American Journal of Otolaryngology最新文献

{"title":"Endoscopic cartilage underlay myringoplasty with or without balloon Eustachian tuboplasty for chronic perforation with Eustachian tube dysfunction","authors":"","doi":"10.1016/j.amjoto.2024.104475","DOIUrl":"10.1016/j.amjoto.2024.104475","url":null,"abstract":"<div><h3>Objective</h3><p>The objective of this study was to compare the outcomes of endoscopic cartilage underlay myringoplasty(CNM) with or without balloon Eustachian tuboplasty (BET) for the treatment of chronic perforation with Eustachian tube dysfunction (ETD).</p></div><div><h3>Materials and methods</h3><p>A total of 50 ears diagnosed with chronic perforation and ETD were randomly divided into receiving alone CNM and CNM + BET. During the 12 months follow-up, the Eustachian tube score (ETS), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), ET inflammation scale, hearing results and graft success rate of the patients were recorded and analyzed.</p></div><div><h3>Results</h3><p>The improvement in the ETDQ-7 score was 6.23 ± 2.51 in the CNM + BET group, which was significantly higher than that in the CNM group (4.22 ± 3.85, <em>P</em> &lt; 0.01) at postoperative 3 months, however, no significant between-group difference was found at post-12 months.The graft success rate was 88.0 % in the CNM group and 92.0 % in the CNM + BET group at postoperative 3 months (<em>P</em> &gt; 0.05). Also, no significant difference was found among two groups (84.0 % vs 88.0 %, <em>P</em> &gt; 0.05).The ABG improvement was 13.16 ± 3.19 dB in the CNM + BET group and 9.74 ± 2.56 dB in the CNM group, with a statistically significant between-group difference (<em>P</em> &lt; 0.01)at postoperative 3 months. However, no significant between-group difference was found at postoperative 12 months. During followup process, neither complications nor patulous symptoms were noted. No patients developted atelectasis or otitis media with effusion. However, myringitis was seen in 8 % patients in the CNM group and 12 % patients in the CNM + BET group.</p></div><div><h3>Conclusions</h3><p>Although BET combined with endoscopic cartilage myringoplasty had better short-term improvement of hearing and ETDQ-7 scores compared with endoscopic cartilage myringoplasty for the treatment of chronic large perforation with ETD, the long-term outcomes was not satisfactory. Also, BET did not improve the 3-and 12 months graft success rate.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911342","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":"Predictive nomograms and an algorithm for managing patients with probable Meniere's disease","authors":"","doi":"10.1016/j.amjoto.2024.104472","DOIUrl":"10.1016/j.amjoto.2024.104472","url":null,"abstract":"<div><h3>Purpose</h3><p>To explore the efficacy of diagnostic tests in accurately reclassifying patients initially diagnosed with probable Meniere's disease (MD) into either definite or non-MD categories.</p></div><div><h3>Materials and methods</h3><p>A retrospective cohort study was conducted at a neurotology clinic between 1/2016 and 5/2022. Patients underwent a battery of tests, from which sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios, were calculated. Additionally, prediction nomograms were developed.</p></div><div><h3>Results</h3><p>Of the 69 patients, 25 (36.2 %) were initially classified as definite MD, 21 (30.4 %), probable MD, and 23 (33.4 %) non-MD. The mean follow-up was 3.5 years. The sensitivity of electrocochleography (ECochG) was the highest (92 %), with a negative likelihood ratio of 15 %. Magnetic resonance imaging (MRI) with MD-protocol had the highest specificity (100 %), with a positive likelihood ratio of 100 %. Videonystagmography, video head impulse test, and cervical vestibular-evoked myogenic potentials, had lower sensitivity and specificity. We were able to reclassify 18 (86 %) patients with probable MD: 12 (57 %) were diagnosed with definite MD, and 6 (29 %) were diagnosed with non-MD, consistent with their clinical course.</p></div><div><h3>Conclusions</h3><p>The combination of ECochG and MRI with MD-protocol provides the most reliable approach to reclassify patients with Probable MD, ensuring a precise and accurate diagnosis. Vestibular tests express the functional status of the labyrinth and may not be reliable. Our findings provide valuable insights into clinical decision-making for patients with Probable MD and raise the consideration of additional diagnostic tests as supplementary to the existing clinical-only diagnosis criteria.