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Objective: To compare functional and cost‐effectiveness of awake transnasal laser assisted‐surgery versus microlaryngeal surgery for benign laryngeal lesions. Methods: This was a prospective non‐inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block‐randomized to receive either awake transnasal laser‐assisted surgery or microlaryngeal surgery, with post‐operative follow‐up in a multidisciplinary voice clinic for 1‐year. Primary outcome was Voice Handicap Index (VHI‐30). Secondary outcomes included operation time, complications, length of stay, peri‐operative discomfort, recurrence, and medical costs. Results: Sixty‐one patients were randomized to either awake transnasal laser‐assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI‐30 score over time and had comparable post‐operative VHI‐30. Awake transnasal laser‐assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost‐analysis showed a significantly lower hospital cost for awake transnasal laser‐assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120). Conclusion: Awake transnasal laser‐assisted surgery was safe, functionally non‐inferior, as measured by VHI‐30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri‐operative discomfort and medical costs. Level of Evidence: 2 Laryngoscope, 134:3732–3740, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed to investigate the feasibility of using high‐density surface electromyography (HD‐sEMG) for swallowing assessment by comparing the quantitative parameters and topographic patterns of HD‐sEMG between post‐irradiated patients and healthy individuals. Methods: Ten healthy volunteers and ten post‐irradiated nasopharyngeal carcinoma patients were recruited. 96‐channel HD‐sEMG was recorded although each participant consumed different consistencies of food (thin and thick liquid, puree, congee, and soft rice). Dynamic topography was generated from the root mean square (RMS) of the HD‐sEMG signals to illustrate the anterior neck muscle function in the swallowing process. The averaged power of muscles and the symmetry of swallowing patterns were assessed by objective parameters including average RMS, Left/Right Energy Ratio, and Left/Right Energy Difference. Results: The study showed different swallowing patterns between patients with dysphagia and healthy individuals. The mean RMS values were higher in the patient group compared to the healthy group, but the difference was not statistically significant. Asymmetrical patterns were shown in patients with dysphagia. Conclusion: HD‐sEMG is a promising technique that could be used to quantitatively evaluate the average power of neck muscles and the symmetry of swallowing activities in patients with swallowing difficulties. Level of Evidence: Level 3 Laryngoscope, 133:2920–2928, 2023 [ABSTRACT FROM AUTHOR]

Objectives: The role of traditional nuclear medicine studies in the management of malignant otitis externa (MOE) is unclear and there are ongoing debates regarding their diagnostic value. The authors perform a systematic review and meta-analysis to assess the sensitivity and specificity of traditional nuclear medicine studies in the diagnosis of MOE.Methods: In accordance with PRISMA guidelines, a query of the Medline, Embase, Web of Science, and Cochrane databases was undertaken. The primary outcomes of interest were the sensitivity and specificity of traditional nuclear medicine studies to detect MOE.Results: Of the initial 1317 hits from the four databases, 20 articles with a combined 608 patients were ultimately included in the review. The pooled sensitivities for Technetium-99 and Gallium-67 were 85.1% (95% CI, 72.0-98.1%) and 71.2% (95% CI, 55.1-87.3%) respectively. The available evidence suggested poor specificity of these modalities, but was insufficient for meta-analysis. Neither modality was shown to be effective in the assessment of disease resolution.Conclusion: The sensitivities of Technetium-99 and Gallium-67 to detect MOE are less favorable than was initially thought. Given this finding and their poor specificity, lack of anatomic resolution, unproven ability to detect disease resolution and variable availability, this review does not support the routine use of these studies in the management of MOE.Level Of Evidence: N/A Laryngoscope, 130:1812-1816, 2020. [ABSTRACT FROM AUTHOR]

Objective: To assess interobserver agreement and intraobserver reproducibility when assessing the nasopharynx for malignancy under white light and narrow band imaging endoscopy because the decision to biopsy hinges on the examiner's perceived chance of malignancy.Methods: An interobserver and intraobserver agreement study utilizing white light and narrow band endoscopic images of the nasopharynx. The setting was an academic referral hospital. Participants were 156 adults with suspected nasopharyngeal carcinoma who underwent white light and narrow band imaging endoscopy and biopsy. Images of the nasopharynges were subsequently scored for malignancy by four otolaryngologists. The nasopharynx was scored on 4-point scales under white light and narrow band imaging endoscopy for the likelihood of malignancy or abnormality, respectively.Results: Intraclass correlation coefficients for intraobserver agreement for nasopharyngeal malignancy for four observers under white light were 0.86, 0.89, 0.79 and 0.88 (mean 0.855), respectively; and under narrow band imaging they were 0.64, 0.68, 0.64, and 0.66 (mean 0.655), respectively (all P values < 0.001). The coefficient for interobserver reliability under white light was 0.79 (95% confidence interval [CI] 0.76-0.82; P < 0.001), which indicated strong agreement. The coefficient for interobserver reliability under narrow band imaging was 0.56 (95% CI 0.50-0.61; P < 0.001), which indicated moderate agreement.Conclusions: Intraobserver and interobserver agreement for nasopharyngeal malignancy was strong on white light endoscopy but only moderate on narrow band imaging endoscopy. Agreement may be improved by adopting a standard set of assessment guidelines, including an objective detailed morphological analysis under white light and vasculature analysis under narrow band imaging.Level Of Evidence: 2a Laryngoscope, 129:1374-1379, 2019. [ABSTRACT FROM AUTHOR]