搜索结果：World journal of otorhinolaryngology - head and neck surgery

For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.

Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.

Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.

Involvement of the head-and-neck area in atopic dermatitis (AD) is common, associated with reduced quality of life, and suggested as an independent criterion for moderate-to-severe AD. The effectiveness of systemic therapies for AD specifically in the head-and-neck area remains underexplored. The objective was to evaluate the effectiveness of approved anti-inflammatory systemic therapies for AD in the head-and-neck area through a systematic review and meta-analysis. We conducted a systematic literature search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) indentifying studies reporting response to systemic anti-inflammatory therapies for AD in the head-and-neck region. Searches were conducted in the databases PubMed, EMBASE, and Web of Science from inception through June 2025. The primary outcomes were mean percentage change of Eczema Area and Severity Index (EASI) for the head-and-neck region (EASI-HN), and proportion of patients achieving 75% improvement of EASI for the head-and-neck region (EASI75-HN). Meta-analyses were performed where data permitted. In total, 22 publications, encompassing 32 unique studies and 11,372 patients in total, met the inclusion criteria. Of the 22 included publications, eight were post hoc analyses of randomized controlled trials (RCTs), and 14 were observational real-world studies. Across studies, the mean reductions of EASI-HN after 16 weeks of treatment ranged from 59% (dupilumab 300 mg every 2 weeks (Q2W) without topical therapy) and 67% (lebrikizumab 250 mg Q2W without topical therapy) to 80% (upadacitinib 30 mg once daily (QD) without topical therapy) and 85% (dupilumab 300 mg Q2W with concomitant topical therapy). EASI75-HN after 16 weeks of treatment ranged from 20% (baricitinib 2 and 4 mg QD) to 66% (upadacitinib 30 mg QD). Evidence for the conventional systemic therapies, cyclosporine and methotrexate, was limited and not readily comparable to the other treatments. In this systematic review, biologics and Janus kinase inhibitors (JAKis) were effective in treating AD in the head-and-neck region, achieving treatment responses comparable to those observed in other body regions. Further research providing direct comparison between therapies are warranted.

Aim: To compare oral corticosteroid (OCS) burden and healthcare resource utilization (HCRU) in patients with chronic rhinosinusitis with nasal polyps undergoing functional endoscopic sinus surgery (FESS; intervention) versus not undergoing FESS. Materials & methods: Retrospective cohort study using US claims data (Optum's de-identified Clinformatics&#xae; Data Mart Database; 2011-2021). Groups were propensity score (PS) matched to adjust for confounding. OCS burden (cumulative dose in mg prednisone equivalents) and HCRU were assessed during baseline (365&#xa0;days pre-index), intervention (days 0-44), and follow-up (days 45-365); costs during intervention and follow-up. Results: Before PS-matching, both groups had substantial comorbidity burden (>50% allergic rhinitis; >25% asthma) and over half of patients had used OCS (65% [FESS] vs 52% [non-FESS]; p&#xa0;<&#xa0;0.01). After PS-matching (n&#xa0;=&#xa0;8909 per group), OCS cumulative dose during follow-up was 18% lower among FESS versus non-FESS patients (mean difference: -40&#xa0;mg per patient [95% CI: -57, -23; p&#xa0;<&#xa0;0.01]). Similar proportions of patients filled OCS prescriptions during follow-up (35% [FESS], 36% [non-FESS]) and in these patients, OCS burden remained high (mean [SD] cumulative dose 521 [786] vs 612 [906] mg, respectively). Mean total healthcare costs per patient during the intervention period were $28,832 (FESS) and $2537 (non-FESS), but similar during follow-up ($15,659 and $15,926, respectively). HCRU was similar in follow-up, except more FESS patients visited an otolaryngologist (57% vs 32%, p&#xa0;<&#xa0;0.01). Conclusion: In US clinical practice, OCS burden in patients with chronic rhinosinusitis with nasal polyps was significantly lower but remained substantial following FESS, and HCRU and costs during follow-up were similar to matched patients without FESS. What was the aim of this research? To compare the burden of medications, visits, procedures and costs between patients with chronic rhinosinusitis with nasal polyps who did nor did not undergo polyp removal surgery. How was the research carried out? Anonymized administrative health-claim data were analyzed through the year before and up to 3&#xa0;years after surgery. To allow for a fair comparison between patients who did and did not have surgery, patients were matched according to a range of factors including age, gender, race and prior use of medications. What were the results? Between 45 and 365&#xa0;days after surgery, patients had an 18% lower average cumulative dose of oral corticosteroids (OCS) compared with patients who did not have surgery. The proportion of patients with prescriptions for OCS was similar between the surgery and nonsurgery groups (35% and 36%, respectively). Similarly, there was little difference in the use of other medications. Otolaryngologist visits were more common for patients who had surgery than those who did not. Costs were similar after surgery between the surgery and no-surgery groups through 3&#xa0;years of follow-up. What do the results of the study mean? This study found that OCS use was lower over the 3&#xa0;years after sinus surgery but remained substantial for both the surgery and nonsurgery patient groups. Further, surgery only marginally reduced costs during the follow-up period. These results serve as evidence for policymakers and healthcare providers when deciding the most cost-effective way to treat patients with chronic rhinosinusitis with nasal polyps.