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896533","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":"Risk of immediate postoperative fever in PFAPA patients undergoing tonsillectomy1","authors":"","doi":"10.1016/j.amjoto.2024.104470","DOIUrl":"10.1016/j.amjoto.2024.104470","url":null,"abstract":"<div><h3>Objective</h3><p>Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in children. Tonsillectomy is considered a potential treatment option.</p><p>A common concept is that patients with PFAPA are more likely to have postoperative fever, which might be hard to distinguish from other etiologies such as malignant hyperthermia or drug adverse effects. For this reason, many institutions require these patients to be cared for at their main center and not at satellite centers.</p><p>Our objective was to evaluate the rate of immediate postoperative fever in PFAPA patients undergoing tonsillectomy.</p></div><div><h3>Material and methods</h3><p>Following IRB approval (STUDY20060029), a retrospective chart review of all PFAPA patients who underwent tonsillectomy at a tertiary children's hospital between January 1st, 2013, and September 30th, 2022.</p><p>The PHIS database was queried from January 1st, 2013, to June 30th, 2022, for pediatric tonsillectomy and PFAPA.</p></div><div><h3>Results</h3><p>Sixty-one patients underwent tonsillectomy for PFAPA during the study period at our institution. Only one (1.6 %) had immediate postoperative fever. Fever episode resolution was seen in 90.25 % of patients, 41/41 (100 %) of the patients reported fever episodes pre-op, compared with 4/41 (9.75 %) post-op (McNemar's Chi-squared test, Chi2 = 37.0, <em>p</em> &lt; 0.001).</p><p>481,118 pediatric tonsillectomies were recorded in the PHIS database during this period, 1197 (0.25 %) were also diagnosed with PFAPA. None of the PFAPA patients had an immediate post-operative fever.</p></div><div><h3>Conclusions</h3><p>Our results suggest there is no increased risk of immediate postoperative fever in PFAPA patients undergoing tonsillectomy.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900650","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":"Multidisciplinary approach to severe intracranial, intraorbital allergic fungal sinusitis","authors":"","doi":"10.1016/j.amjoto.2024.104478","DOIUrl":"10.1016/j.amjoto.2024.104478","url":null,"abstract":"<div><h3>Background</h3><p>Allergic fungal sinusitis (AFS) is a form of paranasal mycosis that often involves bone destruction and can extend into the orbit and anterior skull base. Intracranial and intraorbital involvement are published but not both in each included patient of a series. The purpose of the present study was to review cases of extensive AFS with orbital or/and skull base erosion, including the presenting symptoms, patient socioeconomic background, imaging features, surgical technique, and post-operative outcomes.</p></div><div><h3>Methods</h3><p>The records of 30 patients with the histological diagnosis of AFS and both intracranial and intraorbital involvement were reviewed.</p></div><div><h3>Results</h3><p>The average age of the patients was 25.2 years. 83 % of patients were male. 70 % were African American. 66 % of patients had Medicaid or were uninsured. Presenting symptoms were headaches (80 %), nasal obstruction (33 %), proptosis (40 %), vision change (23 %), facial pressure (10 %), and decreased sense of smell (7 %). 100 % of patients had bone erosion observed on computerized tomography scans with disease extending intracranially through the anterior skull base or posterior wall of the frontal sinus along with disease that eroded through the lamina papyracea. All patients had failed medical management. All patients underwent surgery by Otolaryngology, Ophthalmology, and Neurosurgery with transnasal endoscopic approaches and orbitotomy. 80 % also underwent a bifrontal craniotomy for removal of intracranial extradural disease with cranialization. 53 % of patients had orbital implants remaining after surgery; 23 % had nasal stents. There were no postoperative cerebrospinal fluid leaks. Average hospital stay was 4.8 days. Preoperatively, 13 % of patients underwent allergy testing. 94 % saw an Allergist postoperatively. 21 % required follow up surgery.