New research was presented at AAO-HNSF 2022, the annual meeting of the American Academy of Otolaryngology Head and Neck Surgery, from September 10-14. The features below highlight some of the studies presented during the conference.
Bell’s Palsy Treatment Generally Differs from AAO-HNSF Guidelines
While the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNSF) does have treatment guidelines for patients with Bell’s palsy (BP), patients often present first to primary care providers or EDs. Peter Ciolek, MD, and colleagues sought to examine management and outcomes of patients with BP presenting to internal medicine (IM), family medicine (FM), EDs, and urgent care (UC). The retrospective chart review included 924 patients, most of whom (74.7%) went to the ED, followed by IM (10.1%), FM (9.25%), and UC (6.1%). At first presentation, most patients (84.3%) had incomplete paralysis. Most patients (89.6%) received steroids; 65.7% were prescribed antiviral therapy. Only a fifth of patients (20.2%) received an adequate dose and duration of steroid therapy according to AAO-HNSF guidelines, and only a small proportion of patients (5.8%) were referred to facial plastics (FPRS). Resolution varied, with 31.1% achieving complete resolution, 21.5% achieving incomplete resolution, and 7.3% with persistent palsy; 40.2% were lost to follow-up. “Patients with BP are often not managed according to existing guidelines or recommendations, including inadequate steroid therapy, eye care, and infrequent referrals to FPRS for long-term management of facial palsy,” Dr. Ciolek and colleagues wrote. “These findings suggest a need for a care pathway to guide management of these patients on initial presentation to primary care or the ED.”
Omega-3s Preliminarily Effective for COVID-19-related Olfactory Dysfunction
While many patients with COVID-19-related olfactory dysfunction (OD) recover, there remains a large group of patients with persistent OD for which treatment options are inadequate. To determine whether omega-3 fatty acid (O3FA) supplementation could improve olfactory recovery, Satish Govindaraj, MD, and colleagues prospectively recruited 117 patients with COVID-19 and self-reported, new-onset OD. The experimental group (N=57) received 2g O3FA supplementation, including 1,366 mg eicosapentaenoic acid and 504 mg docosahexaenoic acid; the control group (N=60) received an identical placebo. Each arm took the assigned regimen daily for 6 weeks. Mean duration of OD prior to enrollment was 200.1 days. Patients receiving O3FA supplementation experienced a mean Brief Smell Identification Test (BSIT) improvement of 1.12±1.99 compared with 0.68±1.86 in the placebo group. For patients with severe hyposmia, or a BSIT score of 7 or less, those in the O3FA group (N=23) experienced a BSIT improvement of 2.30±1.77 compared with 1.63±1.82 for those taking placebo (N=16). “Our study showed a trend toward improved olfactory recovery among [patients with] COVID-related OD receiving high doses of O3FA supplementation at a 6 week follow-up time point,” Dr. Govindaraj and colleagues wrote. “Future work will be needed to better define the effectiveness and durability of O3FA supplementation as a treatment for COVID-related OD.”
Hashimoto’s Thyroiditis Reduces Recurrence in Differentiated Thyroid Cancer
Previous research indicates that papillary thyroid carcinoma (PTC), when it occurs in the setting of Hashimoto’s thyroiditis (HT), may be less aggressive, with reduced lymph node and extrathyroidal invasion. Emad Kandil, MD, and colleagues aimed to determine the impact of HT on differentiated thyroid cancer (DTC) among patients with both the wild and mutated BRAF gene. The retrospective cohort study included 320 patients (mean age, 62.3; female, 75.6%). Individuals with HT-positive, BRAF-positive DTC experienced a decreased risk for aggressive disease compared with those with HT-negative, BRAF-positive DTC (11.4% vs 28.4%; P<0.01). Dr. Kandil and
colleagues also reported a statistical difference (P<0.01) in the rate of recurrence among patients with BRAF positive, HT-negative disease (18%), patients with BRAF-positive, HT-positive disease (8.9%), patients with BRAF negative, HT-negative disease (4.8%), and patients with BRAF-negative, HT-positive disease (0%). “Hashimoto’s thyroiditis decreases the rate of recurrence in patients with DTC, [with] no recurrence recorded in BRAFnegative DTC with underlying HT,” Dr. Kandil and colleagues wrote. “We recommend periodic follow-up in patient with HT positive, BRAFnegative DTC.”
Azithromycin Modulates Inflammation in Chronic Rhinosinusitis
The need for adjunct therapies for patients with chronic rhinosinusitis who have type 1 (T1) inflammation prompted researchers to further examine results observed with azithromycin, which has demonstrated in vitro efficacy in decreasing T1 inflammation and restoring epithelial barrier function. Martin Desrosiers, MD, FRCSC, and colleagues randomly assigned 31 patients in whom endoscopic sinus surgery and budesonide nasal irrigation was unsuccessful to treatment with azithromycin (N=13) or placebo (N=18) for 16 weeks. Using samples obtained at the start and again at the end of treatment, the researchers determined that azithromycin was associated with a greater down-regulation of pathways tied to T1 inflammation compared with placebo. These included tumor necrosis factor α signaling (P=0.001), interferon response (P=0.001), and inflammatory response (P=0.001), with concomitant restoration of the cell cycle and an increase in epithelial progenitors with upregulation of key pathways, all of which were significant (P=0.001). “This study demonstrates for the first time that azithromycin successfully decreases T1 inflammation through [interferon] and TNF-α pathways, along with restoration of epithelial function through upregulation of DNA repair and cycle pathways,” Dr. Desrosiers and colleagues wrote. “This suggests azithromycin may be employed as a T1 modulating agent in refractory T1 CRS.”
Decision Aid Helps Parents Make Choices for Kids With Sleep-Disordered Breathing
Decisional conflict impacts parents of children with mild to moderate sleep-disordered breathing (SDB) who are presented with the primary treatment options for the condition: adenotonsillectomy or watchful waiting. To determine whether a decision aid could improve parents’ perceptions of shared decision making, Michael Bezuhly, MD, MSc, SM, FRCSC, and colleagues conducted a prospective, active control, randomized trial among parents (N=101) with children aged 6 and younger assigned to the study group—with oral consultation and a decision aid—or the control group, with a standard oral consultation; 50 parents were assigned to the study group. The decision aid provided information about treatments, associated risks, and parent preferences. Parents using the decision aid had lower median Decisional Conflict Scale (DCS) scores (6.50 vs 19.25; P=0.005) and higher Shared Decision-Making Questionnaire 9 (SDM-Q-9) scores (93.59 vs 80.74; P=0.035). The DCS scores were significantly negatively correlated with SDM-Q-9 scores (P<0.001). “Parents using our decision aid reported lower levels of decisional conflict and greater perceived involvement in the decision-making process for their children with SDB,” Dr. Bezuhly and colleagues wrote.