As the impact of coronavirus disease 2019 (COVID-19) continues to permeate throughout global healthcare systems, the lives of staff physicians, medical and surgical residents, medical students, and other allied healthcare workers are in constant flux. Priorities for healthcare workers currently center around providing effective patient care, ensuring adequate personal protective equipment, ventilator supply, and hospital capacity. In an effort to increase hospital capacity to account for the surge of critically ill COVID-19 patients and to protect healthcare workers, the American College of Surgeons recommended that all hospitals, “review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures” until further notice.1 The American College of Surgeons recommendation has undoubtedly left surgical residents and trainees in a precarious position. With a dramatic reduction in operative exposure, and in some cases, with a mandate to remain at home, how will surgical trainees maintain their surgical skill and intraoperative knowledge? Fortunately, given significant technological advancements over the past several decades, there remain a number of options for the maintenance of intraoperative knowledge beyond textbook-learning that are easily accessible from home. Computer- and phone-based technologies provide access to intraoperative video recordings, virtual reality operating room simulations, and other interactive surgical platforms. Such applications are widely available and have the potential to satisfy and supplement the learning needs of surgical trainees as defined by surgical education governing bodies.2 Moreover, surgical simulation has the potential to increase objective technical proficiency in the operating room, decrease intraoperative errors, and decrease operative time.3 The aim of the present article is to provide an overview of the available computer- and phone-based platforms accessible at home for surgical trainees who currently have limited surgical exposure given the ongoing COVID-19 pandemic. Such a review may allow surgical trainees and surgical education governing bodies to initiate and create at-home surgical curricula during the COVID-19 pandemic. COMPUTER-BASED PLATFORMS Exponential growth of computer processing power over recent decades has fueled a parallel expansion of computer-based surgical platforms. Currently, over 20 computer-based platforms, ranging over 9 surgical specialties, are available on the internet and are accessible from home. Fifteen computer-based platforms are freely accessible, 1 platform (Incision Academy) is offering a 4-week free trial during the COVID-19 pandemic, and 7 platforms require paid accounts. Two paid platforms present material pertaining to all surgical specialties. The Surgical Council on Resident Education Portal provides an online surgical curriculum with access to over 800 modules, 2,000 multiple choice questions, and 220 narrated intraoperative videos. Approximately 95% of American General Surgery residency programs subscribe.4 It has been demonstrated that residents with an active subscription to the Surgical Council on Resident Education Portal score higher on their American Board of Surgery Qualifying Examination.5 The Journal of Medical Insight is a peer-reviewed surgical video journal that offers annotated intraoperative videos along with supporting primary literature, organized neatly into “chapters.” Each chapter pertains to a specific step of the selected procedure, and offers an opportunity for self-assessment. Access to this platform costs $50 per month or $500 per year for surgical residents. Two platforms focus solely on General Surgery and 6 have content pertaining mostly to General Surgery whereas also having additional modules focused on other surgical specialties. Incision Academy is a European-based online platform that presents live intraoperative video. It details the steps of a given operation, provides primary literature evidence, allows for interactive anatomy learning relevant to the operation, and has a section for self-assessment. They have released a free 4-week trial in light of the COVID-19 pandemic. WebSurg is an online platform that publishes multimedia General Surgery, and Gynecology, content monthly. It is produced by the Institute for Research into Cancer of the Digestive System (France) and is supported by Medtronic and Karl Storz. Over 2000 sequenced and subtitled intraoperative videos in 7 languages are currently available. This platform also offers free live webinars and conference broadcasts. Users must register a free online account for full access. Teach Me Surgery has a large General Surgery section and sections available for other surgical specialties. This is a free platform that organizes over 400 peer-reviewed articles, has over 1000 interactive clinical images, and allows for self-assessment. Similarly, Surgery Squad caters to General Surgery, Ophthalmology, and Obstetrical procedures. It is an interactive, virtual reality platform that allows the user to progress through the key steps of an operation. Five platforms focus primarily on Otorhinolaryngology – Head & Neck Surgery. e-lefENT is a United Kingdom-based, interactive, and self-assessment driven online platform that is mapped to fit the Intercollegiate Surgical Curriculum Programme. It is funded by Medtronic and requires a paid subscription. Headmirror is an online surgical atlas with live, narrated intraoperative videos spanning numerous subspecialties (ie, facial plastic surgery, head and neck surgery, laryngology, otology and neurotology, rhinology and sinus surgery, pediatric otolaryngology). It is free platform maintained by the Otorhinolaryngology – Head & Neck Surgery department at The Mayo Clinic. There are 3 ophthalmology-specific platforms available, 2 of which are free to all users. Eye Tube is an online platform that allows users to view fully narrated live intraoperative videos of ophthalmology procedures (ie, cataract, glaucoma, oculoplastics). It offers a new 3-dimensional channel for intraoperative viewing. eIntegrity is a paid platform sponsored by the National Health Services and the Royal College of Ophthalmologists. Three orthopedic-specific computer-based platforms are available from home. Ortho Oracle is a surgical atlas that contains live, intraoperative videos for the following orthopedic subspecialties: shoulder and elbow, hand and wrist, spine, hip, knee, foot and ankle, and oncology. It is a United Kingdom-based platform that costs 7 euros per month for a full subscription. The full version allows you to take notes on their platform while watching videos and uses International Business Machines Corporation Watson to deliver relevant primary literature. AO Surgery Reference is an online repository for the management of fractures at any anatomic location. It provides free access to interactive modules that progress through key steps (with picture instructions) of preoperative, intraoperative, and postoperative fracture management. Fundamental Surgery requires access to HapticVR technology. Two platforms have been validated in peer-review publications. Simulation General and Thoracic Surgery increased resident knowledge base in thoracic surgery procedures (pre-test: 42.5% vs post-test: 78.6%, P < 0.0001) and enhanced confidence when preparing for live thoracic procedures.6 It is a free platform affiliated with the University of Virginia that incorporates ex-vivo videos aimed at highlighting essential steps and equipment for thoracic operations (eg, Nissen Fundoplication, Repair of Acute Esophageal Perforation, Left Postero-Lateral Thoracotomy). CyberSight is a free online surgical learning platform that includes modules focused on the following topics: cataract surgery, cornea anatomy, glaucoma, pediatric ophthalmologic disease, and strabismus. These courses were developed and delivered by Ophthalmologists from around the world, including UC Davis Eye center, New England College of Optometry, and Middle East Africa Council of Ophthalmology. This platform also includes an online mentoring service that, along with the modules, have been shown to be a viable method for delivering ophthalmology expertise globally.7 Other available platforms include VideoUrology, Toronto Video Atlas of Surgery, Decker Med (paid subscription required), Wise-MD, and Multi-media Manual of Cardio-thoracic Surgery. PHONE BASED PROGRAMS In addition to web-based modalities for surgical simulation, there are educational phone-based platforms. Touch Surgery is a free-trial phone surgical simulation application that includes 12 different surgical specialties (Cardiothoracic Surgery; General Surgery; Global Surgery; Neurosurgery; Obstetrics and Gynecology; Ophthalmology; Oro-maxillofacial Surgery; Orthopedics and Trauma; Otolaryngology Head and Neck Surgery; Plastic, Reconstructive and Aesthetic Surgery; Urology and Vascular Surgery) with over 200 procedures for surgical simulation. Furthermore, there is a self-assessment component to ensure material consolidation. Touch Surgery has been validated by 19 independent peer-reviewed publications. For example, Touch Surgery laparoscopy and intramedullary femoral nail simulations were able to significantly distinguish between expert surgeons and novices (P < 0.001, P < 0.001).8,9 Additionally, studies have reported that users find the surgical simulations to be realistic.8,9 Level Ex developed 4 free interactive animated phone applications entitled Cardio Ex, Pulm Ex, Gastro Ex, and Airway Ex. Although Cardio Ex, Pulm Ex, and Airway Ex focus on medical/anesthesiology simulation, Gastro Ex involves colorectal surgery simulation. Gastro Ex provides users with feedback on accuracy and speed during endoscope, biopsy and cautery tasks. No peer-reviewed publications exist validating Level Ex applications. Two free interactive, video-based surgical simulation applications from Belgium were published in 2016–2017, including My Virtual Surgery and CABG - OPCAB Surgery Training. These applications include surgical simulation from Cardiac Surgery, Vascular Surgery, Plastic Surgery, General Surgery, Obstetrics and Gynecology. All of these applications include opportunities for learner self-assessment. Other surgical simulation phone-based platforms include LapGuru, OrthoGuru, and Ensafe VATS. CONCLUSIONS Amidst the COVID-19 public health crisis, that has infected more than 1 million people in over 180 countries, the educational needs of surgical trainees should not be neglected. Promoting remote learning platforms such as those highlighted in the present review and integrating them into formal curriculum can expand educational opportunities beyond the walls of the hospital. Such measures may mitigate the diminished surgical skill among surgical trainees that is foreseeable in hospitals across the word.

The effect of topical intraoperative corticosteroid application on voice quality in thyroid surgery with preserved RLN remains unclear. This randomized controlled trial aimed to evaluate the efficacy and safety of this intervention. Between January 2023 and June 2024, 134 patients scheduled for thyroid surgery were screened for eligibility. Patients who developed loss of signal (LOS) during surgery or who had postoperative impaired vocal cord motility on laryngoscopy were not included in the final analysis. Fourteen patients were excluded (six for previous thyroid/parathyroid surgery, four for preoperative vocal cord paralysis, and four for corticosteroid allergy), leaving 120 patients who were randomized equally to receive either topical intraoperative corticosteroids (n&#xa0;=&#xa0;60) or standard treatment (n&#xa0;=&#xa0;60). Baseline demographic and clinical data were comparable between the groups. Dynamic function of the larynx was monitored intraoperatively using electromyography (EMG), and vocal outcomes were assessed 1&#xa0;week postoperatively using the Voice Handicap Index (VHI) and voice-related quality of life (V-RQOL). Laryngeal findings and adverse events were also recorded. No EMG signal was recognized in any patient. The EMG amplitudes and latencies of the vagus nerve (V1 and V2) did not differ significantly between the groups. EMG signal changes between V1 and V2 were observed in 16% of RLNs in the control group and in 18% in the corticosteroid group, but these were not associated with clinically significant decreases in amplitude or increases in latency. Postoperatively, the corticosteroid group had significantly lower (better) mean VHI scores (12.4&#xa0;&#xb1;&#xa0;3.2 vs. 19.6&#xa0;&#xb1;&#xa0;4.7; p&#xa0;<&#xa0;0.01) and higher V-RQOL scores (88.3&#xa0;&#xb1;&#xa0;6.1 vs. 77.5&#xa0;&#xb1;&#xa0;8.8; p&#xa0;=&#xa0;0.02) than the control group. The subgroup analysis of patients with EMG changes showed similar trends. Vocal fold edema occurred in 2 patients in the corticosteroid group and 5 in the control group, with complete resolution of stroboscopic abnormalities in all patients after 4&#xa0;weeks. No local or systemic complications related to the use of corticosteroids were observed, and the postoperative courses were uneventful in both groups. Topical intraoperative use of corticosteroids in thyroid surgery with preserved RLN is safe and associated with improved early postoperative voice outcomes. No significant adverse events were observed, and RLN function was preserved in all cases. Further studies are needed to assess the long-term clinical relevance of these results.

