American Journal of Otolaryngology最新文献

{"title":"Nerve dissection technique for excision of parotid tumors: Outcomes controlling for tumor size and location","authors":"Joshua D. Smith ,&nbsp;Owen A.F. Darr ,&nbsp;Catherine T. Haring ,&nbsp;Andrew J. Rosko ,&nbsp;Matthew E. Spector ,&nbsp;Molly E. Heft-Neal","doi":"10.1016/j.amjoto.2024.104582","DOIUrl":"10.1016/j.amjoto.2024.104582","url":null,"abstract":"<div><h3>Purpose</h3><div>We examined operative efficiency, rate of facial nerve paresis, and post-operative outcomes in patients undergoing retrograde (RGD) vs anterograde dissection (AGD) of the facial nerve controlling for tumor location.</div></div><div><h3>Methods</h3><div>Single-institution, retrospective analysis of patients with benign parotid tumors undergoing superficial parotidectomy with facial nerve dissection over a six-year period. Operative and pathology reports were reviewed to classify tumor size, location in relation to facial nerve branches, and technique for facial nerve dissection. Chi-square and Student's <em>t</em>-test were used to compare operative time, rates of facial nerve paresis, and post-operative outcomes between groups.</div></div><div><h3>Results</h3><div>Our cohort included 35 patients who underwent RGD and 70 who underwent AGD of the facial nerve. Pleomorphic adenoma was most common in both the RGD (n = 25, 71.4 %) and AGD (n = 69, 98.6 %) groups. Both groups were balanced for demographics, tumor size and location in relation to facial nerve branches. Operative times, rate of surgical drain use, and frequency of post-operative admission were significantly reduced in the RGD group. The rate of temporary facial nerve paresis was significantly reduced (n = 3, 8.6 % vs n = 30, 42.9 % in the RGD vs AGD groups, respectively, <em>p</em> &lt; 0.001) and more frequently limited to single nerve distributions in the RGD group.</div></div><div><h3>Conclusion</h3><div>RGD of the facial nerve during superficial parotidectomy for benign parotid tumors is associated with reduced operative times, post-operative admission rates, and rates of facial nerve paresis compared to AGD even when controlling for tumor location.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104582"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891422","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":"Proximity to traffic is associated with worse symptom severity in patients with chronic rhinosinusitis with nasal polyps","authors":"Snehitha Talugula ,&nbsp;Sharmilee M. Nyenhuis ,&nbsp;Kamal Eldeirawi ,&nbsp;Victoria S. Lee","doi":"10.1016/j.amjoto.2024.104580","DOIUrl":"10.1016/j.amjoto.2024.104580","url":null,"abstract":"<div><h3>Background</h3><div>Environmental exposures may be associated with increased severity of chronic rhinosinusitis (CRS). However, research examining associations of traffic related air pollution with CRS is limited. The purpose of this study was to determine the association between residential traffic proximity and CRS with nasal polyposis (CRSwNP) severity in an existing database of adults in the United States.</div></div><div><h3>Methods</h3><div>This study was conducted on data gathered from 181 participants documented in the NAVIGATE I and NAVIGATE II randomized control trials within the OPTINOSE database. Zip codes for the testing locations of each participant were recorded and EPA traffic proximity data was extracted for each location. Traffic proximity was defined as the average annual daily traffic at major roads within the zip code. SNOT-22 scores were assessed as a measure of CRSwNP severity. The association between traffic proximity and SNOT-22 scores were determined using multiple linear regression.</div></div><div><h3>Results</h3><div>There were 81 female and 100 male participants. The majority of participants were White not Hispanic (84.5 %). On adjusted regression, there was a weak but significant direct association of increased traffic proximity with SNOT-22 scores (β: 0.003; 95 % CI: 0.0003, 0.006; <em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>Increasing traffic proximity, suggestive of exposure to higher levels of pollution, was significantly associated with increased severity of CRSwNP. These findings suggest that pollutant exposure should be considered in CRS assessment and management. Future prospective studies on the association of traffic related air pollution and how pollutants affect symptom severity, may help to better elucidate the role the environment has in CRS.