Laryngoscope最新文献

Objectives: To define persistent and recurrent dysphagia after surgery for CPMD with and without diverticula.

Methods: Patients with CPMD with and without diverticula enrolled in the Prospective Outcomes of Cricopharyngeus Hypertonicity (POuCH) multicenter study who underwent surgery from November 2014 to August 2024 with at least 12 months of follow up were included. Surgical outcomes were evaluated using a validated patient reported dysphagia marker, Eating Assessment Tool 10 (EAT10), where normal is characterized as < 3. Persistent dysphagia is defined as patients with < 50% improvement in EAT-10 or EAT-10 score ≥ 3 at first follow up. Recurrent dysphagia is an initial surgical responder with a delayed worsening in EAT-10 scores during follow-up.

Results: A total of 160 patients were included. Six patients (3.7%) had recurrent dysphagia, with 5 undergoing re-operation. A total of 23 patients (14.3%) had persistent dysphagia immediately post-operatively; one underwent re-operation. Preoperative EAT-10 scores were higher in the persistent group (median 23.5, interquartile interval (IQR) 12.0-28.5) compared to responders (14.0, 8-24) (p = 0.05). Median first post-operative EAT-10 in the persistent dysphagia group was 14 (IQR 8-21) compared to 0 in the responders (0-2; p < 0.0001). There was no difference in esophageal pathology. There was no difference in rates of response to endoscopic versus open surgery.

Conclusion: Patients with recurrent dysphagia are less common than persistent dysphagia, and there are no clear markers to predict surgical responders from persistent dysphagia (e.g., non-responders), however all non-responders occurred in the first 12 months after surgery.

Level of evidence: 4:

Objective: Research productivity among otolaryngology-head and neck surgery (OHNS) residency applicants has increased substantially in recent years, alongside growing participation in dedicated research years. However, the extent to which a research year contributes to meaningful scholarly output remains unclear. This study characterizes and compares research productivity among OHNS residency applicants with and without a dedicated research year.

Methods: We retrospectively reviewed applicants to a single OHNS residency program during the 2025 application cycle. Applicants were categorized by completion of a dedicated research year. Students with ambiguous reasons for a gap in medical education (e.g., personal) were excluded. Research products listed in ERAS were categorized by type, authorship, publication status, and presentation characteristics. Outcomes were compared using the Wilcoxon rank-sum test and reported as medians with interquartile ranges (IQR).

Results: The median number of total research products among all 196 applicants was 26 [IQR 17-37]. Applicants with a dedicated research year (n = 55) had more total research products than those without (n = 90) (32 [21-37] vs. 24 [15.75-37]), comprised primarily by unpublished work (5 [3-8] vs. 3 [1-5]) and oral presentations (6 [3-9] vs. 4 [2-7]). Published articles (5.5 [3-11] vs. 7 [3-12]) and first-author manuscripts (Median 1) did not differ significantly between groups.

Conclusion: A dedicated research year is associated with modestly increased research productivity among OHNS applicants; however, this increase is largely driven by unpublished and middle author work. These findings suggest that volume-based metrics may incompletely capture scholarly engagement and may contribute to increased expectations without proportionate gains in research experience.

Level of evidence: N/A.

Objective: To evaluate a two-stage tracheal reconstruction strategy for repairing extensive tracheal defects in well-differentiated thyroid carcinoma (WDTC) with tracheal invasion.

Methods: Seventy-four patients underwent tumor resection and tracheal excision, followed by staged reconstruction using a free posterior tibial flap (n = 28), pedicled thoracoacromial flap (n = 36), or pedicled supraclavicular flap (n = 10). Functional recovery, decannulation, complications, and survival were analyzed.

Results: Demographic characteristics were comparable across groups. Tracheal defects were significantly larger in the free posterior tibial artery perforator flap group (9.14 ± 1.57 rings) versus the pedicled thoracoacromial (5.89 ± 2.59 rings) and supraclavicular (6.30 ± 1.49 rings) flap groups. The overall endotracheal tube removal rate was 95.9%, with no intergroup differences (p = 0.533). Functional recovery (swallowing, speech, and respiration) was comparable among groups. The 3-year survival rate was 78.4%, with no significant differences across groups (p = 0.633).

Conclusions: Two-stage tracheal reconstruction is a safe and effective approach for long-segment tracheal defects in WDTC patients, offering satisfactory functional recovery. Further studies with larger cohorts and longer follow-up are warranted to confirm long-term efficacy.

Level of evidence: 4:

Objectives: Surgical manipulation of the vocal folds carries a risk of mucosal injury. We used an established unilateral mouse vocal fold injury model to determine whether electronic cigarette (E-cig) exposure after injury induces remodeling and inflammatory responses in the vocal fold mucosa that differ from injury alone.

Methods: Adult mice underwent unilateral vocal fold injury using a wire brush under microscopy and were assigned to an Injury or Injury + E-cig group. The Injury + E-cig group received daily E-cig aerosol exposure after injury. Mice were sacrificed at 3, 14, and 28 days. A room air-exposed group served as Control. We quantified epithelial (EP) thickness and lamina propria (LP) area, measured expression of genes related to EP junctions, extracellular matrix (ECM) remodeling, and inflammation, and performed immunostaining to corroborate gene expression findings.