</p></div><div><h3>Conclusions</h3><p>A team approach of Otolaryngologists, Ophthalmologists, and Neurosurgeons is recommended for this slowly growing but locally destructive disease. Most patients with AFS will present with headaches and nasal obstruction. While most cases of AFS can be successfully managed with transnasal endoscopic techniques, orbitotomy and craniotomy represents an effective treatment for severe AFS cases with extensive intracranial and intraorbital involvement. This disease is found most commonly in young African American males and in the underinsured.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0196070924002643/pdfft?md5=fdd0b080cedb6e0145f004a7f94f59c6&pid=1-s2.0-S0196070924002643-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888190","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":"A retrospective analysis of patients who underwent tracheal resection and end-to-end anastomosis surgery for benign tracheal stenosis, over a 10-year period","authors":"","doi":"10.1016/j.amjoto.2024.104463","DOIUrl":"10.1016/j.amjoto.2024.104463","url":null,"abstract":"<div><h3>Introduction</h3><p>Laryngotracheal stenosis encompasses a diverse range of diagnoses, encompassing complete or partial narrowing of various subgroups of the upper airways, including the laryngeal structures and trachea, due to pathological scar formation. This increasingly prevalent pathology is of significant importance due to its potential for life-threatening consequences. Among the defined treatment modalities, tracheal resection and end-to-side anastomosis remain a valuable therapeutic alternative in appropriate indications.</p></div><div><h3>Objective</h3><p>The objective of this study was to retrospectively evaluate the outcomes of patients who underwent tracheal resection and end-to-end anastomosis at our clinic over the past decade.</p></div><div><h3>Material &amp; method</h3><p>All patients who underwent tracheal resection and end-to-end anastomosis surgery for benign tracheal stenosis at the Department of Otolaryngology, Mustafa Kemal University Hospital between 2013 and 2023 were included in the study. The diagnosis of tracheal stenosis was based on endoscopic examination and computed tomography results. Interventions without postoperative symptoms and without the need for additional surgical intervention were considered successful. The study was approved by Hatay Mustafa Kemal University Ethics Committee with decision number 2023/27.</p></div><div><h3>Results</h3><p>A total of 29 patients were included in the study. The mean age of the patients was 26.48 years. 3 patients (10.35 %) had a comorbidity. In all patients orotracheal intubation or intubation and tracheotomy was the aetiological cause. There were no intraoperative complications. In the postoperative period, wound infection was observed in 3 patients (10.35 %) and subcutaneous emphysema in 2 patients (6.9 %). In 1 patient (3.45 %) recurrent respiratory distress was observed, restenosis was considered and tracheotomy was performed. Our complication rate was 20.69 %. When all patients were evaluated at the end of the postoperative follow-up period, the surgical success rate was calculated to be 96.55 %.</p></div><div><h3>Conclusion</h3><p>With a surgical success rate of 96.55 % and a low complication rate in our study, we believe, in parallel with previous studies, that open surgery is a reliable, physiologically appropriate and successful method among the current treatments for tracheal stenosis.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900648","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":"Centripetal endoscopic sinus surgery in rhinogenic headache","authors":"","doi":"10.1016/j.amjoto.2024.104473","DOIUrl":"10.1016/j.amjoto.2024.104473","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim of this manuscript is to analyse a diagnostic protocol to select correctly patients with Rhinogenic Headache Contact Point (RH) and to investigate the effect of surgical treatment and medical therapy in pain relief.</p></div><div><h3>Methods</h3><p>A prospective no-randomized study selected adult patients with headache and nasal alteration at CT exam or endoscopic vision with positive response to test with nasal spray with corticosteroids and antihistamine or/and local anesthesia test to the contact points. MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month were collected in patients who performed surgery and in patients who performed medical therapy.</p></div><div><h3>Results</h3><p>Following the inclusion, 415 patients were selected for this study. 