American Journal of Otolaryngology最新文献

{"title":"What is the robustness of randomized controlled trials supporting rhinosinusitis guidelines?","authors":"Najm S. Khan ,&nbsp;Aatin K. Dhanda ,&nbsp;Masayoshi Takashima ,&nbsp;Richard Liu ,&nbsp;Yuki Yoshiyasu ,&nbsp;Wenbo Wu ,&nbsp;Whitney Jin ,&nbsp;Edward D. McCoul ,&nbsp;Murugappan Ramanathan Jr. ,&nbsp;Omar G. Ahmed","doi":"10.1016/j.amjoto.2024.104575","DOIUrl":"10.1016/j.amjoto.2024.104575","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the robustness of randomized controlled trials (RCTs) supporting the current rhinosinusitis guideline; International Consensus Statement on Allergy and Rhinology: rhinosinusitis (ICAR-RS).</div></div><div><h3>Materials &amp; methods</h3><div>RCTs referenced by ICAR-RS with primary dichotomous outcomes were analyzed. The Fragility Index (FI) was calculated for trials with statistically significant findings. Trial characteristics, the FI, and FI minus number lost to follow-up (LTF) were assessed for associations.</div></div><div><h3>Results</h3><div>A total of 317 RCTs were identified, with 38 trials possessing a primary dichotomous outcome. Thirty-one percent evaluated surgical interventions and 24 % were industry-sponsored. The mean sample size was 116 with 9 patients, on average, LTF. Sixty-three percent were eligible for FI calculation and had a median FI of 2.5 (IQR 1, 4.25). Sixty-seven percent of trials had an FI ≤ 3, indicating low robustness. No difference in FI was observed between trials with and without industry support (<em>p = 0.</em>577). The FI was less than or equal to the number of patients LTF in 33 % of trials (<em>n</em> = 8). Higher FI was strongly correlated with higher sample size, total number of events, <em>p</em>-value, and grade of recommendation (<em>p &lt; 0.001)</em>. After adjusting for covariates, higher sample size and total number of events were associated with higher FI.</div></div><div><h3>Conclusion</h3><div>The RCTs used to support the ICAR-RS have an overall low robustness and future rhinosinusitis trials should report FI measures to provide improved context of their results.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104575"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909074","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":"Characterization, prognostic factors, and clinical profile of ear infections by Turicella otitidis: Revealing the emerging rise of a controversial pathogen","authors":"Joan Lorente-Piera ,&nbsp;David Terrasa ,&nbsp;Manuel Pina ,&nbsp;José Leiva ,&nbsp;Francisco Javier Cervera-Paz","doi":"10.1016/j.amjoto.2024.104574","DOIUrl":"10.1016/j.amjoto.2024.104574","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Environmental changes and modifications in leisure habits have facilitated the emergence of new bacteria responsible for causing ear infections with different presentations. In this context, &lt;em&gt;Turicella otitidis&lt;/em&gt; is a pathogen for which isolated cases of external and middle ear infections have been reported. However, our experience indicates a resurgence in its occurrence in recent years. The main objective of this study is to examine the possible connection between &lt;em&gt;T. otitidis&lt;/em&gt; and the most frequent clinical ear manifestations, as well as the associated demographic characteristics. Additionally, it seeks to analyze the temporal evolution of the frequency of &lt;em&gt;T. otitidis&lt;/em&gt; isolates and determine the overall antibiotic sensitivity pattern of this microorganism.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and methods&lt;/h3&gt;&lt;div&gt;A retrospective cohort study was conducted, including samples of ear exudates with &lt;em&gt;T. otitidis&lt;/em&gt; from patients in the departments of Otorhinolaryngology, Pediatrics, and Emergency over the past seven years (2017–2024). Cultures were taken using fluid collection devices from the external ear in cases of diffuse external otitis (DEO) or through active, wet perforation in patients with acute otitis media (AOM) or chronic suppurative otitis media (COM). The bacterial cultures were grown using the PCR method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;67 patients (71 ears) were included, with a mean age of 19.45 ± 22.30 years, and 62.69 % (&lt;em&gt;n&lt;/em&gt; = 42) being pediatric patients. The most frequent presentation was acute suppurative otitis media (AOM), accomplishing recurrent acute otitis media (rAOM) criteria in 32.35 % of cases, followed by diffuse external otitis (DEO) in 41.79 % (&lt;em&gt;n&lt;/em&gt; = 28) of the cases. The relationship between &lt;em&gt;T. otitidis&lt;/em&gt; and age, and between &lt;em&gt;T. otitidis&lt;/em&gt; and the risk of rAOM, was statistically significant (&lt;em&gt;p&lt;/em&gt; &lt; 0.001 and &lt;em&gt;p&lt;/em&gt; = 0.01, respectively). Additionally, chronic adenoiditis/adenoid obstruction combined with age was significantly related to the risk of recurrent infections (&lt;em&gt;p&lt;/em&gt; = 0.02). Conversely, there was no significance when studying age with the risk of rAOM caused by &lt;em&gt;T. otitidis&lt;/em&gt; alone (&lt;em&gt;p&lt;/em&gt; = 0.77).