American Journal of Otolaryngology最新文献

{"title":"A machine learning approach to predicting postoperative recurrence in pediatric chronic rhinosinusitis: identification of key metabolic biomarkers","authors":"Shenghao Cheng,&nbsp;Sijie Jiang,&nbsp;Shaobing Xie,&nbsp;Benjian Zhang,&nbsp;Hua Zhang,&nbsp;Junyi Zhang,&nbsp;Zhihai Xie,&nbsp;Weihong Jiang","doi":"10.1016/j.amjoto.2025.104676","DOIUrl":"10.1016/j.amjoto.2025.104676","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric chronic rhinosinusitis (CRS) is a common chronic inflammatory disease with a high recurrence rate after surgery. This study aimed to construct and validate a machine learning-based predictive model to predict the risk of postoperative recurrence of pediatric CRS and to identify potential biomarkers.</div></div><div><h3>Methods</h3><div>One hundred and fifteen pediatric patients who underwent functional endoscopic sinus surgery were included. The dataset was divided into training and testing sets (7:3 ratio). Demographic characteristics and laboratory data of were collected and used as features in the predictive models. Eight machine learning algorithms, including Random forest (RF), were applied to construct predictive models. Feature selection was performed, and hyperparameters were optimized using a grid search with 10-fold cross-validation. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and F1 score.</div></div><div><h3>Results</h3><div>The Random Forest model performed best in predicting the postoperative recurrence of CRS in children, with AUC of 0.830. Feature selection analyses showed that metabolic markers, such as DBIL, Glu, and TBIL, had an important role in predicting CRS recurrence. In the test set, the AUC of the RF model reached 0.864 and an F1 score of 0.9, showing good stability and generalization ability.</div></div><div><h3>Conclusion</h3><div>In this study, we successfully constructed a model to predict the postoperative recurrence of pediatric CRS. The predictive model indicated that key metabolites were significantly associated with disease outcomes, and individualized management of postoperative pediatric CRS.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104676"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069773","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":"Developing a smart system for binary classification of disordered voices using machine learning","authors":"Yat Chun Au,&nbsp;Manwa L. Ng","doi":"10.1016/j.amjoto.2025.104672","DOIUrl":"10.1016/j.amjoto.2025.104672","url":null,"abstract":"<div><h3>Objectives</h3><div>Voice disorder is characterized by disruptions in voice quality caused by issues in vocal fold vibration during phonation. The study explored the application of machine learning, based on the Random Forest (RF) and Decision Tree (DT) models, in the classification of normophonic and disordered voices using acoustic features. The RF and DT classifiers were compared, and the diagnostic utility of individual acoustic parameters was evaluated across multilingual databases, with an emphasis on Cantonese voice samples.</div></div><div><h3>Methods</h3><div>Sustained vowel /a/ recordings were extracted from the Saarbruecken Voice Database, the Perceptual Voice Qualities Database, and a local Cantonese clinical repository. A total of 1986 samples were used for training and testing. Twenty-nine acoustic features were extracted using Parselmouth, a Python interface to Praat. RF and DT models were trained on overseas data and validated on local Cantonese recordings. The RF and DT models were compared based on classification accuracy, sensitivity, specificity, and F1-score. Feature importance was assessed using Mean Decrease in Impurity (MDI) and Mean Decrease in Accuracy (MDA). Receiver Operating Characteristic (ROC) analysis was performed to evaluate the discriminative ability of each acoustic parameter by sex and dataset origin.</div></div><div><h3>Results</h3><div>The RF model outperformed the DT model, with RF achieving an accuracy of 89 %, precision of 79 %, and F1 score of 77 %, compared to 78 % accuracy and 61 % F1 score associated with DT. RF demonstrated superior true positive and negative rates, and lower false negative rates, making it more suitable for clinical applications. Acoustic feature analysis identified age, CSID, and shimmer and jitter measures as key contributors to classification performance. ROC analyses revealed that CSID and stdevF0Hz were reliable discriminators for male voices, while CSID, localabsoluteJitter, apq11Shimmer, and localdbShimmer demonstrated strong classification performance in female voices across all datasets. However, threshold variability between local and overseas datasets highlights the need for population-specific calibration.</div></div><div><h3>Conclusion</h3><div>This study underscores the potential of machine learning, particularly the RF algorithm, in enhancing the accuracy of voice disorder diagnosis by automating acoustic feature analysis. The integration of such models into clinical practice could offer more reliable, non-invasive methods for early detection and management of voice disorders, thus improving patient outcomes. Future research should focus on expanding dataset diversity and further validation to enhance the generalizability and clinical applicability of these findings.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 4","pages":"Article 104672"},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071765","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 prognostic value of systemic immune-inflammation index and lymphocyte-to-monocyte ratio in cases with profound sudden sensorineural hearing loss","authors":"Kun Zhao,&nbsp;Hongfeng Ma","doi":"10.1016/j.amjoto.2025.104671","DOIUrl":"10.1016/j.amjoto.2025.104671","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the prognostic value of SII and LMR in predicting hearing recovery outcomes in profound SSHL cases.</div></div><div><h3>Methods</h3><div>The relationships between inflammatory markers and hearing outcomes were assessed using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive accuracy of SII and LMR for recovery outcomes.</div></div><div><h3>Results</h3><div>The study revealed that SII and LMR were linked to hearing recovery in profound SSHL. Cases in the complete recovery group had significantly lower SII (806.57 ± 217.26) and higher LMR (2.14 ± 0.94) compared to those in the partial and no recovery groups (<em>P</em> &lt; 0.001 for both). Multivariate logistic regression identified Tbil, SII, and LMR as independent predictors of recovery outcomes. Higher SII and lower LMR were significantly associated with poor recovery, while lower SII and higher LMR predicted better recovery. ROC curve analysis showed that SII and LMR had moderate predictive power for partial recovery (AUC: 0.668 for SII, 0.696 for LMR) and excellent predictive power for no recovery (AUC: 0.804 for SII, 0.819 for LMR). The combination of SII and LMR further enhanced predictive accuracy (AUC: 0.879 for no recovery).</div></div><div><h3>Conclusion</h3><div>SII and LMR are valuable biomarkers for predicting recovery outcomes in cases with profound SSHL. Elevated SII and reduced LMR are associated with poor recovery, while lower SII and higher LMR suggest a favorable prognosis. The combined use of these markers improves the accuracy of prognosis prediction and could guide clinical management in SSHL cases.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 4","pages":"Article 104671"},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943314","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 Characteristics, Concomitant Malformations and Hearing Status in Congenital Microtia - A Retrospective Analysis of 635 Cases","authors":"Weiliang Zhao ,&nbsp;Sijun Zhao ,&nbsp;Min Wang ,&nbsp;Zhong Xie ,&nbsp;Lihua Xie ,&nbsp;Min Huang ,&nbsp;Xiangyue Peng ,&nbsp;Guanghui Zhu","doi":"10.1016/j.amjoto.2025.104668","DOIUrl":"10.1016/j.amjoto.2025.104668","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to investigate the clinical characteristics of congenital microtia, providing valuable insights for its diagnosis and treatment.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the medical records of 635 patients with congenital microtia admitted to our hospital between July 2017 and July 2021. Patients were categorized based on the presence of concomitant malformations, including craniofacial, cutaneous, and limb skeletal deformities. Mastoid CT scans were used to assess the prevalence of inner ear malformations and middle ear inflammation. Additionally, pure-tone audiometry and auditory brainstem response (ABR) tests were performed to compare the median hearing thresholds across various frequencies, including air conduction, bone conduction, and ABR.</div></div><div><h3>Results</h3><div>Of the 635 patients, 111 (17.5 %) exhibited concomitant anomalies. The most common associated anomaly was craniofacial deformities, found in 39.6 % (44 out of 111) of cases. A statistically significant correlation was observed between the severity of auricular deformity and the presence of concurrent craniofacial anomalies (<em>P</em> &lt; 0.05), but no significant correlation was found with other associated anomalies. Furthermore, a significant association was observed between deformities of the external auditory canal and middle ear inflammation (<em>P</em> &lt; 0.05), while no significant link was found between external auditory canal deformities and inner ear malformations. The severity of auricular deformity was significantly