Annals of Otology,Rhinology & Laryngology

Limited research has been done previously in examining the utility of PET/CT in the preoperative staging of betel nut associated OSCC (BNOSCC). This study was conducted to evaluate the relationship between the standardized uptake values (SUV) of lymph nodes via FDG-PET/CT and their corresponding pathological specimens in betel nut chewers.

Retrospective review.

Single-institution academic center.

A retrospective review of patients with BNOSCC seen at the Tipler Army Medical Center (TAMC) Head and Neck Surgery clinic from October 2004 to October 2019 was conducted. Preoperative FDG-PET/CT images were analyzed for the SUVmax of regional lymph nodes, with a node positive for malignancy defined as >3. The extent of disease spread predicted by FDG-PET/CT was then compared to the postoperative histopathological results.

Among patients with BNOSCC, FDG-PET/CT was found to significantly overpredict the extent of lymph node involvement identified on pathological analysis. Metabolic activity of lymph nodes was significantly overestimated on preoperative imaging. These findings highlight a clear discrepancy between the sensitivity and specificity of FDG-PET/CT found in BNOSCC and that in non-betel nut related disease.

Elevated false-positive rates for LN positivity on FDG-PET/CT have been observed in BNOSCC patients. This finding could potentially lead to upstaging, and lead to excessive, more invasive treatment courses and interventions. This is a phenomenon that Head and Neck surgeons should be cautious about when working with BNOSCC patients.

3.

Interactive technologies are evolving along with their applications in medicine. Under this umbrella lie both augmented reality (AR), the process of visually overlaying digital information on top of the physical world, and mixed reality (MR), which builds upon AR with the inclusion of interactions between the digital display and the physical world. Previous reviews of AR and MR in OHNS have been limited in their scope and do not address underlying technological shortcomings.

A scoping review of relevant literature was conducted using PRISMA methodology. Electronic databases were screened using keywords including “augmented reality,” “mixed reality,” “ENT, “OHNS,” and “otolaryngology.” Editorials, reviews, meta-analyses, unpublished, and -only articles were all excluded. Studies were individually assessed for quality using technological usability heuristics.

A total of 107 studies were reviewed with 46 studies meeting our inclusion criteria. Of the included studies, there were 4 (8.7%) studies on preoperative surgical planning, 37 (80.4%) on intraoperative surgical guidance, and 5 (10.9%) on surgical education. The majority of studies on AR or MR in OHNS were in subspecialty Otology/Neurotology with 19 studies, while 10 were in Rhinology, and 7 were in Head and Neck Surgery. The majority have been on intraoperative usage. However, almost all of these were preclinical studies (84.8%). Commonly cited challenges limiting the transition of intraoperative guidance from models to the OR include accuracy of registration and ease-of-use.

Current studies in this field have focused on intraoperative guidance and were predominantly in the preclinical phase. The limitations in current AR/MR technology have prevented a greater level of evidence in studies and advancements in AR/MR implementation.

This study aimed to determine the prevalence, subtypes, and control status of chronic rhinosinusitis (CRS) among patients with severe asthma receiving biologic therapy in a tertiary allergy clinic.

A single-center, cross-sectional observational study was conducted in adult patients with severe asthma receiving biologics for at least 6 months. CRS diagnosis and control were assessed based on European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 criteria. The Sinonasal Outcome Test-22 (SNOT-22) was also administered. Statistical analyses were performed using appropriate univariate and multivariate methods.

Among 148 patients with severe asthma receiving biologic therapy, 97 (65.5%) were diagnosed with comorbid CRS. Of these, 68 (45.9%) had CRS with nasal polyps (CRSwNP) and 29 (19.5%) had CRS without nasal polyps (CRSsNP). A total of 54 patients (55.6%) were treated with omalizumab and 43 (44.3%) with mepolizumab. Overall, 32.9% of patients had controlled CRS, 36.0% were partly controlled, and 30.9% were uncontrolled. In multivariable ordinal regression analysis, the presence of N-ERD and higher BMI were associated with poorer CRS control, whereas early-onset asthma and prior maintenance systemic corticosteroid use were associated with better control, suggesting that these factors may be related to CRS control status in this population.

