Yi-Chieh Lee

Background: Carotid blowout syndrome (CBS) is a life‐threatening complication of head and neck cancer (HNC). This study evaluated clinical outcomes and prognostic factors in patients with HNC who presented to the emergency department (ED) with CBS and underwent endovascular management. Methods: We conducted a retrospective, multi‐institutional observational study across four hospitals in Taiwan from January 1, 2011, to December 31, 2023. Adult patients with HNC who presented to the ED with bleeding suggestive of CBS on computed tomography angiography underwent endovascular therapy and had the diagnosis confirmed by digital subtraction angiography were included. The primary endpoint was in‐hospital mortality. Independent prognostic factors were identified using multivariable logistic regression, and a predictive nomogram was constructed and internally validated by bootstrap resampling. Results: A total of 348 patients were included. Most were male (93.7%), had Stage IV disease (74.7%), and were treated with arterial embolization (93.4%). In‐hospital mortality occurred in 57 patients (16.4%). The estimated 30‐day and 1‐year survival rates were 84.8% and 51.7%, respectively. In multivariable analysis, vasopressor use (odds ratio [OR], 6.54), failed hemostasis (OR, 4.68), tracheostomy status (OR, 2.04), multivessel involvement (OR, 1.98), and lower systolic blood pressure (OR, 0.99 per mmHg) were independently associated with in‐hospital mortality. The nomogram showed moderate discrimination with a C ‐statistic of 0.73. Conclusions: Among patients with HNC presenting to the ED with CBS and undergoing endovascular management, in‐hospital mortality remained substantial. A nomogram incorporating readily available clinical and imaging variables may assist early risk stratification after ED presentation.

Purpose Rapid eye movement–related obstructive sleep apnea (REM-OSA) is a physiological phenotype of OSA whose clinical significance and impact on surgical outcomes remain unclear. This study evaluated the prevalence, clinical characteristics, and predictive value of REM-OSA for palatal surgery outcomes. Methods Adult patients with OSA intolerant of continuous positive airway pressure who underwent palatal surgery were retrospectively reviewed. REM-OSA was defined as a REM apnea–hypopnea index (AHI) at least twice the non-REM AHI. Surgical success was defined as a > 50% reduction in AHI and a postoperative AHI < 20 events/hour. Logistic regression was performed to identify predictors of surgical success. Results Among 90 patients, 24 (26.7%) had REM-OSA. Compared with NREM-OSA, REM-OSA patients were younger (35.9 vs. 39.3 years, p = 0.043) and had lower baseline AHI (36.4 vs. 52.0 events/hour, p = 0.005). Although AHI reduction was similar between groups, REM-OSA showed a significantly higher surgical success rate (79.2% vs. 53.0%, p = 0.007). REM-OSA remained an independent predictor of surgical success after adjustment for age and baseline AHI (adjusted OR 5.44, 95% CI 1.41–21.00, p = 0.014). Conclusions REM-OSA was associated with younger age and lower baseline disease severity. Although the absolute reduction in AHI following palatal surgery was comparable between groups, patients with REM-OSA achieved a significantly higher surgical success rate. These findings suggest that REM-OSA may serve as a clinically useful predictor of favorable outcomes following palatal surgery.

Objective: To track quantitative laryngeal electromyography (LEMG) and voice outcome survey (VOS) changes over 12 months postiatrogenic unilateral vocal fold paralysis (UVFP). To explore the factors influencing these changes.Study Design: Historical cohort study.Setting: Tertiary medical center.Methods: Patients who developed UVFP after surgery underwent a series of assessments, including quantitative LEMG, videolaryngostroboscopy, voice acoustic analysis, and completion of the VOS at diagnosis and at the 12‐month follow‐up. The subsequent data from these assessments were then compared for analysis. Bivariate analysis examined predictors of changes in VOS and LEMG data respectively, with significant factors further included in a multivariate regression model.Results: The study enrolled 99 patients. LEMG data were prospectively collected within 3.9 months (±SD: 0.2) postsurgery, followed by an average 13.2‐month (±SD: 0.2) follow‐up. A worse initial turn ratio of thyroarytenoid‐lateral cricoarytenoid muscle correlated with more significant subsequent improvement in LEMG findings, reflecting a similar trend observed in the change of VOS scores.Conclusion: This study contributes valuable insights into the temporal change of quantitative LEMG and VOS in patients with iatrogenic UVFP. It suggests that poor initial LEMG and VOS results do not necessarily determine a worse prognosis in terms of electrical activity.

INPLASY202430013 The effect of continuous positive airway pressure treatment on the reduction of gestational complications in pregnant women with obstructive sleep apnea Keywords: pregnancy, obstru…

Diagnosis of the Human Immunodeficiency Virus (HIV) remains challenging due to non-specific clinical presentations and mostly flu-like symptoms, e.g., fever, headache, sore throat, and general weakness. Oral lesions, such as oral candidiasis and Kaposi sarcoma, are also frequently associated with HIV infection, whereas laryngeal manifestations are rare. We report two cases of newly diagnosed HIV patients with clinical presentations of sore throat, and endoscopy revealed an epiglottic ulcerative tumor-like lesion. A laryngomicrosurgical biopsy of the lesions was performed for persistent symptoms and suspicion of malignancy. The result revealed acute and chronic inflammation without a conclusive pathology diagnosis. Further laboratory analysis was arranged in consideration of autoimmune diseases, Epstein–Barr virus (EBV), and HIV infection due to their persistent and atypical symptoms. The results were positive for HIV infection. These patients were treated successfully with antiviral treatment and the laryngeal symptoms improved within weeks. In patients with idiopathic and persistent epiglottitis or an epiglottic ulcer after medical treatment, HIV infection needs to be considered as a potential etiology in order to institute proper treatment.

Background: Many patients with obstructive sleep apnea (OSA) are mouth-breathers. Mouth-breathing not only narrows the upper airway, consequently worsening the severity of OSA, but also it affects compliance with nasal continuous positive airway pressure (CPAP) treatment. This study aimed to investigate changes in OSA by the use of mouth tape in mouth-breathers with mild OSA. Method: Mouth-breathers with mild OSA who met inclusion criteria and tolerated the sealing of the mouth were enrolled in the study. We used 3M silicone hypoallergenic tape was used to seal the mouths of the participants during sleep. The home sleep test (HST) used in this study was ApneaLink^®. Subjects received both a baseline HST and an outcome HST to be used 1 week later while their mouths were taped. The changes between the baseline and the outcome HSTs were compared, and the factors that influenced the differences in the sleep-test parameters after the shift of the breathing route were analyzed. A “responder” was defined as a patient who experienced a reduction from the baseline snoring index of at least 50% under mouth-taping in the HST; otherwise, patients were considered as having a poor response. Results: A total of 20 patients with mild OSA were included. Following the taping of the mouth, a good response was found in 13 patients (65%). The median apnea/hypopnea index (AHI) decreased significantly, from 8.3 to 4.7 event/h (by 47%, p = 0.0002), especially in supine AHI (9.4 vs. 5.5 event/h, p = 0.0001). The median snoring index (SI) was also improved (by 47%, 303.8 vs. 121.1 event/h, p = 0.0002). Despite no significant difference in the mean saturation, improvements in the oxygen desaturation index (8.7 vs. 5.8, p = 0.0003) and the lowest saturation (82.5% vs. 87%, p = 0.049) were noted. The change in AHI was associated with baseline AHI (r = −0.52, p = 0.02), oxygen desaturation index (ODI) (r = −0.54, p = 0.01), and SI (r = −0.47, p = 0.04). The change in SI was strongly associated with baseline SI (r = −0.77, p = 0.001). Conclusions: Mouth-taping during sleep improved snoring and the severity of sleep apnea in mouth-breathers with mild OSA, with AHI and SI being reduced by about half. The higher the level of baseline AHI and SI, the greater the improvement was shown after mouth-taping. Mouth-taping could be an alternative treatment in patients with mild OSA before turning to CPAP therapy or surgical intervention.

Background: Early injection laryngoplasty (EIL) using hyaluronic acid (HA) is an effective treatment for glottic insufficiency in patients with acute unilateral vocal fold paralysis (UVFP). Most patients benefit by showing improvement in voice and quality of life and implied reduced need for permanent laryngoplasty. However, injected HA might resolve within a short period, so its long-term outcomes and the need for secondary procedures need to be clarified. Methods: Patients who underwent EIL with HA for acute UVFP from January 2015 to December 2018 were included. The factors that may associate with the prognosis including voice performance and laryngeal configuration at presentation, the cause of UVFP, and the type of HA for EIL were analyzed. Results: Ninety-four patients were included for analysis, with a mean follow-up period of 25.1 months (95% CI: 22.8–27.4 months). After primary HA injection, 22 patients (23.4%) underwent secondary procedures (rate: 13.1% per person-year), and most (63.6%) of the events occurred after one year from the first injection. The rate of secondary procedures within the first 12 months was 9.0% (14.1% and 4.3% for low-concentrated HA (LHA) and high-concentrated HA (HHA), respectively). The incidence of the secondary procedures was higher in the LHA group (18.2%) (p = 0.026) than in the HHA group (7.5%). Conclusions: The rate of secondary procedures was lower than the prediction based on the resorption time of HA, a finding that could be partly accounted for by both natural nerve recovery and a long-lasting effect of EIL. EIL with HHA had a lower rate of re-treatment than that with LHA, suggesting a better clinical utility for acute UVFP.