Dylan Z. Erwin,Matthew Y. Liu,Mason R. Krysinski,Alexander M. Choi,Bundhit Tantiwongkosi,Philip G. Chen
Publicatie 29-10-2024
Allergic fungal rhinosinusitis (AFRS) often results in expansion of disease beyond the paranasal sinuses, which may put important structures, such as the anterior ethmoid artery (AEA) or lateral lamella of the cribiform, at risk of injury during endoscopic sinus surgery (ESS). This study aims to compare the AEA to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP), as well as additional anatomic variants. A single institutional retrospective chart review of patients undergoing ESS for AFRS and CRSwNP was performed. AEA-SB length were compared between the 2 groups. Other anatomic variants, including Keros measurement and presence of supraorbital ethmoid air cells (SOEC), concha bullosa (CB), sphenoethmoidal, and infraorbital ethmoid cells were measured and compared between the 2 groups. Twenty-one patients were included in each cohort. The AFRS group was younger in age ( AFRS harbors anatomical differences when compared to CRSwNP, with the former associated with a longer AEA-SB length. This key difference should be considered in preoperative planning to prevent injury to the AEA in patients undergoing ESS for AFRS.
Pubmed PDF WebJosefine Hastrup von Buchwald,Martin Frendø,Andreas Frithioff,Anders Britze,Thomas Winther Frederiksen,Jacob Melchiors,Steven Arild Wuyts Andersen
Publicatie 17-10-2024
Otoscopy is a key clinical examination used by multiple healthcare providers but training and testing of otoscopy skills remain largely uninvestigated. Simulator-based assessment of otoscopy skills exists, but evidence on its validity is scarce. In this study, we explored automated assessment and performance metrics of an otoscopy simulator through collection of validity evidence according to Messick's framework. Novices and experienced otoscopists completed a test program on the Earsi otoscopy simulator. Automated assessment of diagnostic ability and performance were compared with manual ratings of technical skills. Reliability of assessment was evaluated using Generalizability theory. Linear mixed models and correlation analysis were used to compare automated and manual assessments. Finally, we used the contrasting groups method to define a pass/fail level for the automated score. A total of 12 novices and 12 experienced otoscopists completed the study. We found an overall We explored validity evidence supporting an otoscopy simulator's automated score, demonstrating that this score mainly reflects cognitive skills. Manual assessment therefore still seems necessary at this point and external video-recording is necessary for valid assessment. To improve the reliability, the test course should include more cases to achieve a higher G-coefficient and a higher pass/fail standard should be used.
Pubmed PDF WebSarit Dhar,Dhruv S. Kothari,Camille Reeves,Anthony M. Sheyn,Marion Boyd Gillespie,Sanjeet V. Rangarajan
Publicatie 29-10-2024
Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients. To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS. Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments. Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population.
Pubmed PDF WebKomal Aggarwal,Rohit Ravi
Publicatie 02-10-2024
Gestational diabetes mellitus (GDM) is associated with several adverse health conditions in newborns such as preterm birth, hyperbilirubinemia, macrosomia, respiratory distress. However, the effect of GDM on the hearing sensitivity of newborns is still unclear. The study aimed to explore the effect of GDM on newborn hearing. The study aimed to explore the effect of GDM on newborn hearing. A systematic search was conducted using PubMed, Scopus, and CHINAL databases. Keywords like "gestational diabetes," "diabetic pregnancies," "hearing loss," "hearing impairment," and "hearing disorder" were used to form a search string. The Rayyan software was used for screening procedure. The full-length articles were shortlisted, extracted, and appraised. The 7 articles were included in the review. Findings suggest that hearing loss is more prevalent in newborns with GDM pregnancies than in non-GDM pregnancies. In addition, OAE findings were "referred during the first hearing screening of newborns with GDM pregnancies." The refer rate of the first bilateral hearing screening was higher for newborns with GDM pregnancies. Furthermore, children of diabetic pregnancies were found to be at risk of bilateral hearing loss, particularly sensorineural in nature. The present systematic review suggests an association between GDM and a higher refer rate in hearing screening. A multidisciplinary collaboration between gynecologists, pediatricians, and audiologists can smoothen the early detection of hearing loss in newborns with GDM pregnancies, leading to early intervention and better clinical outcomes to improve the quality of life of affected newborns.
Pubmed PDF WebYueqing Tao,Haozhe Zhang,Dongming Wang,Wenzhen Li
Publicatie 22-10-2024
We aimed to estimate the global prevalence of hearing loss among adults and to explore its associated factors. Our systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). We retrieved corresponding documents published up to Sep 24, 2021 in PubMed and Web of Science. Random-effects models were used to calculate the pooled prevalence of hearing loss. Subgroup analyses were conducted to explore potential heterogeneity. The pooled prevalence of any hearing loss across 100 studies was 31.0% (95% CI: 26.9-35.1, Our results demonstrate high prevalence of hearing loss among adults worldwide and verify several related factors of the disease. Prevention and intervention measures should be implemented.
Pubmed PDF WebIman S. Iqbal,Jonathan M. Carnino,Rohith R. Kariveda,Jessica R. Levi
Publicatie 06-11-2024
This article seeks to systematically review existing literature on the use of acupuncture in treating olfactory dysfunction in order to better understand the methodology and efficacy of this alternative treatment modality. A comprehensive search of PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar was conducted. The review was conducted by 2 independent reviewers that authored this article. Inclusion criteria included all studies analyzing the efficacy of acupuncture for treatment of olfactory dysfunction. Articles were excluded if they were duplicates, opinion or review papers, incomplete or unavailable papers, or if they were in a language other than English. The review found 10 articles matching the inclusion criteria that overall showed a positive improvement in olfactory dysfunction after acupuncture intervention in multiple settings. Challenges highlighted in this review include variability in acupuncture protocols, such as differences in point selection, session frequency, and overall treatment duration, as well as the lack of standardized outcome measures for assessing olfactory function. This systematic review suggests acupuncture may have therapeutic effect on improvement of olfactory function across various types of olfactory disorders, most notably seen in post-viral anosmia. Given the variability in acupuncture protocols and lack of standardized outcome measures, there is a need for further research with standardized methods and larger sample sizes. Olfactory dysfunction is fundamentally a quality-of-life issue; advancing research could solidify acupuncture as a valuable and cost-effective addition to treatment plans, optimizing patient well-being.
Pubmed PDF WebTroy Wesson,Mohamad Z. Saltagi,Shalini Manchanda,Stephanie Stahl,Yelena Chernyak,Noah Parker
Publicatie 06-11-2024
Hypoglossal nerve stimulation (HNS) is a treatment option for patients with moderate-to-severe obstructive sleep apnea. In the post-implant period, awake endoscopy with advanced programming (AEAP) can be employed to improve apnea hypopnea index (AHI) reduction and/or patient comfort. This study describes response patterns to HNS after AEAP as well as patient-specific patterns in our patient population. Retrospective evaluation of 17 consecutive patients who underwent AEAP between June 2019 and December 2022. Post-AEAP AHIs were used to create 2 response groups, which facilitated analysis of patient-based characteristics. AHI reporting, deemed non-titration AHI (NT-AHI), is the whole-night AHI resulting from non-titration studies. Chi-squared, Pearson correlation coefficient, and independent samples Fifteen of 17 patients (88.2%) presented for failed NT-AHI reduction, and 2/17 (11.8%) presented for comfort measures. Eleven patients (65%) showed an improvement in post-AEAP NT-AHI; 6 (35%) patients failed to improve. Four patients with either lateral wall collapse or concentric wall collapse at the tongue base failed to improve NT-AHI compared to a single patient who showed an improved NT-AHI ( AEAP is a powerful tool that offers the ability to identify settings conducive to increased therapy efficacy and improved treatment tolerability. Airway phenotypes are closely correlated with treatment efficacy, and as such, careful anatomical consideration of the upper airway must be performed when titrating therapy. Amongst the different treatment options for obstructive sleep apnea, hypoglossal nerve stimulation has been shown to be effective in positive-airway-pressure intolerant patients. This article explores response patterns to AEAP and highlights the importance of careful anatomical considerations of the upper airway. Level 3.
Pubmed PDF WebElizabeth M. Puyo,Lindsay R. Salvati,Neha Garg,Henry Bayly,Rohith R. Kariveda,Jonathan M. Carnino,Ajay S. Nathan,Jessica R. Levi
Publicatie 06-11-2024
The objective of this study is to investigate various demographic, socioeconomic, COVID-related, and clinical factors associated with missed otolaryngology appointments in the outpatient setting at Boston Medical Center (BMC), an urban safety net hospital. A retrospective chart review was conducted on adults (≥18 years old) with scheduled appointments in the otolaryngology department at BMC from May 1, 2015, to May 1, 2022. Data were extracted from the electronic medical record and included appointment-related factors (eg, status and type), demographic variables (eg, age, sex, race, and ethnicity), and socioeconomic factors (eg, employment and insurance). Statistical analyses utilized a binary mixed-effects model to identify predictors of appointment non-attendance, with pre-COVID, during COVID, and post-COVID periods defined for comparative analysis. Out of 14 050 patients, 5725 (40.8%) were classified as no-show. Older age decreased the likelihood of missing appointments (OR = 0.989, 95% CI = [0.986, 0.992]). Males (OR = 1.090, 95% CI = [1.022, 1.161]), Black/African American (OR = 2.047, 95% CI = [1.878, 2.231]), and Hispanic or Latino individuals (OR = 1.369, 95% CI = [1.232, 1.521]) were more likely to not show up. Retired participants (OR = 0.859, 95% CI = [0.753, 0.981]) and those with private insurance (OR = 0.698, 95% CI = [0.643, 0.758]) were less likely to miss appointments. During the COVID-19 pandemic, appointment attendance improved (OR = 0.865, 95% CI = [0.767, 0.976]). In-person appointments had a significantly higher non-attendance rate compared to telemedicine appointments (OR = 6.133, 95% CI = [5.248, 7.167]). Appointment non-attendance in otolaryngology is influenced by various demographic and socioeconomic factors, with significant disparities observed among racial and ethnic groups. The COVID-19 pandemic altered attendance patterns, highlighting the potential benefits of telemedicine. These findings underscore the need for targeted interventions to address healthcare disparities and improve appointment adherence, particularly among minority and socioeconomically disadvantaged populations. Future research should incorporate patient perspectives to better understand barriers to appointment attendance.
Pubmed PDF WebKhodayar Goshtasbi,Karen Tawk,Pooya Khosravi,Mehdi Abouzari,Hamid R. Djalilian
Publicatie 07-11-2024
To evaluate the efficacy of a smartphone-based application providing tinnitus-specific cognitive behavioral therapy and customized sound therapy for tinnitus. In a prospective randomized controlled trial, the treatment group participated in daily sound therapy and weekly interactive CBT modules, and the control group did not receive the program (waitlisted). Outcome measures after 8 weeks included the Tinnitus Functional Index (TFI), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI). Ninety-two patients (mean age = 57.2 ± 11.9 years) were included. The treatment (n = 47) and control (n = 45) cohorts had similar TFI, PHQ-9, GAD-7, PSS, and PSQI scores at presentation (all This novel smartphone application providing cognitive behavioral therapy and customized sound therapy was effective in reducing symptom severity and improving anxiety, sleep, and mood for tinnitus patients.
Pubmed PDF WebUğur Dincer,Ayşegül Verim,Çağrı Becerik,Nilüfer Gürsan,Çiğdem Tepe Karaca,Sema Zer Toros
Publicatie 07-11-2024
Rosuvastatin is an antihyperlipidemic statin group pharmacological agent with antioxidant, neuroprotective, and anti-inflammatory effects. In this study, we aimed to examine the functional, electrophysiological, and histopathological effects of rosuvastatin or in combination with corticosteroids on facial nerve regeneration in rats with traumatic peripheral facial paralysis (PFP). PFP was induced in 28 female Sprague Dawley rats that we divided into 4 groups: group 1, control group; group 2, methylprednisolone group; group 3, rosuvastatin group; group 4, rosuvastatin and methylprednisolone group. Electrophysiological, functional, and histopathological examinations were performed before and after the medications. Electrophysiological threshold values of group 3 and group 4 were found to be significantly lower than the control group on day 21 after treatment ( Rosuvastatin, especially when combined with methylprednisolone was found to significantly increase the facial nerve electrophysiological, functional, and histopathological recovery in injury-induced traumatic PFP.
Pubmed PDF WebAntoinette R. Esce,Robert G. Nicholas,Noah P. Syme,Garth T. Olson,Nathan H. Boyd
Publicatie 09-11-2024
Intraoperative parathyroid hormone (IOPTH) monitoring has become routine in parathyroid surgery to facilitate less invasive techniques to treat hyperparathyroidism. Despite this, little is known about in vivo IOPTH kinetics, which can greatly affect the reliability of its interpretation. A prospective cohort of patients undergoing routine parathyroidectomy was studied. During each case, IOPTH was measured frequently, during all key perioperative events. Qualitative, univariate, and multivariate analysis was performed to better understand the patterns of in vivo IOPTH kinetics. The IOPTH increased from preoperative baseline in every case, but some patients had a rapid spike after gland manipulation while others had a more gradual increase. The IOPTH peak occurred prior to excision in almost every case. The IOPTH began to fall prior to excision, typically returning to preoperative baseline levels just before excision. The average in vivo half-life of parathyroid hormone (PTH) was 5.2 minutes. There is substantial variation in the in vivo IOPTH kinetics and more research is needed to understand predictors of kinetic patterns and PTH half-life during parathyroidectomy.
Pubmed PDF WebSaba Shafiq,Abdur Rehman,Shahzaib Maqbool
Publicatie 06-11-2024
Pooja D. Reddy,Akshaya Raman,Soukaina Eljamri,Amber Shaffer,Reema Padia
Publicatie 02-01-2025
Granulation tissue formation and tracheitis are common pediatric tracheostomy complications. Ciprofloxacin/dexamethasone is frequently prescribed, but the influence of social determinants on this topic is unexplored. This study extends a prior cohort study of pediatric tracheostomy patients at a single academic institution from 2016 to 2020. Social determinants of health, including race, insurance status, and residence characteristics, including Area Deprivation Index (ADI), were evaluated. Logistic regression, Wilcoxon rank-sum, and log-rank tests (α = .05) analyzed relationships between these determinants and prescriptions and post-tracheostomy outcomes. This cohort included 182 patients; 98/182 (53.9%) were male, and 140/182 (76.9%) were White, non-Hispanic. Non-White race was associated with increased odds of receiving nebulized ciprofloxacin/dexamethasone (OR = 2.80, 95% CI = 1.25-6.29). In those with tracheal culture results available (n = 63), Staphylococcus aureus was more common with public insurance (29/47, 7 with MRSA, 61.7%) compared with private (5/16, 3 with MRSA, 31.3%; OR = 3.54, 95% CI = 1.05-11.9). ADI was greater in the 7 patients with Streptococcus pneumoniae (median = 95, IQR = 88-99) compared to without (median = 77, IQR = 65-81, This study revealed racial disparities in ciprofloxacin/dexamethasone usage, residence-related differences in tracheal culture results, and ADI-related dressing choices, which highlight the need for tailored, equitable care to optimize outcomes. 4.
Pubmed PDF WebNicholas R. Randall,Dane M. Barrett,Dennis O. Frank-Ito,Keven Seung Yong Ji,Thien Hoang,Tom D. Wang,Myriam Loyo
Publicatie 27-12-2024
Functional septorhinoplasty is an effective treatment for nasal airway obstruction. Little distinction exists between bilaterally and unilaterally obstructed patients in literature. Our study evaluates outcomes in patients with unilateral nasal airway obstruction compared to those with bilateral nasal airway obstruction as measured by nasal obstruction symptom evaluation scores following functional septorhinoplasty. A total of 227 patients underwent functional septorhinoplasty for nasal airway obstruction. Patients were grouped into unilateral (n = 64) and bilateral (n = 163) nasal obstruction cohorts based on patient report and physician assessment. Nasal obstruction symptom evaluation (NOSE) scores were obtained pre-operatively and post-operatively at least 3 months following surgery. Patients with unilateral nasal obstruction had slightly less severe symptoms preoperatively than patients with bilateral obstruction. Average preoperative NOSE scores for patients with unilateral obstruction was 64 (SD = 19) and 72 (SD = 18) for patients with bilateral obstruction ( Symptoms in patients with unilateral obstruction are similar but slightly less severe than patients with bilateral obstruction. Patients with unilateral and bilateral nasal obstruction experienced a similar degree of improvement in symptom following functional septorhinoplasty.
Pubmed PDF WebIman S. Iqbal,Tyler Ostrowski,Jason Mouzakes,Jessica R. Levi
Publicatie 26-12-2024
The ability to hear is germane in fostering communiation skills in children and plays a crucial role in their overall wellbeing. Unfortunately, hearing impairment is one of the most common developmental discrepancies in children. To describe and evaluate the current legislation surrounding pediatric hearing aid reimbursement and the implications of these policies. A review of the scientific literature in addition to several state legislature sites was used to write this article. Private insurance reimbursement for pediatric hearing aids is variable between vendors and states. Only half of United States have passed legislation requiring insurers to cover hearing aids for their subscribers. Due to the lack of reimbursement for these expensive yet medically necessary devices, families across the country experience financial distress associated with the lack of coverage for hearing aids. In many cases, this leaves children without the ability to hear to their fullest potential. It is time we as otolaryngologists advocate for a national solution to this issue and promote a national policy to require private insurers to cover the costs of hearing aids for their subscribers.
Pubmed PDF WebOllivier Laccourreye,Michaele Francesco Corbisiero,Dominique Garcia,Haitham Mirghani,Philippe Giraud
Publicatie 26-12-2024
To evaluate whether supracricoid partial laryngectomy (SCPL) may be a viable alternative to radiation therapy (RT) for patients with glottic cT3N0M0 squamous cell carcinoma (SCC) who are surgical candidates for total laryngectomy (TL) and respond well to platinum-based induction chemotherapy. Retrospective case series review of 18 consecutive patients with cT3N0M0 glottic SCC, initially considered surgical candidates only for TL who showed a good response to platinum-based induction chemotherapy, managed at a French university teaching institution with either SCPL (n = 9) or RT (n = 9). The main endpoints were 10-year local control and laryngeal preservation. The secondary endpoints were 10-year survival, causes of death analysis, and univariate analysis of local control and survival. The 10-year actuarial local control, laryngeal preservation, survival rates were 77.8%, 88.9%, and 66.7% after SCPL, respectively, and 72.9%, 87.5%, and 33.3%, after RT without significant statistical differences. In univariate analysis none of the clinical variables under analysis were related to local control and survival. Our data suggest that SCPL may warrant further consideration as a treatment option for glottic cT3N0M0 SCC patients who respond well to platinum-based induction chemotherapy. However, additional prospective research is warranted given the retrospective, nonrandomized nature of the presented case series.
Pubmed PDF WebMainak Dutta,Debjit Jana,Diptanshu Mukherjee,Tanaya Panja,Amit Kumar Shukla,Divya Daga,Krishna Kumar Yadav,Swarnali Mondal,Saumendra Nath Bandyopadhyay
Publicatie 25-12-2024
An endoscopic screening program following successful weaning from prolonged mechanical ventilation maintained through endotracheal tube (ET; To evaluate effects of prolonged intubation in children through endoscopic screening of the laryngotracheal airway. In this cross-sectional pilot project, children (2 months-12 years) successfully extubated following prolonged intubation were selected, irrespective of having symptoms, for a 1-time flexible nasolaryngoscopy at third to sixth month post-extubation (follow-up window). Laryngotracheal airway changes, if present, were noted. Out of 122 children, 42 developed symptoms of complications. Five of them attended within 3 months post-extubation, the rest were evaluated in the follow-up window. Eighty children aged ≤6 years and 4 children >6 years were intubated with uncuffed ET. Symptoms, when present, included respiratory distress (100%), noisy breathing (~36%), cough (~29%), and dysphagia (~12%). Screening revealed positive findings in 40 out of 42 symptomatic children, and in 8 out of 80 asymptomatic children (χ The present study proposes the potential utility of follow-up endoscopic screening of upper (laryngotracheal) airway in children successfully weaned from prolonged intubation. A statistically significant relationship existed between prolonged intubation and upper airway complications that were not always symptomatic.
Pubmed PDF WebKoffi L. Lakpa,Daniel G. Eyassu,Joshua P. Wiedermann
Publicatie 24-12-2024
External ear malformations represent a spectrum of congenital anomalies that may involve the external auditory canal (EAC), tympanic membrane (TM), or associated structures. A rare anomaly, the EAC skin wedge, results from incomplete canalization during embryologic development. This report presents the clinical presentation, diagnostic evaluation, and surgical management of this condition. To detail the successful surgical management of an isolated EAC skin wedge and demonstrate the applicability of argon laser in treating these congenital anomalies. A 13-month-old female presented with recurrent otitis media and mild bilateral conductive hearing loss. Physical examination revealed a fan-like skin wedge spanning the EAC to the TM. Imaging with temporal bone computed tomography confirmed the extent of the anomaly. Under general anesthesia, the skin wedge was ablated using an argon laser, followed by antibiotic-soaked packing to prevent scarring and recurrence. Follow-up audiometry and endoscopic evaluations assessed outcomes. The procedure was well-tolerated, with no intraoperative complications. At 3 weeks and 3 months postoperatively, no recurrence of the skin wedge was observed, and audiometry normalized. The patient demonstrated improved middle ear ventilation and resolution of conductive hearing loss. This case demonstrates the successful use of argon laser in the management of a rare congenital EAC anomaly. Argon lasers offer precise ablation and excellent hemostasis, making them a valuable option for similar cases. This report emphasizes the importance of tailored surgical approaches for rare pediatric ear malformations.
Pubmed PDF WebAhmed Abdelmoneim Teaima,Badr Eldin Mostafa,Khaled Mohamed Nabil,Ossama Mustafa Mady
Publicatie 21-12-2024
Laryngeal carcinoma is not uncommon worldwide. We conducted this study to comprehensively compare the outcome of stapler versus conventional suturing in total laryngectomy primary or salvage. This is a retrospective study conducted in our tertiary institute from 2015 to 2022 involving patients diagnosed with laryngeal carcinoma who underwent total laryngectomy either primary or salvage. We divided patients into 4 groups: primary or salvage laryngectomy, closed with stapler or manual suturing. The reported outcomes included : operative time, length of hospital stay, start of oral feeding, incidence of pharyngocutaneous fistula, positivity of surgical margins, and surgical site infection. Patients with multiple comorbidities and those requiring a flap for pharyngeal closure were excluded . A total of 91 patients were included in our study. Pharyngocutaneous fistula rate was 19% in conventional patient group in comparison to 6.7% in stapler group for primary total laryngectomy while it was 12.5% for salvage with stapler and 25% for salvage with conventional. Hospital stay was 6 ± 1.5 days for stapler and 11.4 ± 2.9 days for conventional suturing in primary laryngectomy. It was 8.8 ± 1.3 days for stapler and 13.1 ± 1.8 for conventional suturing in salvage laryngectomy. There was highly significant difference found as regard mean operative time, start of oral feeding and hospital stay in favor of stapler use. Stapler use in total laryngectomy is is a simple, fast, and effective technique with tension free watertight closure, better hemostasis, less contamination of surgical field than manual suturing.
Pubmed PDF WebAndrea A Lopez,Shilin Zhao,Kaitlin July O’Brien,Sarah Rohde,Ryan H. Belcher
Publicatie 18-12-2024
Parathyroid gland (PG) auto-transplantation is performed to preserve the function of de-vascularized or unintentionally removed PGs, however, little has been published about the technique and outcomes in children. In our study, we aimed to present the results of PG auto-transplantation in children undergoing thyroidectomy or parathyroidectomy at a tertiary single institution. A retrospective review identified 14 patients (<18 years of age) who underwent PG auto-transplantation from January 2000 to December 2022. 57.1% (8/14) had transient postoperative hypocalcemia and 14.3% (2/14) had permanent postoperative hypocalcemia. Eight patients had transient hypoparathyroidism, correlating with the rate of transient hypocalcemia. The most common reimplantation site was the sternocleidomastoid (11/14) and it was significantly associated with normalized calcium levels 6 months after auto-transplantation (p=0.033). Bilateral central neck dissection and surgical indication of cancer had a statistically significant association with transient hypocalcemia (p=0.03 and p=0.005, respectively). Our study provides valuable insights into the outcomes of PG auto-transplantation in pediatric patients, highlighting the potential for successful engraftment and factors associated with hypocalcemia.
Pubmed PDF WebXiaoqiong Qian,Danping Li,Yu Zhang,Tiantian Su,Song Shi
Publicatie 17-12-2024
Soluble fibrinogen-like protein 2 (sFGL2) may be involved in the pathology and progression of allergic rhinitis (AR) through regulating T-helper (Th)2 cell response. This study aimed to explore the ability of sFGL2 to estimate outcomes in AR patients. sFGL2 was detected in the serum sample of 119 AR patients at baseline and 20 healthy controls (HCs) after enrollment by enzyme-linked immunosorbent assay. In AR patients, disease severity was assessed at baseline as well as 4 weeks (W4) and 8 weeks (W8) after enrollment by the total nasal symptom score (TNSS). sFGL2 was higher in AR patients than HCs [median (interquartile range): 100.0 (70.0-154.0) vs 47.0 (31.5-78.5) ng/mL] ( Serum sFGL2 is increased in AR patients, and its high level estimates an increased Th2 cytokine and disease severity as well as poor outcomes.
Pubmed PDF WebArjun Sharma,Khodayar Goshtasbi,Jay Bhatt
Publicatie 16-12-2024
The reach and impact of social media as it pertains to medical information among the parents and guardians of pediatric otolaryngology patients is unknown. This survey-based study investigates the use of social media as a source of medical knowledge in this population. Parents and guardians visiting a pediatric Otolaryngology clinic located at a tertiary care children's hospital in southern California from September 2022 to May 2023 were approached for study inclusion. Decision tree and logistic regression analysis was conducted to identify patterns of social media usage in association with factors of interest. Of the 400 parents included in the study, most were female (80.0%); 49.5% were 30 to 40 years of age, and 18.8% were <30 years old. Most (90.0%) used social media, and 44.5% actively used it to obtain health information related to care for their children. A large proportion of parents (73.0%) were interested in social media content to better understand their child's condition, particularly the opportunity to view videos and images of a surgery planned for their child (75.0%). About half (50.5%) would permit their child's doctor to post about their child on social media, and 53.8% stated they would be more inclined to choose a surgeon who uses social media to educate families about their child's condition. Most parents/guardians were interested in and had obtained critical medical information on social media, especially content pertaining to their child's medical condition(s). Analysis of survey responses identified the social media content most valued by parents/guardians of children undergoing otolaryngological surgery. These findings can be used by pediatric otolaryngologists to better understand their patients' preferences and improve access to health information for their patients on social media, as well as to grow their practices.