This study aimed to evaluate longitudinal changes in the quality of life (QOL) of patients with recurrent or metastatic head and neck cancer treated with pembrolizumab in real-world clinical practice. We retrospectively analyzed the data of patients with recurrent or metastatic head and neck cancer who underwent pembrolizumab treatment at our institution between 2020 and 2023. QOL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at baseline and at nine and 18 weeks after treatment initiation. Changes in Global Health Status (GHS) were defined as the primary endpoint and analyzed over time using least-squares mean estimates. In total, 68 patients were included in the analysis. The mean GHS score increased from 57.0 at baseline to 62.5 at nine weeks, indicating a trend toward improvement (p=0.051). The GHS score remained higher at 18 weeks (58.7) than at baseline, although the difference was not statistically significant. No significant deterioration was observed in other functional or symptom scales. The objective response and disease control rates were 36.8% and 77.9%, respectively. With the use of pembrolizumab, QOL tended to be maintained or improved from the early phase of treatment in patients with recurrent or metastatic head and neck cancers. These findings are consistent with the results of the KEYNOTE-048 trial and other real-world studies, suggesting that immune checkpoint inhibitor therapy may preserve patients' QOL without compromising treatment efficacy.

The first-line treatment for platinum-sensitive recurrent or metastatic head and neck cancer (R/M HNSCC) is pembrolizumab with or without chemotherapy. The decision to combine chemotherapy largely depends on programmed death-ligand 1 (PD-L1) expression; however, chemotherapy is often difficult to administer in older adult patients because of reduced physiological reserve and comorbidities. Therefore, we analyzed real-world data to evaluate the effectiveness of pembrolizumab monotherapy according to age and PD-L1 combined positive score (CPS). This multicenter retrospective observational study analyzed the medical records of patients who received pembrolizumab monotherapy for R/M HNSCC. Patients with unknown CPS were excluded. This study was approved by our institutional review board. Overall survival (OS), progression-free survival (PFS), response rates, and immune-related adverse events were evaluated. All analyses were exploratory, and statistical significance was set at p<0.05. A total of 130 patients were included (median age, 72.5 years; range=40-89 years). Patients were classified into a young group (<75 years, n=75) and an older adult group (&#x2265;75 years, n=55). Median OS and PFS did not differ significantly between the young and older adult groups. Among older adult patients, those with high CPS (&#x2265;20) showed a trend toward improved OS compared with those with low CPS. Response rates and the incidence of immune-related adverse events were comparable between age groups. Pembrolizumab monotherapy demonstrated clinically meaningful real-world effectiveness and acceptable tolerability in older adult patients with R/M HNSCC, particularly in those with high PD-L1 expression (CPS&#x2265;20). In contrast, the benefit appeared limited in older adult patients with low CPS, underscoring the importance of careful patient selection and timely consideration of alternative strategies in real-world practice.

Laryngeal dysplasia and Reinke's edema (RE) are common vocal fold lesions associated with smoking. While the former is cancer prone, most cases of the latter do not undergo malignant transformation. Therefore, we proposed identifying biomarkers of smoking-induced benign-malignant transformation of vocal fold lesions. Intraoperative vocal fold tissue specimens were collected from 12 smoking patients, including 4 cases of RE, 4 cases of high-risk dysplasia (HD), and 4 cases of laryngeal carcinoma (CA), and from 4 nonsmoking vocal fold polyps (VFP) patients. RE and HD were set as experimental groups, and CA and VFP were set as positive and negative control groups, respectively (for subsequent expression analysis of hub genes screened). RNA sequencing and DIA-MS were employed to screen for differentially expressed genes (DEGs) and differentially expressed proteins (DEPs) in RE\HD. Venn analysis was used to identify co-expressed DEGs\DEPs. Functional enrichment analysis was performed to explore DEG\DEP-related pathways. LASSO regression and SVM-RFE algorithm were applied to screen for hub genes. The expression levels and prognosis of the hub genes were analyzed based on the TCGA database. The expression levels of the hub genes were further verified using RT-qPCR. A total of 45 co-expressed DEGs\DEPs were identified in RE\HD, with significant enrichment observed in the HIF-1 signaling pathway. Three hub genes were identified: TMPRSS11B, SASH1, and TPRG1, which exhibited reduced expression and were associated with poor prognosis in head and neck squamous carcinomas. RT-qPCR analysis confirmed that the mRNA levels of TMPRSS11B were highly expressed in RE and low in HD compared to VFP. This study reveals that TMPRSS11B may be a potential biomarker of smoking-induced benign-malignant transformation of the vocal fold lesions, providing a predictive and therapeutic target for early diagnosis and treatment of laryngeal carcinoma.

Auditory neuropathy (AN) is an auditory disorder that affects the function of the auditory pathway. An increasing number of AN cases have been identified with the revelation of the underlying mechanisms, the advancements of diagnostic and detecting techniques. The precise assessment, intervention, and effective rehabilitation of AN, which are crucial for AN patients and their families, have become challenging and significant topics in the field of otology. To discuss and lead the development of the "Chinese Clinical Practice Guideline for AN," more than 200 experts from China and other countries were invited to the "the International Advanced Forum on Auditory Neuropathy," which was hosted by the Chinese PLA General Hospital from 2016 to 2020, basing on the global research progress on AN and the clinical practice achievements in China. This guideline was jointly launched by the "Chinese Multi-center Research Collaborative Group on Clinical Diagnosis and Intervention of Auditory Neuropathy," the "Editorial Board of the Chinese Journal of Otorhinolaryngology Head and Neck Surgery," the "Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association," the "China Division, International Association of Physician in Audiology," and the "Society of Audiology and Vestibular Medicine, China International Exchange and Promotion Association for Medical and Health Care." This guideline aims to embody the characteristics and contributions of Chinese research in terms of disease diagnosis consistency, operational procedure standardization, disease subtype classification, lesion location classification, precise genetic diagnosis, personalized intervention, and follow-up of the natural course. It aims to establish and improve the Chinese Clinical Practice Guidelines for AN (gCAN) that conform to Chinese medical conditions.

Head and neck cancers (HNCs) are common malignancies with generally unfavorable prognoses worldwide, among which squamous cell carcinoma (SCC) represents the predominant histological type. The Combined Positive Score (CPS), a key metric for evaluating PD-L1 expression, has demonstrated predictive value for response to immunotherapy across various solid tumors. However, its distribution patterns and clinical significance among tumors originating from different anatomical subsites within the head and neck region remain unclear.This retrospective study included 591 patients with malignant head and neck tumors treated at Beijing Tongren Hospital between January 2022 and November 2024, comprising 316 hypopharyngeal, 202 laryngeal, 45 oropharyngeal, and 28 nasal cavity and paranasal sinus carcinoma. PD-L1 expression was assessed using the PD-L1 IHC 22C3 pharmDx assay, and CPS was calculated accordingly. Results showed that the CPS was significantly lower in hypopharyngeal carcinoma (18.89&#x2009;&#xb1;&#x2009;21.65) compared to oropharyngeal carcinoma (24.71&#x2009;&#xb1;&#x2009;25.97; P&#x2009;<&#x2009;0.05). Furthermore, CPS was negatively correlated with tumor differentiation in hypopharyngeal cancer (r&#x2009;=&#x2009;-0.1434, P&#x2009;=&#x2009;0.018), with a similar trend observed in laryngeal cancer (P&#x2009;=&#x2009;0.054), whereas no significant correlation was found in oropharyngeal or nasal cavity and paranasal sinus carcinoma.Survival analysis in the immunotherapy-treated subgroup revealed no statistically significant differences in overall survival (OS) or progression-free survival (PFS) between patients with CPS&#x2009;&#x2265;&#x2009;20 and those with CPS&#x2009;<&#x2009;20. However, in hypopharyngeal cancer, the CPS&#x2009;<&#x2009;20 group exhibited a hazard ratio (HR) for death of 4.55 (95% CI: 1.019-20.31), suggesting a potential clinically relevant difference.This study highlights significant heterogeneity in the immune microenvironment across different subsites of head and neck squamous cell carcinoma. The relationship between CPS and tumor differentiation is site-specific, indicating that the value of CPS as a biomarker for immunotherapy response should be interpreted in the context of tumor location.

Obstructive sleep apnea (OSA) is a common chronic disorder characterized by abnormal breathing during sleeping. OSA can damage various organs throughout the body and is burdensome, both socially and economically. Moreover, as OSA has been increasingly studied in recent years, new evidence-based guidelines for its diagnosis and surgical treatment are needed. A working group responsible for establishing Guidelines for the Diagnosis and Surgical Treatment of Adult OSA, the Otolaryngology Branch of the Chinese Medical Association (Subspecialty Group of Laryngopharyngology and Voice) and the Editorial Board of the Chinese Journal of Otorhinolaryngology Head and Neck Surgery partnered to formulate the "Chinese Guidelines for the Diagnosis and Surgical Treatment of Adult Obstructive Sleep Apnea (2024)" to ultimately standardize clinical decision-making. We searched or performed systematic reviews of currently available evidence and graded the evidence to provide recommendations for 10 important clinical issues. The aim of these guidelines was to improve the diagnosis and surgical treatment of adult OSA in China and therefore reduce the social and economic burden of OSA.

Endoscopic ear surgery has been widely performed in China since 2015 due to the development and rapid popularization of endoscopic technology. Due to the relative shortness of the auditory meatus, only a fixed endoscope is required in many cases, rather than a motion similar to a nasal endoscope, and uncontrollable bleeding is virtually non-existent. Compared to microscopy, endoscopy allows for rapid and flexible changes in the field of view, eliminating the need for bone grinding. On these grounds, the advantages of endoscopy in ear surgery have been largely recognized. At the same time, physicians have become more rational about expanding indications for endoscopic ear surgery due to limitations such as single-handed surgery. The debate and standardization surrounding endoscopic ear surgery is ongoing. This review focuses on the current status and development of endoscopic ear surgery in China, discusses the advantages, limitations, and prospects of endoscopic ear surgery.

This systematic review aims to evaluate the effectiveness of Tezepelumab, a monoclonal antibody targeting the thymic stromal lymphopoietin, in patients affected by chronic rhinosinusitis with nasal polyposis, both with and without comorbid asthma. A systematic search of the literature was conducted across PubMed, SCOPUS, and Google Scholar databases until April 2025. Studies were selected based on predefined inclusion criteria, focusing on adult patients with clinically diagnosed chronic rhinosinusitis with nasal polyps who received Tezepelumab treatment for at least four weeks and reported validated clinical outcomes. Studies involving patients receiving prior standard treatment and comorbid asthma were included. Outcome measures included sinonasal symptom scores, imaging scores, pulmonary function tests, quality of life assessments, systemic corticosteroid use, and the need for surgical intervention. Study selection, data extraction, and quality assessment were conducted independently by two reviewers. Out of 221 screened records, three randomized controlled trials involving a total of 691 patients met the eligibility criteria. Tezepelumab treatment resulted in significant improvements in nasal symptom scores, including reductions in nasal congestion and loss of smell, as well as improved quality of life and sleep-related symptoms. Objective assessments showed a reduction in polyp size and radiological scores, with fewer patients requiring systemic corticosteroids or surgical intervention compared to placebo. Improvements were also observed in lung function and disease control among patients with comorbid asthma. The effect size exceeded minimal clinically important difference thresholds across key outcome measures. Tezepelumab demonstrated consistent and clinically meaningful benefits in the treatment of chronic rhinosinusitis with nasal polyps, including symptom relief, reduced polyp burden, and decreased need for corticosteroids or surgery. Its upstream mechanism offers potential advantages over existing biologic therapies. Further long-term and real-world studies are needed to confirm its role in clinical practice and define ideal patient selection strategies.