Results: Injury + E-cig mice exhibited blunted post-injury weight gain versus Controls. EP thickness and EP junction gene expression recovered similarly in Injury and Injury + E-cig groups. In contrast, early LP expansion and acute increases in TNF-α, F4/80, and Col3α1 were attenuated with E-cig exposure, indicating selective disruption of acute macrophage-associated inflammatory and ECM responses.

Conclusion: This is the first study to examine the effects of E-cig exposure on vocal fold wound healing. Clinically, these findings raise concern about postoperative E-cig use after vocal fold surgery. Although often viewed as safer than smoking, E-cig use may alter early wound healing responses that are essential for restoring vocal fold structure and function.

Level of evidence: N/A.

Objective: To evaluate hearing outcomes in postneonatal treatment of congenital cytomegalovirus (cCMV) infection and assess the effect of treatment initiated after the first month of life.

Data sources: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched.

Review methods: Articles reporting antiviral treatment of cCMV, with Ganciclovir (GCV) or Valganciclovir (VGCV) in the postneonatal period were included. Outcomes of interest included viral load (urine and plasma), neutropenia, and hearing outcomes (return to normal hearing, improvement, deterioration, and no change). Mean difference (MD) was used for continuous outcomes and proportions for binary endpoints, with 95% confidence intervals (CI).

Results: Eight studies with 192 patients met inclusion criteria. Oral VGCV was associated with a reduction in viral load during the first 2 months. At 2 months, pooled MD for urine viral load was -3.67 (95% CI -4.33 to -3.02, I² = 75.4%), and for plasma was -0.80 (95% CI -1.08 to -0.52, I² = 31.6%). Among patients with hearing loss, normalization occurred in 42.29% (95% CI 13.48 to 77.51, I² = 84.3%) and improvement in 38.48% (95% CI 16.77 to 66.00, I² = 88.2%) of total ears. Hearing deterioration was uncommon, affecting 5.47% of total ears (95% CI 2.15 to 13.25, I² = 60.9%). Neutropenia was infrequent, with 9.09% experiencing grade 1-2 and 3.67% grade 3-4.

Conclusion: Postneonatal antiviral treatment for cCMV may reduce viral load and improve hearing in a substantial proportion of patients, with low rates of adverse events. However, long-term outcomes remain unclear, and larger prospective studies are needed to confirm efficacy.

Level of evidence: N/A.

Objectives: Extracellular matrix (ECM)-based scaffolds and gels demonstrate promise for vocal fold scar treatment; however, these injectables necessitate invasive procedures and repeated dosing. Multiple injections to the folds can damage the tissue, leading to fibrotic outcomes. We hypothesize that a nebulized vocal fold lamina propria ECM (VFLP-ECM) formulation can provide an effective regenerative treatment for upper airway delivery in a novel delivery approach.

Methods: A porcine-derived, nebulized formulation of VFLP-ECM was synthesized for targeted VF delivery. Bilateral vocal fold injuries were induced in Sprague Dawley rats using micro forceps. Forty-eight hours postinjury, animals were assigned to a (1) injury alone/control group or a nebulized treatment group receiving (2) phosphate buffer saline (PBS), (3) collagen type I (COLI), or (4) extracellular matrix (VFLP-ECM), with six animals in each group. Larynges were harvested 14 days postinjury and histologically analyzed using Hematoxylin and Eosin and Masson's trichrome staining.

Results: Histological analysis demonstrated reduced collagen deposition and lower myofibroblast density in the VFLP-ECM treated group compared to PBS and injury alone controls. Additionally, treated tissues exhibited increased lamina propria thickness and improved extracellular matrix organization, indicative of regenerative rather than fibrotic remodeling.

Conclusion: Nebulized delivery of VFLP-ECM improved VF tissue characteristics. This study suggests a potential application for nebulized decellularized ECM in supporting vocal fold tissue regeneration during the acute phase of wound healing, with long-term effects warranting further investigation.

Level of evidence: NA.

Objectives: Portable, tablet-based audiometry has been proposed as a diagnostic tool for patients unable to access traditional sound booth audiometry. However, the validity of tablet-based audiometry for diagnostic use in pediatric patients has not been established. The objective of this study is to validate self-administered tablet-based diagnostic audiometry in a pediatric clinic setting.

Methods: Children 4 to 17.9 years-old were recruited from a pediatric audiology clinic. Tablet audiometry was performed with tablet-based software, SHOEBOX Audiometry (Ottawa, ON) at six frequencies (250-8000 Hz). Hearing thresholds from traditional pure tone audiometry in a sound booth were used as a gold-standard comparison. Hearing loss was defined as ≥ 1 hearing threshold of > 20 dB.

Results: 120 children underwent tablet-audiometry, though not all were able to complete the test. In 948 individual frequencies tested, the mean threshold difference was -0.95 dB (95% CI -1.5 to -0.42 dB) between traditional and tablet audiogram. Most tablet-assessed thresholds (92%, n = 873) were within 10 dB of corresponding traditional audiometry thresholds. Tablet audiometry demonstrated 92% sensitivity (95% CI 84%-97%) and 85% specificity (95% CI 77%-92%) for diagnosis of hearing loss. Test-retest reliability of tablet audiometry was high, with 93% (55/59) of test-retest hearing threshold differences falling within ±5 dB.

Conclusion: Tablet audiometry is valid and reliable for children aged 5-17 years who can successfully complete testing in a non-soundproof clinic setting. It may serve as a tool for remote hearing testing, with potential applications in schools, clinics, and research.

Level of evidence: 2: