were equally the most common location of the intractable bleeding.</p></div><div><h3>Conclusion</h3><p>In patients with epistaxis requiring hemostatic treatments, comorbidities such as hypertension, dyslipidemia, liver diseases, COPD, and asthma were associated with intractable epistaxis. The main bleeding sites of intractable epistaxis were the middle and inferior turbinate.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 797-802"},"PeriodicalIF":1.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536042","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":"Boron neutron capture therapy as a larynx-preserving treatment for locally recurrent laryngeal carcinoma after conventional radiation therapy: A preliminary report","authors":"Masaaki Higashino ,&nbsp;Teruhito Aihara ,&nbsp;Satoshi Takeno ,&nbsp;Hu Naonori ,&nbsp;Tsuyoshi Jinnin ,&nbsp;Keiji Nihei ,&nbsp;Koji Ono ,&nbsp;Ryo Kawata","doi":"10.1016/j.anl.2024.06.007","DOIUrl":"10.1016/j.anl.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><p>Laryngeal preservation and a radical cure are the treatment goals for laryngeal carcinoma, and larynx-preserving therapy is generally preferred for early-stage laryngeal carcinoma. When laryngeal carcinoma recurs locally, patients are often forced to undergo total laryngectomy, resulting in loss of vocal function. However, many patients with laryngeal carcinoma who have residual or recurrent disease after radiotherapy wish to preserve their voice. The purpose of this study was to investigate the possibility of using BNCT as a larynx-preserving treatment for residual or recurrent laryngeal carcinomas following radical irradiation.</p></div><div><h3>Patients and Methods</h3><p>This study included 15 patients who underwent BNCT for residual or recurrent laryngeal carcinoma after radical laryngeal carcinoma irradiation. The number of treatment sessions for all patients was one irradiation. Before BNCT, the recurrent laryngeal carcinoma stage was rT1aN0, rT2N0, rT2N1, rT3N0, rT3N1, and rT4aN0 in one, six, one, three, one, and three patients, respectively. The median maximum tumor diameter before BNCT was 15 mm (8–22 mm). All patients underwent a tracheostomy before BNCT to mitigate the risk of upper airway stenosis due to laryngeal edema after BNCT. Treatment efficacy was evaluated retrospectively using monthly laryngoscopy after BNCT and contrast-enhanced CT scans at 3 months. The safety of treatment was evaluated based on examination findings and interviews with patients.</p></div><div><h3>Results</h3><p>The median hospital stay after BNCT was 2 days (1–6). The response rate at three months after BNCT in 15 patients with locally recurrent laryngeal carcinoma was 93.3 %, and the CR rate was 73.3 %. The most frequent adverse event associated with BNCT was laryngeal edema, which occurred in nine patients the day after BNCT. The average course of laryngeal edema peaked on the second day after BNCT and almost recovered after 1 week in all patients. One patient had bilateral vocal fold movement disorders. None had dyspnea because of prophylactic tracheostomy. No grade four or higher adverse events occurred. Other grade 2 adverse events included pharyngeal mucositis, diarrhea, and sore throat. Three months after BNCT, tracheostomy tubes were removed in nine patients, retinal cannulas were placed in three patients, and voice cannulas were placed in three patients.</p></div><div><h3>Conclusions</h3><p>BNCT for locally recurrent laryngeal carcinoma can safely deliver radical irradiation to tumor tissues, even in patients undergoing radical irradiation. BNCT has shown antitumor effects against recurrent laryngeal carcinoma. However, further long-term observations of the treatment outcomes are required.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 792-796"},"PeriodicalIF":1.