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study highlights the importance of preventing and treating ear infections caused by &lt;em&gt;Turicella otitidis&lt;/em&gt;, especially in the context of migration and changes in leisure habits. The pathogenic role of &lt;em&gt;T. otitidis&lt;/em&gt; is debated, suggesting its involvement in various ear infections with antibiotic resistance. Preventive measures should include maintaining good ear hygiene, regular monitoring, and appropriate antibiotic selection based on susceptibility profiles. Further research is needed to clarify its pathogenic role and its relationship with factors such as age and adenoid obstruction. Despite limitations, this study expands knowledge on these e","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104574"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891417","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":"Olfactory cleft brushing: A minimally invasive tool for biomarker analysis in rhinology","authors":"Beatrice Francavilla ,&nbsp;Gianluca Velletrani ,&nbsp;Denise Fiorelli ,&nbsp;Goran Latif Omer ,&nbsp;Francesco Maria Passali ,&nbsp;Marzia Nuccetelli ,&nbsp;Stefano Di Girolamo","doi":"10.1016/j.amjoto.2024.104589","DOIUrl":"10.1016/j.amjoto.2024.104589","url":null,"abstract":"<div><h3>Introduction</h3><div>Olfactory dysfunction is a prevalent condition associated with post-viral syndromes, chronic rhinosinusitis, and neurodegenerative diseases. While olfactory cleft sampling has been investigated in neurology, its potential for assessing localized biomarkers in rhinological conditions remains underexplored. This study presents a minimally invasive nasal brushing technique specifically targeting the olfactory cleft, enabling simultaneous biomarker quantification and cytological analysis. A comprehensive literature review was performed to highlight its potential utility in both clinical practice and research.</div></div><div><h3>Methods</h3><div>Nasal brushing was performed under endoscopic guidance in the olfactory cleft using a cytology brush. Samples were processed to quantify localized biomarkers, including calprotectin, circulating immune complexes, and anti-endothelial cell antibodies, among others. Cytological analysis evaluated cellular composition and inflammatory changes. A literature review focused on nasal brushing applications for biomarker collection across rhinology and other fields.</div></div><div><h3>Results</h3><div>This technique allowed precise biomarker analysis specific to the olfactory cleft, demonstrating feasibility and reproducibility. The procedure was well-tolerated, with only minor discomfort and occasional spotting reported. Cytological analysis revealed preserved cellular architecture and inflammatory changes in patients with olfactory dysfunction. Reproducibility testing demonstrated consistent biomarker levels (Spearman correlation 0.9) and stable cytological findings.</div></div><div><h3>Conclusion</h3><div>Olfactory cleft brushing provides a minimally invasive and reproducible approach for assessing localized biomarkers and cytological characteristics in olfactory dysfunction. By focusing on the olfactory cleft, this method offers a targeted tool for advancing the diagnosis and understanding of OD, CRS, and related rhinological conditions.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104589"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891423","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":"Systemic immune inflammation index combined with Epstein–Barr virus DNA for predicting the prognosis of nasopharyngeal carcinoma: A retrospective study","authors":"Han Jie Lin ,&nbsp;Jing-Gu Jiang ,&nbsp;Ping-Yi Lin ,&nbsp;Yu-Hsin Lin ,&nbsp;Wan-Lun Hsu ,&nbsp;Li-Jen Liao","doi":"10.1016/j.amjoto.2024.104571","DOIUrl":"10.1016/j.amjoto.2024.104571","url":null,"abstract":"<div><h3>Background</h3><div>Cancer has consistently been the leading cause of death worldwide, with head and neck cancer (HNC) being one of the top ten causes of cancer-related death. Nasopharyngeal carcinoma (NPC), in particular, is a cancer that is unique to East Asia. Numerous studies have shown that the Epstein–Barr virus (EBV) DNA load and the systemic immune inflammation (SII) index can serve as prognostic indicators for NPC patients. However, no studies have compared different predictive models of inflammatory factors. This study combines the SII and the EBV virus load in patients with stage I to IV NPC and compares different inflammatory factor models to determine the best predictive model.</div></div><div><h3>Materials and methods</h3><div>We reviewed 240 patients with stage I to IV NPC who were diagnosed between January 2016 and July 2023. We collected data from adult patients who were diagnosed with NPC and included those who completed the definitive staging workup and treatment in this analysis. We tested various inflammatory markers and the EBV DNA load via Cox regression for survival analysis.</div></div><div><h3>Results</h3><div>We found that the EBV viral load, the SII, and the SIRI are related to the severity of nasopharyngeal cancer. In the univariate Cox regression analysis, clinical stage, EBV virus load (HR: 2.15, 95 % CI: 1.19–3.90), NLR (2.37, 1.29–4.34), PLR (2.7, 1.06–6.87), SIRI (2.02, 1.11–3.68), and SII (2.45, 1.251–4.89) were prognostic factors for overall survival. In the multivariate analysis, after adjusting for sex, age and clinical stage, a higher EBV virus load and SII were associated with a worse prognosis (HR: 4.71, 1.95–11.41).</div></div><div><h3>Conclusion</h3><div>The combination of the EBV viral load and the SII was a better predictor of NPC prognosis.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104571"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876025","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":"Pediatric endoscopic sinus surgery: Revisited 35 years later","authors":"Julian A. Purrinos ,&nbsp;Ramzi Younis","doi":"10.1016/j.amjoto.2024.104567","DOIUrl":"10.1016/j.amjoto.2024.104567","url":null,"abstract":"<div><div>Over the past 35 years, pediatric endoscopic sinus surgery (PESS) has significantly evolved from its inception as a novel intervention to become a cornerstone in the management of pediatric sinus disorders. This evolution is reflective of a broader shift towards a more nuanced understanding and treatment of pediatric chronic rhinosinusitis (PCRS), marked by the introduction of comprehensive guidelines and the refinement of surgical indications. Recent literature and the extensive experience of the senior author, who has been at the forefront of utilizing PESS since its inception, highlight a noticeable shift in the procedure's utilization. This paper reviews the journey of PESS, highlighting the impact of advancements in medical treatment modalities, such as improved diagnostic techniques and the adoption of less invasive procedures. The development and optimization of PESS are discussed in the context of changing practice patterns, including the prevalent use of adenoidectomy and the selective application of PESS for refractory cases. An emphasis is placed on the outcomes associated with different surgical interventions for PCRS, highlighting their efficacy in alleviating symptoms and managing underlying conditions. The paper concludes by emphasizing the importance of ongoing innovation and collaborative research in further refining surgical techniques and expanding treatment options, with the ultimate goal of delivering safe, effective, and patient-centered care to children with sinus-related disorders. This retrospective analysis demonstrates a commitment to enhancing the quality of life for pediatric patients, reflecting the substantial progress achieved in the field of pediatric otolaryngology over the last three decades.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104567"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884838","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":"Impact of age stratification on risk of lymph node metastasis in T1 oral tongue squamous cell carcinomas patients","authors":"Yujiao Li,&nbsp;Chaosu Hu","doi":"10.1016/j.amjoto.2024.104532","DOIUrl":"10.1016/j.amjoto.2024.104532","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study is to assess the association between age and lymph nodes metastasis (LNM) in T1 oral tongue squamous cell carcinomas (OTSCC) patients.</div></div><div><h3>Methods</h3><div>Patients with T1 OTSCC were extracted from the SEER database between 2005 and 2014. Univariate and multivariate logistic regression models were produced to recognize the association between age and risk factors of LNM.