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104580"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891424","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":"The effect of antibiotic prophylaxis duration on infection rates and outcomes after head and neck reconstruction with bony free flaps and hardware","authors":"Kevin Chacko ,&nbsp;Zhanna Galochkina ,&nbsp;Ji-Hyun Lee ,&nbsp;Dustin Conrad ,&nbsp;Carolyn Dirain ,&nbsp;Peter Dziegielewski","doi":"10.1016/j.amjoto.2024.104584","DOIUrl":"10.1016/j.amjoto.2024.104584","url":null,"abstract":"<div><h3>Background</h3><div>Although the literature supports a shorter course of 24 h of prophylaxis after head and neck free flap reconstruction, studies supporting this duration do not differentiate between flap types. There is a paucity of evidence on the optimal duration of prophylaxis for osteocutaneous free flaps with hardware, which may have higher rates of post-operative complications compared to other free flaps. This study aimed to examine the effect of different lengths of antibiotic prophylaxis on surgical site infection (SSI) rates after head and neck reconstruction with osteocutaneous free flaps and hardware.</div></div><div><h3>Methods</h3><div>In this single-institution retrospective cohort study, 198 patients undergoing head and neck reconstruction with osteocutaneous free flaps and hardware were included. Prophylaxis duration varied: 93 patients received a short course (24–72 h), and 105 patients received a long course (&gt;72 h).</div></div><div><h3>Results</h3><div>Thirty-nine percent of patients in the short course group and 33 % of patients in the long course group developed an SSI within 30 days after surgery (<em>p</em> = 0.460). Rates of hardware exposure within 6 months were 5 % for both groups (<em>p</em> &gt; 0.999).</div></div><div><h3>Conclusions</h3><div>A shorter course of antibiotic prophylaxis did not result in a significant increase in SSI or hardware exposure compared to a longer course of prophylaxis in head and neck reconstruction with osteocutaneous free flaps and hardware. In complex head and neck reconstruction with osteocutaneous free flaps and hardware, a short course of prophylaxis may effectively minimize SSI.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104584"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143159113","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":"Social determinants of health and donor site morbidity in head and neck reconstructive limbs","authors":"Emma Elbert ,&nbsp;Kelly L. Schmidt ,&nbsp;Elena Doctor ,&nbsp;Patrick Tassone ,&nbsp;Tabitha Galloway","doi":"10.1016/j.amjoto.2024.104577","DOIUrl":"10.1016/j.amjoto.2024.104577","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Anterolateral thigh and fibula free tissue transfers are widely used methods of reconstruction in head and neck malignancy, yet the risk factors for donor site morbidity are not well studied. The objective of this study was to characterize anterolateral thigh and fibula free flap donor site morbidity and identify associations with social determinants of health. In 116 patients who underwent anterolateral thigh or fibula free tissue transfer for the reconstruction of head and neck oncologic defects, the presence of a social determinant of health did not lead to an increased rate of donor site morbidity. However, having two or more social determinants was associated with an increased risk of flap failure, and the presence of social determinants may reduce likelihood of patient completion of recommended postoperative physical therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Importance and purpose&lt;/h3&gt;&lt;div&gt;Anterolateral thigh and fibula free tissue transfers are widely used methods of reconstruction in head and neck malignancy, yet the risk factors for donor site morbidity are not well studied. The objective of this study was to characterize anterolateral thigh and fibula free flap donor site morbidity and identify associations with social determinants of health.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design and methods&lt;/h3&gt;&lt;div&gt;This retrospective cohort study examined 116 patients from December 2015 through June 2022 who underwent head and neck oncologic reconstruction with anterolateral thigh or fibula free flaps at a single institution tertiary care center. The one year postoperative period was inspected, and data on outcomes of donor site morbidity, flap failure, and physical therapy completion were collected.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;116 patients (91 male and 25 female) met inclusion criteria. Thirteen (17.6 %) of the 74 anterolateral thigh patients and 22 (52.4 %) of the 42 fibula patients developed any donor site complication within the one year postoperative period. 