correlated with medium to low-frequency air conduction pure-tone hearing thresholds in the 0.25–2 kHz range (<em>P</em> &lt; 0.05), while no significant correlation was identified with high-frequency air conduction thresholds above 2 kHz. Finally, no significant correlation was found between bone conduction pure-tone hearing thresholds, ABR, and the severity of auricular deformity (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>This study provides a comprehensive analysis of the clinical characteristics of congenital microtia. It reveals a clear correlation between increased severity of auricular deformity and a higher likelihood of associated craniofacial anomalies. Additionally, higher thresholds for medium to low-frequency air conduction hearing were linked to more severe auricular deformities. Furthermore, individuals with narrower external auditory canals had a higher prevalence of middle ear inflammation.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 4","pages":"Article 104668"},"PeriodicalIF":1.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069592","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":"Comprehensive analysis of smoking as a risk factor and its prognostic implications in patients with deep neck infections","authors":"Yu-Ching Tseng ,&nbsp;Chia-Ying Ho ,&nbsp;Yu-Chien Wang ,&nbsp;Shy-Chyi Chin ,&nbsp;Shih-Lung Chen","doi":"10.1016/j.amjoto.2025.104669","DOIUrl":"10.1016/j.amjoto.2025.104669","url":null,"abstract":"<div><h3>Background</h3><div>Deep neck infection (DNI) is a potentially life-threatening bacterial infection that affects the anatomical spaces within the neck, with upper airway infections being among the most common etiological factors. Smoking has well-documented local and systemic effects on the respiratory tract, immune system, as well as on the skin and soft tissues. However, the relationship between smoking and the development of DNI remains inadequately addressed in the existing literature. The objective of this study is to investigate the potential association between smoking and the occurrence of DNI.</div></div><div><h3>Methods</h3><div>A total of 332 patients diagnosed with DNI were enrolled in this study. Of these, 81 patients were identified as smokers, while 251 were non-smokers. A comprehensive analysis of relevant clinical data was conducted to assess the potential association between smoking status and clinical outcomes in this cohort.</div></div><div><h3>Results</h3><div>In the univariate analysis, age ≥ 60 years (OR = 3.5161, 95 % CI: 1.0481–11.792, <em>p</em> = 0.0293), elevated C-reactive protein (CRP) levels ≥300 mg/L (OR = 3.9375, 95 % CI: 1.1958–12.965, <em>p</em> = 0.0263), and the involvement of multiple anatomical spaces (≥ 3) (OR = 5.8776, 95 % CI: 1.9446–17.764, <em>p</em> = 0.0012) were identified as statistically significant risk factors for prolonged hospitalization (&gt;14 days) in patients with DNI who were smokers. Upon conducting multivariate analysis, it was found that the involvement of multiple spaces (≥ 3) (OR = 3.7383, 95 % CI: 1.1332–12.331, <em>p</em> = 0.0304) emerged as an independent and significant predictor of prolonged hospitalization in this cohort of smokers. However, no statistically significant differences were observed between the groups in terms of the extent of space involvement, the spectrum of pathogens, or the incidence of complications.</div></div><div><h3>Conclusions</h3><div>This study explored the potential association between smoking and the development of DNI. The findings demonstrated that advanced age, elevated CRP levels, and the involvement of multiple deep neck spaces were significant risk factors for prolonged hospitalization. Multivariate analysis further identified the involvement of three or more deep neck spaces as an independent predictor of extended hospital stay among smokers. Collectively, these results suggest that smokers with DNI exhibit a worse clinical prognosis, which may be attributed to smoking-induced impairments in immune function and upper respiratory tract integrity.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 4","pages":"Article 104669"},"PeriodicalIF":1.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917423","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":"Evaluating advanced AI reasoning models: ChatGPT-4.0 and DeepSeek-R1 diagnostic performance in otolaryngology: a comparative analysis","authors":"Soumil Prasad,&nbsp;Jake Langlie,&nbsp;Luke Pasick,&nbsp;Ryan Chen,&nbsp;Elizabeth Franzmann","doi":"10.1016/j.amjoto.2025.104667","DOIUrl":"10.1016/j.amjoto.2025.104667","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the diagnostic accuracy, comprehensiveness, and clinical relevance of two advanced artificial intelligence (AI) models, OpenAI's ChatGPT-4.0 and DeepSeek-R1, in the field of otolaryngology.</div></div><div><h3>Methods</h3><div>Five common otolaryngology procedures—adenotonsillectomy, tympanoplasty, endoscopic sinus surgery, parotidectomy, and total laryngectomy—were analyzed through standardized queries posed to both AI models<strong>.</strong> Because the prompts replicate questions that patients typically search online, our evaluation focuses on patient-facing informational adequacy. Responses were independently evaluated by two study members for accuracy, clinical relevance, and comprehensiveness, with discrepancies resolved through consensus. The analysis included comparison with clinical guidelines.</div></div><div><h3>Results</h3><div>ChatGPT-4.0 generally provided detailed procedural insights, effectively covering indications, methodologies, risks, and recovery processes. However, it occasionally suggested excessive diagnostic imaging and omitted subtle yet significant surgical nuances. DeepSeek-R1 delivered concise, structured responses clearly categorizing indications, treatment alternatives, and procedural risks. Nonetheless, it frequently lacked detailed elaboration, omitting important surgical techniques and minor complications. For instance, DeepSeek-R1 omitted specifics such as hemostatic techniques in adenotonsillectomy and graft stabilization details in tympanoplasty. Neither model adequately addressed critical elements like comprehensive staging, detailed surgical planning, and long-term recovery nuances, especially for complex procedures such as total laryngectomy.</div></div><div><h3>Conclusions</h3><div>Both ChatGPT-4.0 and DeepSeek-R1 demonstrated significant diagnostic potential but revealed limitations in precision, comprehensiveness, and nuanced clinical reasoning. Their clinical utility remains restricted, highlighting a continued need for AI refinement to enhance patient-specific decision-making capabilities in otolaryngology.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 4","pages":"Article 104667"},"PeriodicalIF":1.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937362","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":"Impact of intraoperative NBI on complete resections and recurrence in oral and oropharyngeal cancer","authors":"Francesca Boscolo Nata ,&nbsp;Rossana Bussani ,&nbsp;Egidio Sia ,&nbsp;Fabiola Giudici ,&nbsp;Paolo Boscolo-Rizzo ,&nbsp;Giancarlo Tirelli","doi":"10.1016/j.amjoto.2025.104630","DOIUrl":"10.1016/j.amjoto.2025.104630","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to assess the number of complete resections and recurrence rates in oral and oropharyngeal squamous cell carcinoma treated with intraoperative narrow-band-imaging.</div></div><div><h3>Materials and methods</h3><div>In this observational study, superficial resection margins of oral and oropharyngeal squamous cell carcinoma were intraoperatively defined using narrow-band-imaging. The number of complete resections was assessed. Patients were followed up for at least 5 years: disease free survival and the cumulative incidence of local recurrence were recorded.</div></div><div><h3>Results</h3><div>93 squamous cell carcinoma were considered. Surgical resection was complete in 84.9 % of cases. The 5-years disease free survival was 76.2 % (95%CI: 67.1 %–84.4 %). Cumulative incidence of local recurrence was 9.7 % (95%CI: 4.7 %–16.7 %), lower compared to previous literature: it was higher in patients over 68 years (14.3 %, 95%CI: 6.2 %–25.6 % vs 4.5 %, 95%CI: 0.8 %–13.8 %) although without statistically significance.</div></div><div><h3>Conclusions</h3><div>In oral and oropharyngeal squamous cell carcinoma surgery, narrow-band imaging is a valuable tool for accurately identifying the true superficial extent of the tumor, facilitating complete resection and potentially reducing local recurrence.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 4","pages":"Article 104630"},"PeriodicalIF":1.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912559","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":"Gender differences in the management of pediatric orbital cellulitis","authors":"Tyler Wanstreet,&nbsp;Amani Kais,&nbsp;Chadi A. Makary,&nbsp;Ruifeng Cui,&nbsp;Hassan H. Ramadan","doi":"10.1016/j.amjoto.2025.104661","DOIUrl":"10.1016/j.amjoto.2025.104661","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to investigate gender differences in the disease severity and management of orbital infections in children hospitalized for treatment.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of all children aged 0 to 18 years who had a confirmed diagnosis of preseptal or postseptal cellulitis and were hospitalized over a 15-year period.