CRS is highly prevalent among patients with severe asthma receiving biologics, and approximately one-third remain uncontrolled despite treatment. These findings emphasize the importance of regular upper airway assessment and may inform future strategies for optimizing biologic selection and treatment outcomes in this population.

This study aimed to assess the effectiveness of local anesthesia in reducing pain associated with fine needle aspiration (FNA) of thyroid nodules, examine the side effects of local anesthesia, and identify factors that influence pain during FNA of thyroid nodules.

We conducted a randomized clinical trial in the Department of Otolaryngology at Ramathibodi Hospital. Patients scheduled to undergo FNA of thyroid nodules were divided into four groups and subsequently administered four types of local anesthesia: Group A (Placebo cream), Group B (Cold placebo cream), Group C (Topical anesthetic cream), and Group D (Cold topical anesthetic cream). The primary outcome was the mean difference in pain levels (measured using a visual analog scale [VAS] and a numeric rating scale [NRS]) between the treatment and control groups.

Initially, 72 participants were enrolled in this study, and data from 62 participants were analyzed. The VAS scores were measured at 0, 10, and 30 minutes post-procedure, with mean scores of 25.85 ± 4.65 (Group A), 21.26 ± 4.81 (Group B), 18.05 ± 4.51 (Group C), and 16 ± 4.97 (Group D). Although Group D showed the lowest pain scores, statistical analysis revealed no significant differences between groups (all P > .05).

Local anesthesia and cooling can decrease the level of pain. However, in this study, topical anesthetic did not significantly reduce pain compared to non-anesthetic treatments.

2.

Estrogen has been found to impact cochlear blood flow and auditory function, but epidemiological studies on menopause and hearing are inconsistent. This study investigates the associations of menopause, its age at onset, reproductive lifespan, and hormone replacement therapy (HRT) with hearing loss in adult women in the US.

Study cohort includes 1778 adult women (40-69 years), from the National Health and Nutrition Examination Survey 2011 to 2012 and 2015 to 2016 who had complete data on audiometry and reproductive health. Hearing loss was defined based on speech-frequency pure-tone average (0.5, 1, 2, and 4 kHz) in better hearing ear. Menopause status was self-reported. Multivariable regression analyses were performed to explore the associations of menopause, age at onset, reproductive lifespan, and HRT with hearing loss.

After adjusting for age, demographics, medical comorbidities, and noise exposure, there was no significant association between binary postmenopausal status and hearing loss (β: 0.92 dB, [95% CI: −1.02 to 2.86]). When further considering age of menopause onset and reproductive lifespan, we found that late onset of menopause (vs early onset) was significantly associated with the better hearing (β: −4.60 dB, [95% CI: −8.42 to −0.79]) and longer reproductive lifespan was significantly associated with better hearing (β: −0.16 dB per year, [95% CI: −0.32 to −0.002]). Comparing reproductive lifespan quartiles, the fourth quartile was significantly associated with better hearing relative to the first quartile (β: −4.86 dB, [95% CI: −8.28 to −1.44]). Among post-menopausal women, there was no significant association between hearing loss and HRT (β: 0.45 dB, [95% CI: −1.69 to 2.58]).

While menopausal status was not significantly associated with hearing loss, later onset of menopause and longer reproductive lifespan were associated with better hearing. Future studies should evaluate the clinical significance of the associations between hearing and reproductive health and potential causal relationships.

2b

To investigate the relationship between frailty and steroid treatment outcomes in patients with sudden sensorineural hearing loss (SSNHL).

Retrospective cohort study

Tertiary-care institution.

185 adult patients (≥19 years) with unilateral SSNHL presenting January 1, 2017 to May 24, 2023, stratified by 5-Factor Modified Frailty Index (mFI5).

Oral prednisone and/or intratympanic dexamethasone.

Post-treatment changes in pure-tone average (PTA), speech reception threshold (SRT), and word recognition scores (WRS).

Female and younger patients were significantly less frail than male and older patients (P = .004, P < .001 respectively). Patients with higher frailty scores (≥2) were less likely to receive oral steroids (59.6% vs 82.8%, P = .004), though equally likely to receive intratympanic steroids (P = 1.000). However, patients classified as frail (≥1) were not more likely to receive intratympanic steroids alone compared to combination therapy (P = .220). Higher frailty scores were significantly associated with metabolic syndrome (P = .002), but specific treatment patterns in diabetic patients could not be delineated as treatment was individualized. Dizziness (P = .650) and vertigo (P = .200) did not correlate with frailty or treatment outcomes. The number of comorbidities increased with higher frailty scores (P < .001) but did not directly correlate with SSNHL outcomes. No significant differences were observed in audiometric outcomes (PTA/SRT/WRS) based on patient frailty scores across all comparisons (P’s > .05).