</div></div><div><h3>Results</h3><div>A total of 3535 patients were analyzed. Younger patients more frequently presented with LNM compared to their older peers (P &lt; 0.01). In multivariate analyses, older age was associated with a significantly lower risk of LNM. Compared to patients aged 12–39-years-old, the hazard ratios for patients aged 40–49, 50–59, 60–69, 70–79 and 80–101 years old were 0.999 (95 % confidence interval [CI] 0.684–1.461), 0.863 (95 % CI 0.611–1.219), 0.972 (95 % CI 0.687–1.373), 0.667 (95 % CI 0.452–0.983), and 0.395 (95 % CI 0.241–0.646), respectively. Subgroups analysis shows that the effect of older age was significantly associated with a lower risk of LNM in Caucasian female who harbored moderately differentiated disease.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that younger patients with T1 OTSCC had a higher risk of LNM than their old peers, especially for tumors with poor differentiation. More accurate assessments of LNM and prophylactic neck dissection or prophylactic adjuvant radiation therapy to neck will be imperative for reducing recurrence in younger T1 OTSCC.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104532"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930501","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":"Treatment of hereditary hemorrhagic telangiectasias with sclerotherapy: A case series","authors":"Jenny Ji ,&nbsp;Andrew M. Peterson ,&nbsp;Jay F. Piccirillo","doi":"10.1016/j.amjoto.2024.104537","DOIUrl":"10.1016/j.amjoto.2024.104537","url":null,"abstract":"<div><h3>Background</h3><div>Hereditary hemorrhagic telangiectasia (HHT) is characterized by abnormal blood vessel formation. One treatment for HHT-related arteriovenous malformations (AVMs) is sclerotherapy, which collapses the blood vessels by irritating the endothelial lining.</div></div><div><h3>Methods</h3><div>This case series describes two HHT patients undergoing in-office sodium tetradecyl sulfate sclerotherapy for non-nasal telangiectasias and AVMs. The first patient had AVMs on the red lip while the second patient had an AVM and several telangiectasias on the tongue.</div></div><div><h3>Results</h3><div>Both patients' AVMs required only one treatment visit and were no longer noticeable within a week. Neither of the patients had any side effects from treatment.</div></div><div><h3>Conclusion</h3><div>Sclerotherapy was used to successfully treat HHT-related AVMs in-office with no scarring and is an option that should be considered by providers.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104537"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823746","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 treatment of adhesive otitis media using cartilage tympanoplasty with plasma radiofrequency ablation tuboplasty","authors":"Zhengcai Lou","doi":"10.1016/j.amjoto.2024.104594","DOIUrl":"10.1016/j.amjoto.2024.104594","url":null,"abstract":"<div><h3>Objective</h3><div>The long-term outcomes of patients with adhesive otitis media (AdOM) treated with a combination of cartilage tympanoplasty and plasma radiofrequency ablation tuboplasty (PRT) were evaluated.</div></div><div><h3>Material and methods</h3><div>Cartilage tympanoplasty with PRT was performed in 21 patients (21 ears) with AdOM who met the inclusion criteria. Graft success, hearing improvement, aeration of the tympanic cavity and mastoid computed tomography (CT) scans and complications were evaluated during a 2-year follow-up period.</div></div><div><h3>Results</h3><div>The mean follow-up was 26.2 ± 1.7 months (range: 24–28 months). Ossiculoplasty was performed in 19.0 % ears. Hyperplasia and edema of the ET orifice mucosa were significantly reduced after PRT. Successful graft healing and hearing improvement were obtained in 100.0 % ears. 90.5 % patients reported ear fullness improvement and tinnitus improvement in 71.4 %. Mean ABG values were 29.5 ± 6.3 preoperatively and 17.4 ± 9.1 postoperatively; the difference was statistically significant (<em>P</em> &lt; 0.01).</div><div>The 6-month postoperative CT showed that aeration in the tympanic cavity and mastoid was completely restored in 76.2 %, improved in 19.0 %, and no change in 4.8 %. The 12-month postoperative CT revealed that aeration was completely restored in 85.7 % and improved in 14.3 %. Additionally, among the 20 patients with planned tube removal, CT showed partial poor aeration and endoscopic inspection revealed ET orifice stenosis in 15 %, but good aeration in 85 % patients with spontaneous closure. No adhesion or invagination of the TM was evident during the follow-up period, and no PRT-related complications were detected.</div></div><div><h3>Conclusions</h3><div>Despite limitations including a small sample size and lack of controls, our study showed that cartilage tympanoplasty with PRT is a safe, simple, and effective surgical method for the management of AdOM.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104594"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143159438","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":"Comprehensive analysis of Burkholderia species head and neck infections: A systematic review","authors":"Douglas P. Nanu ,&nbsp;Alejandro R. Marrero-Gonzalez ,&nbsp;Shaun A. Nguyen ,&nbsp;Jason G. Newman","doi":"10.1016/j.amjoto.2024.104544","DOIUrl":"10.1016/j.amjoto.2024.104544","url":null,"abstract":"<div><h3>Objective</h3><div>To report the first systematic review and meta-analysis of <em>Burkholderia</em> species infections of the head and neck to facilitate understanding of the disease's demographics, mortality rate, comorbidities associated, symptoms, and antibiotic treatments utilized.</div><div>Data Sources.</div><div>COCHRANE Library, CINAHL, PubMed, and Scopus.</div><div>Review Methods.</div><div>A systematic review and meta-analysis were performed using PRISMA reporting guidelines. Inclusion criteria included non-surgical patients who were diagnosed with any head and neck Burkholderia infection. Demographics included, patient age and gender. Symptoms, antibiotics given, bacteriology, comorbidities and mortality were analyzed. Meta-analysis of continuous measures (mean), and proportions (%) with a 95 % confidence interval (CI) was conducted. Studies were accessed for bias via the JBI appraisal tool.</div></div><div><h3>Results</h3><div>There were 740 studies screened with 45 studies (<em>N</em> = 132) being included. In total, 50.1 % were females (95 % CI: 43–57) with a mean patient age of 28.7 years (95 % CI: 25.9 to 31.5). Overall survival rate was 83.4 % (95 % CI: 77.5 to 88.4) and predominant localized symptoms were neck swelling at 38.4 % (95 % CI: 27.5 to 49.9), followed by neck abscess at 34.1 % (27.5 to 41.2) and head and neck suppurative lymphadenitis at 22.9 % (17.3 to 29.4). Main antibiotic treatments included: trimethoprim-sulfamethoxazole at 63.0 % (95 % CI: 55.9 to 69.8), ceftazidime at 47.9 % (40.7 to 55.1), and doxycycline at 26.7 % (10.7 to 33.5).</div></div><div><h3>Conclusion</h3><div><em>Burkholderia</em> infections exhibit diverse symptoms, which pose a challenge in diagnosis. Additionally, prescription of non-guideline antibiotics highlights the initial difficulty in identifying these organisms as the primary culprit of infection causing delayed treatment.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104544"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783886","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":"Posterior nasal nerve surgical neurectomy versus ablation for chronic rhinitis","authors":"Sainiteesh Maddineni,&nbsp;Peter H. Hwang,&nbsp;Zara M. Patel,&nbsp;Jayakar V. Nayak,&nbsp;Michael T. Chang","doi":"10.1016/j.amjoto.2024.104553","DOIUrl":"10.1016/j.amjoto.2024.104553","url":null,"abstract":"<div><h3>Introduction</h3><div>For chronic rhinitis (CR) refractory to medical management, several ablative procedures exist that target the posterior nasal nerve (PNN). Here we compare outcomes of PNN surgical neurectomy to in-office ablative procedures.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with CR who trialed ipratropium at our center from 2013 to 2024 and received PNN ablation (cryoablation or radiofrequency) or neurectomy. We used the SNOT-22 questionnaire to assess outcomes, specifically evaluating the rhinologic subdomain: need to blow nose, sneezing, runny nose, nasal obstruction, loss of smell, cough, post-nasal discharge, and thick nasal discharge.</div></div><div><h3>Results</h3><div>Our cohort consisted of 55 patients, 34 receiving PNN ablation and 26 receiving surgical neurectomy (9 receiving both). Mean follow-up time was 243 ± 353 days. Surgical neurectomy (18.6 ± 5.5 to 14.9 ± 5.9, <em>p</em> = 0.02) were associated with significant SNOT-22 rhinologic domain improvements, and neurectomy was associated with significant rhinorrhea improvement (3.4 ± 1.6 to 2.4 ± 1.7, <em>p</em> = 0.04). Surgical neurectomy was associated with a greater decrease in sneezing (p = 0.04) scores than ablation, although there were no significant differences in total or rhinologic subdomain SNOT-22 scores between ablation and neurectomy. No clear improvements were observed in patients undergoing a neurectomy following ablation. Multivariable logistic regression analysis did not reveal any predictors of post-procedure improvement.</div></div><div><h3>Conclusion</h3><div>Both surgical neurectomy and in-office ablation were associated with improvements in rhinologic symptoms for patients with CR, although neurectomy may have increased benefit for specific symptoms like sneezing. There is limited evidence that secondary procedure after an initial ablation is beneficial.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104553"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806065","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}