302 patients performed nasal surgery (septoplasty, turbinoplasty and/or endoscopic surgery with centripetal technique), 113 performed medical therapy. There was a statistically significant improvement in MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month in patients who performed surgery and in patients who performed medical therapy. Regarding the comparison between patients who performed surgery (Group A) and patients who performed only medical therapy for RH (Group B), better outcomes were obtained by Group A. Considering the daily life handicap index, the lowest handicap was obtained in Group A.</p></div><div><h3>Conclusion</h3><p>This study demonstrates that surgery, using in some cases centripetal technique, gives an improvement statistically significant than medical therapy in RH. The use of nasal spray with corticosteroids and with anti-histamine is a good method in the diagnosis of RH, especially in patients with anatomical variants such as concha bullosa, agger nasi cells and Haller cells.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896517","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":"Refining parotid acinic cell carcinoma treatment: Balancing risk factors and extent of resection","authors":"","doi":"10.1016/j.amjoto.2024.104446","DOIUrl":"10.1016/j.amjoto.2024.104446","url":null,"abstract":"<div><h3>Objectives</h3><p>Acinic cell carcinoma (ACC) most frequently arises in the parotid gland. Treatment consists of surgical resection and sometimes adjuvant therapy. ACC is most often a low-grade malignancy with good prognosis. Higher-grade tumors are often treated aggressively with total parotidectomy, neck dissection, and adjuvant therapy; however, the effect of parotid gland resection extent on oncologic outcomes has not been studied. Herein, we examine predictors of oncologic outcomes, including the effect of extent of resection.</p></div><div><h3>Methods</h3><p>Patients with diagnosis of parotid ACC treated at our institution were included in this retrospective study. Patient factors were examined, and patients were grouped by extent of resection and tumor grade.</p></div><div><h3>Results</h3><p>58 patients, including 32 low-grade, 7 intermediate-grade, and 14 high-grade were included. Patients with low-grade tumors were more likely to undergo lesser extent of parotidectomy and less likely to undergo neck dissection. Two patients with low grade tumors developed recurrence, one local and one regional. Recurrence rate did not differ with resection extent in low-grade tumors. High tumor grade was found to be associated with disease progression. There was no association with adjuvant treatment and outcomes. Across all tumor grades advanced AJCC stage was found to be associated with disease progression.</p></div><div><h3>Conclusions</h3><p>In ACC patients with low-grade tumors and lower disease stage who undergo lesser extent of surgical resection oncologic outcomes were favorable. Patients with high-grade tumors carry a high risk of recurrence, despite aggressive treatment. AJCC stage and histopathologic grade may predict outcomes and guide treatment.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888191","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":"Risk of lymph node metastasis in T1 tonsil squamous cell carcinomas patients according to age stratification at diagnosis","authors":"","doi":"10.1016/j.amjoto.2024.104452","DOIUrl":"10.1016/j.amjoto.2024.104452","url":null,"abstract":"<div><h3>Background</h3><p>The objective of this study is to assess the association between age and lymph nodes metastasis (LNM) in T1 tonsil squamous cell carcinomas (TSCC) patients.</p></div><div><h3>Methods</h3><p>Patients with T1 TSCC 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.</p></div><div><h3>Results</h3><p>A total of 2430 patients were analyzed. Younger patients more frequently presented with LNM compared to their older peers (<em>P</em> &lt; 0.01, respectively.). In multivariate analyses, older age was associated with a significantly lower risk of LNM. Compared to patients aged 29–39-years-old, the hazard ratios for patients aged 40–49, 50–59, 60–69, and 70–88 years old were 0.911 (95 % confidence interval [CI] 0.370–2.245), 0.641 (95 % CI 0.268–1.535), 0.511 (95 % CI 0.212–1.231), and 0.236 (95 % CI 0.095–0.584), respectively. Subgroups analysis shows that the effect of older age was significantly associated with a lower risk of LNM in all groups except for Asian patients (<em>P</em> &lt; 0.05, respectively).</p></div><div><h3>Conclusion</h3><p>Our study demonstrates that younger patients with T1 TSCC had a higher risk of LNM than their old peers and the effect of older age was significantly associated with a lower risk of LNM in all groups except for Asian patients. 