Environmental pollution and climate change seriously affect human health, leading to the onset and exacerbation of chronic respiratory diseases, such as allergic rhinitis and lung diseases. Over the past several decades, increasing air pollution and environmental exposure owing to global urbanization, industrialization, and rapid economic growth have led to an increase in the prevalence of allergic and respiratory diseases. Allergic rhinitis and lung diseases are global health problems affecting people of all ages. This article summarizes the effects of environmental pollution and accompanying climate change on allergic rhinitis and lung diseases and discusses the interactions between the pathogenesis of allergic rhinitis and lung diseases and environmental pollution. The molecular mechanisms of allergic rhinitis and lung diseases and their common features are discussed. The prevention and control measures of allergic rhinitis and lung diseases caused by air pollution and climate change are described. Given that climate change could bring about numerous unforeseen and enduring impacts on allergic respiratory conditions, healthcare practitioners ought to champion efficient measures for mitigation and adaptation to curtail its adverse effects on respiratory health.

Head and neck cancer care delays are challenging, given the complexity of cancer care pathways, which leads to delays throughout the patient journey, from the symptom onset to treatment completion. Current models and literature addressing cancer care are limited by heterogeneous definitions of care intervals, a focus on specific aspects of the patient journey instead of the whole care continuum, and limited use of implementation science to target gaps in implementing evidence-based interventions. Here, we propose the Head and Neck Cancer TImely aCess TO Care Model as an approach to conceptualize, measure, and address delays in diverse health systems.

To investigate the effects of swallowing instructional methods and content on instructional compliance among patients with Parkinson's disease (PD). Overall, 59 of the 317 patients with PD who underwent a videofluoroscopic examination of swallowing (VF) and completed the Japanese version of the Dysphagia Handicap Index (DHI-J) within 45 days before and after VF were analyzed. Based on records of compliance with alternative strategies from the time of instruction to 6 months, patients were classified into the compliance (CP) and noncompliance (NCP) groups. The NCP and CP groups included 31 (52.5%) and 28 (47.5%) patients, respectively. No significant differences in self-reported severity or DHI score were identified, and quality of life (QOL) and awareness did not influence compliance. The CP group had more patients who received instruction using swallowing charts or handouts than the NCP group. More patients lived with family members. The NCP group had significantly higher DHI-Physical (P) and DHI-Total scores and lower QOL post-instruction reassessment (Post) than pre-instruction reassessment (Pre). Conversely, the CP group had significantly lower DHI-P, DHI-Emotional, and DHI-Total scores and higher QOL in Post than in Pre. When teaching swallowing with alternative strategies for dysphagia, using visual elements rather than verbal instructional elements alone is beneficial for improving compliance with instructional content. Compliance with swallowing instructions can maintain and improve QOL after the intervention. Patients living with family members demonstrated better compliance, likely due to meals provided by family members, along with advice and cooperation influencing compliance with the guidelines.

Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is an entity with peculiar clinical and molecular characteristics, which mainly arises from the reticulated epithelium lining the crypts of the palatine tonsils and the base of the tongue. The only head and neck site with a definite etiological association between persistent high-risk (HR) HPV infection and development of SCC is the oropharynx. HPV-positive malignancies represent 5-20% of all HNSCCs and 40-90% of those arising from the oropharynx, with widely variable rates depending on the geographic area, population, relative prevalence of environment-related SCC and detection assay. HPV-16 is by far the most common HR HPV genotype detected in oropharyngeal SCC (OPSCC), and the only definitely carcinogenic genotype for the head and neck region. Patients with HPV-induced OPSCC are more likely to be middle-aged white men, non-smokers, non-drinkers or mild to moderate drinkers, with higher socioeconomic status and better performance status than subjects with HPV-unrelated SCC. HPV-induced HNSCCs are often described as non-keratinizing, poorly differentiated or basaloid carcinomas, and are diagnosed in earlier T-category with a trend for a more advanced N-category, with cystic degeneration, than the HPV-unrelated carcinomas. HPV positivity is associated with better response to treatment and modality-independent survival benefit. Treatment selection in HPV-related oropharyngeal carcinoma is becoming a critical issue, and although there is no evidence from randomized, controlled trials to support a treatment de-escalation in HPV-positive SCC, some investigators argue that intensive combined modality strategies may represent an overtreatment.