</div></div><div><h3>Results</h3><div>The sample consisted of 124 children, 52.4 % male, with mean age of 7.1 years (SD = 4.88, range = 4.9–18) and a relatively equal distribution between preseptal (52.4 %) and postseptal (47.6 %) cellulitis. Although males and females did not differ in rates of preseptal and postseptal cellulitis and Lund-Mackay scores (p &gt; 0.05 for all), males were more likely to undergo surgical management (21.5 % vs 8.5 %; p = 0.049).</div></div><div><h3>Conclusion</h3><div>Additional research is needed to understand why the management of cellulitis differs between male and female pediatric patients and how it may affect treatment outcomes.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104661"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949068","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 surgical outcomes in endoscopic repair of type 1 laryngeal clefts (LC-1) and deep interarytenoid notches (DIN)","authors":"Brooke Swain ,&nbsp;Niketna Vivek ,&nbsp;Oliver Sihua Zhao ,&nbsp;Kalpnaben Patel ,&nbsp;Heidi Chen ,&nbsp;Lyndy Jane Wilcox","doi":"10.1016/j.amjoto.2025.104658","DOIUrl":"10.1016/j.amjoto.2025.104658","url":null,"abstract":"<div><div>The authors conducted a retrospective chart review evaluating the predictors of success for endoscopic repair of type 1 laryngeal clefts (LC-1) or deep interarytenoid notches (DIN). Demographics, birth history, medical comorbidities, surgical details, feeding history, and swallow function were collected (n = 52). Repair success was defined as improvement on videofluoroscopic swallowing study (VFSS) when initially evaluating the procedure's success (n = 36) and patient-reported symptom improvement when assessing predictive factors (n = 48). McNemar or McNemar-Bowker tests evaluated VFSS-assessed symptom improvement. Patients with post-operative symptom documentation were categorized based on predictors in outcome and assessed for post-operative improvement using the Pearson Chi-square test. Postoperatively, 58 % of patients with VFSS-identified aspiration had resolution. Dysphagia severity decreased (p = 0.009) with no severe cases post-repair. Furthermore, pregnancy complications, preterm birth, NICU stay, prior airway and feeding interventions, and syndromes were not significantly correlated with outcomes. However, trends in data suggest that preterm birth and NICU stay are more common in unsuccessful repairs. Overall, operative intervention significantly reduced aspiration and dysphagia severity.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104658"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907988","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":"Pain management after pediatric adenotonsillectomy: Do opioids influence healthcare utilization?","authors":"Tae Ho Koh ,&nbsp;Amy S. Whigham","doi":"10.1016/j.amjoto.2025.104657","DOIUrl":"10.1016/j.amjoto.2025.104657","url":null,"abstract":"<div><h3>Introduction</h3><div>Adenotonsillectomy (AT) is one of the most common outpatient pediatric surgical procedures in the United States. Due to the risks of opioids, guidelines recommend multimodal pain regimens. This study aims to assess differences in healthcare utilization in pediatric postoperative AT patients by postoperative medication regimen.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 699 patients aged 3–18 years who underwent AT from December 2015 to March 2017 was analyzed. Patients were stratified into young children (3–4 years), children (5–12 years), and adolescents (≥13 years). Non opioid regimens of acetaminophen and ibuprofen were recommended for all. Some patients also received an opioid prescription. Total calls made, calls made regarding pain/dehydration (P/D), and ED visits were recorded.</div></div><div><h3>Results</h3><div>There was no significant correlation between opioid prescriptions and calls nor ED visits for P/D in patients ≥5 years. In young children, non-opioid prescriptions were associated with a higher likelihood of any phone call (<em>p</em> = 0.049). White patients had a significantly higher rate of phone calls (<em>p</em> = 0.0183). White and unknown-race patients made significantly more calls (<em>p</em> &lt; 0.001) related to P/D. No racial differences were observed in ED visits.</div></div><div><h3>Conclusion</h3><div>Limiting opioid prescriptions in pediatric AT patients does not appear to impact healthcare utilization. However, in young children, opioid use correlated with fewer phone calls, though not specifically related to P/D. Future prospective studies documenting pain scores and medication administration would more accurately explore the optimization of pain control in pediatric patients after AT.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 5","pages":"Article 104657"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949069","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}