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 TSCC.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888192","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":"Manometric Abnormalities in Patients With and Without Chronic Cough","authors":"","doi":"10.1016/j.amjoto.2024.104445","DOIUrl":"10.1016/j.amjoto.2024.104445","url":null,"abstract":"<div><h3>Purpose</h3><p>This study examines the relationship between chronic cough and vagal hypersensitivity by measuring baseline esophageal motility, with interest in the upper esophageal sphincter (UES).</p></div><div><h3>Materials and methods</h3><p>Patients undergoing workup for dysphagia were assigned to a chronic cough or control group based on self-reported symptoms. Differences in demographics, medical comorbidities, and high resolution esophageal manometry findings were obtained retrospectively.</p></div><div><h3>Results</h3><p>62.5% of our cohort had chronic cough (30/48). There were no significant differences between the two groups with respect to sex, age, and race/ethnicity. Laryngopharyngeal reflux (LPR) was the only statistically significant predictor of CC (OR 74.04, <em>p</em> = 0.010). Cough patients had upper esophageal sphincter relaxation duration (734 ms) significantly longer than the non-cough patients (582 ms; <em>p</em> = 0.03), though both groups had similar upper esophageal mean basal pressure, mean residual pressure, relaxation time-to-nadir, and recovery time. No significant difference was found in the median intrabolus pressure and UES motility mean peak pressure between groups.</p></div><div><h3>Conclusion</h3><p>Subtle differences in high-resolution manometry between patients with and without cough suggest, in line with previous studies, baseline alterations of upper esophageal function may manifest in patients with chronic cough through an undetermined mechanism that may include underlying vagal hypersensitivity. These findings encourage further manometric study examining the relationship between UES dysfunction and chronic cough.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S019607092400231X/pdfft?md5=9e8ca027fc7c5f69dec2e05c99c1b174&pid=1-s2.0-S019607092400231X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892691","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":"Association of prealbumin with complications after total laryngectomy with free flap reconstruction","authors":"","doi":"10.1016/j.amjoto.2024.104451","DOIUrl":"10.1016/j.amjoto.2024.104451","url":null,"abstract":"<div><h3>Objective</h3><p>Malnutrition is an important risk factor for patient surgical outcomes. This is especially true for head and neck cancer (HNC) patients receiving a total laryngectomy with free flap reconstruction (TLwFFR). Preoperative prealbumin and albumin values have both been used to indicate poor nutrition. This study aims to identify the prognostic value of preoperative prealbumin and albumin levels with wound healing complications in HNC patients after TLwFFR.</p></div><div><h3>Methods</h3><p>A retrospective review was conducted in all HNC patients who underwent TLwFFR from 2016 to 2022 at a tertiary-care institution. Patients with either preoperative (within 1 month of surgery) prealbumin or albumin lab values were included. Low preoperative prealbumin (low prealbumin) levels and low preoperative albumin (low albumin) levels were defined as ≤20 mg/dL and &lt;3.4 g/dL, respectively. Outcomes collected included all wound healing complications (infection, wound dehiscence, pharyngocutaneous fistula). The association between prealbumin and albumin with outcomes were analyzed using multivariable logistic regression.</p></div><div><h3>Results</h3><p>A total of 83 patients met the inclusion criteria. The mean age at surgery was 61.6 ± 9.3. The overall wound healing complication rate was 33.7 %. There was an association between low prealbumin levels and any wound healing complication. On multivariate analysis, low prealbumin levels were associated with postoperative wound healing complications (OR, 4.7; CI 1.3–17.0. <em>P</em> = 0.02) after controlling for low albumin level, age, smoking, and preoperative radiation.</p></div><div><h3>Conclusions</h3><p>Low prealbumin levels were associated with wound healing complications in TLwFFR patients. Consideration of consistent prealbumin testing with nutritional intervention may reduce wound healing complications.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141964558","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}