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536040","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 influencing residual plus moist HS-W calcium alginate packing material after endoscopic sinus surgery","authors":"Kazuhiro Nomura ,&nbsp;Tomotaka Hemmi ,&nbsp;Mitsuru Sugawara ,&nbsp;Ryoukichi Ikeda","doi":"10.1016/j.anl.2024.06.005","DOIUrl":"10.1016/j.anl.2024.06.005","url":null,"abstract":"<div><h3>Objective</h3><p>This study aims to evaluate the presence of residual Plus Moist HS-W (PM), a novel calcium alginate packing material, during the initial postoperative visit following endoscopic sinus surgery. The research aims to identify factors that influence the quantity of remaining PM.</p></div><div><h3>Methods</h3><p>A retrospective review of medical records was conducted for patients who underwent middle meatus packing with PM.</p></div><div><h3>Results</h3><p>A total of fifty-two patients (representing 92 sides of paranasal sinuses) were included in the analysis. The remaining PM was classified as follows: absent (0) in 41 out of 92 cases, minimal (1) in 22 out of 92 cases, moderate (2) in 15 out of 92 cases, and substantial (3) in 14 out of 92 cases. Notably, all three patients who underwent Draf III surgery exhibited a significant amount of PM during their initial visit, with two patients classified as grade 2 and one patient as grade 3. Other factors investigated were found to be unrelated to the persistence of PM. Removal of all PM was achieved effortlessly using suction under flexible endoscopy.</p></div><div><h3>Conclusion</h3><p>This study highlights the efficacy of PM in post-endoscopic sinus surgery care. It is important to limit an amount of PM, particularly in Draf III procedures.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 779-782"},"PeriodicalIF":1.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473006","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":"Concordance in bacterial colonization profiles between voice prostheses and oral microbiota post-laryngectomy: An experimental study","authors":"Salvatore Cocuzza ,&nbsp;Antonino Maniaci ,&nbsp;Ignazio La Mantia ,&nbsp;Federica Maria Parisi ,&nbsp;Jerome Lechien ,&nbsp;Miguel Mayo-Yanez ,&nbsp;Maddalena Calvo ,&nbsp;Tareck Ayad ,&nbsp;Mario Lentini ,&nbsp;Salvatore Lavalle ,&nbsp;Nicolas Fakhry ,&nbsp;Laura Trovato","doi":"10.1016/j.anl.2024.06.006","DOIUrl":"10.1016/j.anl.2024.06.006","url":null,"abstract":"<div><h3>Objective</h3><p>Knowledge about voice prosthesis microbial colonization is vital in laryngectomized patients’ quality of life (QoL). Herein, we aimed to explore the relationship between oral microbial patterns, demographic variables and voice prosthesis performance.</p></div><div><h3>Methods</h3><p>Thirty laryngectomy patients were assessed for microbial colonization in their voice prostheses and oral cavities. Factors like age, proton pump inhibitor (PPI) usage, and alcohol consumption were considered.</p></div><div><h3>Results</h3><p>Participants' average age was 74.20 ± 7.31 years, with a majority on PPIs. <em>Staphylococcus aureus</em> was the most common bacterium in prostheses (53 %), followed by <em>Pseudomonas aeruginosa</em> (27 %). <em>Candida albicans</em> was the primary fungal colonizer (67 %). A statistically significant moderate correlation was found between fungal species before and after oral rinsing (<em>p</em> = 0.035, Phi=0.588, Cramer's <em>V</em> = 0.416). Voice prosthesis and oral cavity microbiota profiles showed significant concordance (kappa=0.315, <em>p</em> &lt; 0.004). Among subgroup analyses, bacterial patterns of colonization did not significantly influence VHI (<em>p</em> = 0.9555), VrQoL (<em>p</em> = 0.6610), or SF-36 (<em>p</em> = 0.509) scores. Conversely, fungal patterns of VP colonization significantly impacted subjective voice scores, with <em>Candida krusei</em> demonstrating better VHI (35.25 ± 3.63 vs. 44.54 ± 6.33; <em>p</em> = 0.008), VrQoL (7.13 ± 1.69 vs. 10.73 ± 2.00; <em>p</em> = 0.001), and SF-36 (69.36 ± 7.09 vs. 76.50 ± 7.73; <em>p</em> = 0.051) scores compared to <em>C. albicans</em>.</p></div><div><h3>Conclusions</h3><p>There was a significant correlation between the oral microbiota and voice prosthesis colonization. These insights can inform improved care strategies for voice prostheses, enhancing patient outcomes.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 783-791"},"PeriodicalIF":1.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473005","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":"Guidance of clinical management for patients with tonsillar focal disease","authors":"Miki Takahara ,&nbsp;Akira Doi ,&nbsp;Ayako Inoshita ,&nbsp;Junichiro Ohori ,&nbsp;Masamitsu Kono ,&nbsp;Ai Hirano ,&nbsp;Takuya Kakuki ,&nbsp;Kentaro Yamada ,&nbsp;Hirofumi Akagi ,&nbsp;Kenichi Takano ,&nbsp;Seiichi Nakata ,&nbsp;Yasuaki Harabuchi","doi":"10.1016/j.anl.2024.05.010","DOIUrl":"10.1016/j.anl.2024.05.010","url":null,"abstract":"<div><p>Tonsillar focal diseases (TFDs) are defined as “diseases caused by organic and/or functional damage in organs distant from tonsil, and the disease outcome is improved by tonsillectomy.” Although several reports and reviews have shown the efficacy of tonsillectomy for TFDs, no guidelines for the clinical management of the diagnosis and treatment of TFDs have been reported. Therefore, the Society of Stomato-pharyngology established a committee to guide the clinical management of patients with TFDs, and the original guide was published in May 2023. This article summarizes the English version of the manuscript. We hope that the concept of TFDs will spread worldwide, and that one as many patients with TFDs will benefit from tonsillectomy.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 761-773"},"PeriodicalIF":1.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0385814624000695/pdfft?md5=104f211f27d60e2d01ee7df2db51cc03&pid=1-s2.0-S0385814624000695-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322124","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":"Modified method for tracheoesophageal fistula closure in intractable cases","authors":"Atsushi Suehiro,&nbsp;Keigo Honda,&nbsp;Yo Kishimoto,&nbsp;Ken Iwanaga,&nbsp;Shintaro Fujimura,&nbsp;Yoshitaka Kawai,&nbsp;Tsuyoshi Kojima,&nbsp;Kiyomi Hamaguchi,&nbsp;Koichi Omori","doi":"10.1016/j.anl.2024.06.002","DOIUrl":"10.1016/j.anl.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><p>Tracheoesophageal puncture (TEP) is one of the most established methods for voice reacquisition following total laryngectomy. The most difficult complication following TEP is the management of saliva leakage or secretion into the trachea due to TE fistula enlargement. In this study, we devised a new strategy to close TE fistulas and confirmed its safety and effectiveness.</p></div><div><h3>Methods</h3><p>Skin incision: If the tracheal mucosa around the voice prosthesis appears intact and normal, an arcuate incision, from 10 to 2 o'clock, is made on the skin 5 mm superior to the edge of the stoma. However, if the surrounding tracheal mucosa is fragile because of leaking, the incision is made on the superior edge of the stoma, with later reconstruction of the posterior tracheal wall. Separation of the trachea and esophagus: If the esophagotracheal spatium appears normal and is easy to dissect, the connective pipes can be found easily. After cutting the pipe, a ligature alone is sufficient for the tracheal side; however, the esophageal wall is closed with Gambee sutures. If the esophagotracheal spatium is compromised and the posterior tracheal wall is fragile (due to saliva leakage), we remove the posterior wall and reconstruct the area using the superior skin flap. We performed our novel method on four patients with intractable conditions; postradiotherapy for laryngeal cancer, total pharyngo-laryngo-esophagectomy (TPLE) with jejunum reconstruction, TPLE with gastric lifting reconstruction, and in a patient who underwent cervicothoracic incisional drainage for descending necrotizing mediastinitis.</p></div><div><h3>Results</h3><p>None of the cases showed postoperative leakage from the fistula, and oral intake was resumed without difficulty.</p></div><div><h3>Conclusion</h3><p>This study showed that this strategy based on TE fistula conditions is effective even in difficult-to-treat cases.</p></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 4","pages":"Pages 774-778"},"PeriodicalIF":1.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322125","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}