While we found an association between frailty scores and treatment selection for SSNHL, we did not find a significant association between frailty scores and treatment outcomes. Therefore, treatment may be individualized in frail patients without compromising audiometric outcomes.

Flexible fiberoptic nasolaryngoscopy is among the most common procedures performed by otolaryngologists worldwide. Despite this, there is no standard training method. High-fidelity approaches typically require trainees to learn on live patients and provide general qualitative information about the scope’s path. However, trainees lack objective quantitative procedural feedback to optimize their technique, and patients may be subjected to pain and epistaxis. A trainer that provides a safe, reusable interface and quantitative report would transform this learning experience.

Our team developed a cost-effective 3D-printed task trainer for flexible fiberoptic nasolaryngoscopy and coupled this with a calibrated electromagnetic tracker to evaluate scope trajectory across users. Thirty-one subjects ranging from secondary school student to practicing otolaryngologist used the trainer. Participant confidence and perceived model realism were assessed with surveys. Scope trajectory was assessed using the electronic tracker.

Mean score on the realism of endoscopic appearance was 7.5 on a 10-point visual analog scale. All subjects reported stable or increased confidence in flexible nasolaryngoscopy after using the model, with novices demonstrating the most significant change (P = .005). Trajectory data from the fine-wire tracker demonstrated that less experienced trainees paused and backtracked more than more experienced trainees (P = .004).

This novel 3D-printed model offers a feasible task trainer for flexible nasolaryngoscopy and yields trajectory information that distinguishes between novices and experts. This model can provide an accessible training method that does not compromise patient experience, while simultaneously offering objective feedback to trainees as they grow their skills.

To evaluate the effectiveness of autologous serum drops combined with paper patch myringoplasty in enhancing tympanic membrane (TM) perforation closure among patients with prior patch failure.

This retrospective chart review included 81 patients with chronic TM perforations unresponsive to initial paper patching. Patients were divided into 2 groups: the experimental group received autologous serum drops alongside secondary paper patching, while the control group received patching alone. The primary outcome was TM closure at 8 weeks. Kaplan–Meier survival analysis and Cox regression were used to evaluate time-to-closure and the effect of patient variables.

Closure rates were significantly higher in the experimental group (54.5%) compared to the control group (21.6%; P = .002). The addition of serum drops was associated with improved healing outcomes, even in cases unresponsive to initial patching. Perforation size and location influenced closure, with smaller and posterior TM perforations showing higher success. No significant associations were found between healing and age, sex, race, comorbidities, or perforation etiology. No adverse effects from serum drops were reported.

Autologous serum drops significantly improve TM closure rates when added to paper patch myringoplasty, offering a safe, cost-effective, and non-surgical option for managing chronic perforations. Further studies with larger sample sizes and long-term follow-ups are warranted.

Riedel’s thyroiditis (RT) is a rare, severe IgG4-related fibrosing inflammatory process of the thyroid gland that may present with airway obstruction, dysphagia, and/or dysphonia. Most published reports of treatment of airway obstruction from RT focus on thyroid isthmectomy to relieve compressive or restrictive symptoms, however tracheal stenosis from direct invasion is a more unusual cause of obstruction. Our objectives were to report surgical management of a case of severe, recurrent tracheal stenosis secondary to RT and to review the management of this rare condition.

Case report of single patient with recurrent, severe tracheal stenosis secondary to RT, with literature review of similar cases.

We report a case of severe recurrent tracheal stenosis in the setting of RT managed with bilateral subtotal thyroidectomy and slide tracheoplasty, a previously unreported intervention. Review of the literature identified a single case report in which stenosis secondary to RT was successfully managed with endoscopic dilation.

Tracheal stenosis is an extremely rare complication of RT. In patients with recurrent or severe tracheal stenosis secondary to RT, slide tracheoplasty may be considered after failure of endoscopic dilation.