53.4 % of the population had at least one documented social determinant of health. The presence of a social determinant was not associated with an increase in adverse donor site outcomes compared to patients without documented social determinants (OR = 0.54, 95 % CI 0.24–1.20, &lt;em&gt;p&lt;/em&gt; = 0.135). However, 14.3 % patients with two or more social determinants of health experienced flap failure compared to 1.1 % the those with one or zero social determinants (&lt;em&gt;p&lt;/em&gt; = 0.012). Within the subpopulation that had further post-discharge physical therapy recommendations, 72.7 % of patients with social determinants of health failed to complete this therapy compared to 0 % of patients with no social determinants (&lt;em&gt;p&lt;/em&gt; = 0.026).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and relevance&lt;/h3&gt;&lt;div&gt;The presence of a social determinant of health did not lead to an increased rate of donor site morbidity. However, having two or more social determinants was associated with an increased risk of flap failure, and the pr","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 2","pages":"Article 104577"},"PeriodicalIF":1.8,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143324808","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":"An alternative to neuromodulation for refractory chronic idiopathic cough","authors":"Miles Weinberger","doi":"10.1016/j.amjoto.2024.104505","DOIUrl":"10.1016/j.amjoto.2024.104505","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104505"},"PeriodicalIF":1.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387263","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":"Neurogenic cough: A commentary on the step-up approach and therapeutic considerations","authors":"Nader Wehbi ,&nbsp;Austin Lever ,&nbsp;David Ahmadian ,&nbsp;Claire Gleadhill ,&nbsp;Helena T. Yip","doi":"10.1016/j.amjoto.2024.104506","DOIUrl":"10.1016/j.amjoto.2024.104506","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104506"},"PeriodicalIF":1.8,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357587","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":"A national survey of otolaryngologists' perspectives on uses and barriers to palliative care","authors":"Soraya Fereydooni ,&nbsp;Ashley R. Wang ,&nbsp;Hemali P. Shah ,&nbsp;Avanti Verma","doi":"10.1016/j.amjoto.2024.104507","DOIUrl":"10.1016/j.amjoto.2024.104507","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104507"},"PeriodicalIF":1.8,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142374979","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":"Transoral non-robotic surgery for oropharyngeal squamous cell carcinoma","authors":"Giancarlo Tirelli ,&nbsp;Simone Zucchini ,&nbsp;Andrea D'Alessandro ,&nbsp;Jerry Polesel ,&nbsp;Fabiola Giudici ,&nbsp;Alberto Vito Marcuzzo ,&nbsp;Paolo Boscolo-Rizzo ,&nbsp;Nicoletta Gardenal","doi":"10.1016/j.amjoto.2024.104504","DOIUrl":"10.1016/j.amjoto.2024.104504","url":null,"abstract":"<div><h3>Purpose</h3><p>This retrospective cohort study aims to evaluate the clinical, oncological, and functional outcomes of transoral non-robotic surgery for oropharyngeal squamous cell carcinoma (OPSCC).</p></div><div><h3>Materials and methods</h3><p>Data from 131 patients with surgically treated OPSCC (2010-2022) were analyzed. Patients who underwent exclusively transoral surgery were included in the study. The surgeries were performed under microscopic or endoscopic guidance and either a CO₂ laser or an ultrasound/radiofrequency scalpel was used as a cutting instrument, depending on the characteristics and location of the tumor. Functional outcomes were assessed in terms of length of hospital stay, tracheostomy rate, duration of feeding tube dependency and complications. Survival outcomes were assessed in terms of overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS).</p></div><div><h3>Results</h3><p>Of 74 included patients, transoral surgery demonstrated safety with no major complications. Tracheotomy was performed in 51.4 % of cases, and was maintained for a median of 10 days. Complete swallowing recovery was restored in 97.3 % of cases, after a median of 5 days. The median length of hospital stay was 12 days. At 5 years, OS was 68.2 %, PFS was 58.2 % and DSS was 83.6 %.</p></div><div><h3>Conclusion</h3><p>The study confirms the safety and efficacy of a transoral approach for OPSCC. Having the capability to utilize and access a variety of tools provides the opportunity to tailor the technique to the individual patient and specific circumstances.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104504"},"PeriodicalIF":1.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238822","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":"Improving readability and comprehension levels of otolaryngology patient education materials using ChatGPT","authors":"Allison D. Oliva,&nbsp;Luke J. Pasick,&nbsp;Michael E. Hoffer,&nbsp;David E. Rosow","doi":"10.1016/j.amjoto.2024.104502","DOIUrl":"10.1016/j.amjoto.2024.104502","url":null,"abstract":"<div><h3>Objective</h3><p>A publicly available large language learning model platform may help determine current readability levels of otolaryngology patient education materials, as well as translate these materials to the recommended 6th-grade and 8th-grade reading levels.</p></div><div><h3>Study design</h3><p>Cross-sectional analysis.</p></div><div><h3>Setting</h3><p>Online using large language learning model, ChatGPT.</p></div><div><h3>Methods</h3><p>The Patient Education pages of the American Laryngological Association (ALA) and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) websites were accessed. Materials were input into ChatGPT (OpenAI, San Francisco, CA; version 3.5) and Microsoft Word (Microsoft, Redmond, WA; version 16.74). Programs calculated Flesch Reading Ease (FRE) scores, with higher scores indicating easier readability, and Flesch-Kincaid (FK) grade levels, estimating U.S. grade level required to understand text. ChatGPT was prompted to “translate to a 5th-grade reading level” and provide new scores. Scores were compared for statistical differences, as well as differences between ChatGPT and Word gradings.</p></div><div><h3>Results</h3><p>Patient education materials were reviewed and 37 ALA and 72 AAO-HNS topics were translated. Overall FRE scores and FK grades demonstrated significant improvements following translation of materials, as scored by ChatGPT (<em>p</em> &lt; 0.001). Word also scored significant improvements in FRE and FK following translation by ChatGPT for AAO-HNS materials overall (<em>p</em> &lt; 0.001) but not for individual topics or for subspecialty-specific categories. Compared with Word, ChatGPT significantly exaggerated the change in FRE grades and FK scores (<em>p</em> &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Otolaryngology patient education materials were found to be written at higher reading levels than recommended. Artificial intelligence may prove to be a useful resource to simplify content to make it more accessible to patients.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104502"},"PeriodicalIF":1.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087879","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 head and eye dynamic may explain saccades in dizzy patients with normal VOR gain","authors":"C. Orsini ,&nbsp;A.M. Cedras ,&nbsp;A. Sam Pierre ,&nbsp;J. Dion ,&nbsp;M. Maheu","doi":"10.1016/j.amjoto.2024.104503","DOIUrl":"10.1016/j.amjoto.2024.104503","url":null,"abstract":"<div><h3>Objective</h3><p>Compare the vestibulo-ocular reflex (VOR) gain, compensatory saccades and head and eye coordination during head impulses between patients with dizziness but normal VOR gain and healthy controls.</p></div><div><h3>Methods</h3><p>Video head impulses test (vHIT; ICS impulse, Otometrics, Denmark) was reviewed in 40 participants (20 patients with dizziness; 20 controls). VOR gain, saccades characteristics (frequency of occurrence, amplitude, latency) and time difference between head and eye velocity was compared.</p></div><div><h3>Results</h3><p>No significant difference between groups was observed for VOR gain. However, saccade frequency was greater and time difference between head and eye was prolonged in patients with dizziness. No significant difference was observed for saccade amplitude, nor for saccade latency between groups.</p></div><div><h3>Conclusions</h3><p>The present study highlights that saccades observed in patients with normal VOR gain could reflect a clinical marker for dizziness in patients with normal VOR gain. We propose that theses saccades are caused by a prolonged time delay between head and eye velocity leading to a gaze position error.</p></div><div><h3>Significance</h3><p>The results support previous findings suggesting additional value of saccades and time delay when interpreting vHIT results. This study goes further by proposing time delay as a possible mechanism to explain increased saccade frequency in dizzy patients with normal VOR gain.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104503"},"PeriodicalIF":1.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122612","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}