Pubmed PDF WebMaya Guhan,Grace Anand,Yi-Chun Liu
Publicatie 11-12-2024
Taylor G. Lackey,Avery Allen,Nevan McCabe,Matthew Clary,Katherine K. Green,Daniel S. Fink
Publicatie 10-12-2024
To investigate the association between subglottic stenosis (SGS) and obstructive sleep apnea (OSA). This is a cross-sectional pilot cohort study conducted at a single tertiary academic center from 2022 to 2023. Subjects with non-traumatic SGS were recruited for enrollment. All subjects completed a peak expiratory flow (PEF) measurement, validated sleep questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and a 1-night home sleep test (HST). Demographic data were summarized. Prevalence was calculated and descriptively compared to a matched population. Partial correlation analysis evaluated the relationship of PEF% and Meyer-Cotton grading, in addition to PEF% and apnea-hypopnea index (AHI). Sleep quality was compared in subjects with and without OSA via a Mann-Whitney Twenty subjects participated; all were Caucasian females with a mean age of 48.4 (10.4) years and a body mass index (BMI) of 24.1 (3.8). The majority (80%) had idiopathic SGS, and a mean PEF 288 (71) L/min. OSA was present in 40% of subjects, of which 15% had moderate OSA. PEF% did not correlate to AHI ( OSA prevalence is elevated in a cohort of subjects with SGS. Further study of airway dilation's impact on OSA is necessary. Screening and surveillance for OSA in patients with subglottic stenosis may need to be considered based on this study's findings.Level of Evidence: Level 3.
Pubmed PDF WebBharat Akhanda Panuganti,Harishanker Jeyarajan
Publicatie 06-12-2024
Transoral robotic surgery (TORS) for benign glottic conditions is scarcely represented in the literature. We aimed in this study to report on the technical feasibility of an explicitly transoral robotic approach for a patient with posterior glottic stenosis, and to highlight extant limitations in exposure and robotic instrumentation of the glottis. Retrospective chart review of a single patient undergoing a TORS approach to maximize the posterior glottic aperture. A 42-year-old female patient with posterior glottic stenosis and a tracheotomy was consented for a robotic posterior glottic scar lysis, KTP-laser assisted partial arytenoidectomy, balloon dilation, and steroid injection. The da Vinci Intuitive Surgical single-port robotic platform was used with 2 robotic arms (needle driver and scissors), and an FK-WO transoral retractor with a straight tongue blade was deployed to facilitate endolaryngeal exposure. KTP laser fiber was passed through a robotic, semi-flexible drop-in guide, and manipulated with the needle driver. Case duration was 40 minutes. There were no perioperative or immediate post-operative complications noted on short-term follow-up. We demonstrate technical feasibility and equipoise between an explicitly robotic approach and a standard endoscopic approach to posterior glottic stenosis, a common glottic condition. Further technological development and adaptation of surgical technique are necessary to advance benign robotic laryngeal surgery.
Pubmed PDF WebHannah Kreuser,Kenneth C. Fletcher,Ruth J. Davis
Publicatie 30-11-2024
Vocal fold injection augmentation with hyaluronic acid (HA) fillers is a common treatment for glottic insufficiency. While generally well-tolerated, rare inflammatory reactions can occur in 3% to 5% of patients. All reported reactions resolved after corticosteroid treatment, and no cases of recurrent inflammatory reaction with airway obstruction following steroid treatment have been reported. This case report describes a unique case of recurrent inflammatory reactions following laryngeal HA injection and management with hyaluronidase injection to prevent further reactions. A retrospective review was conducted of this patient's medical record. We present the case of a 42-year-old female with left vocal fold immobility who experienced recurrent inflammatory reactions and airway symptoms following laryngeal HA injection despite corticosteroid treatment. Recurrent inflammatory reaction following corticosteroid treatment of an initial inflammatory reaction has not been reported. This patient was managed with hyaluronidase injection to dissolve residual HA, which successfully prevented further reactions. This case highlights the potential for recurrent inflammatory reactions following HA injection despite corticosteroid treatment and describes the novel role of hyaluronidase in managing such complications.
Pubmed PDF WebDaniel R. S. Habib,Naadir H. Jamal,Kalpnaben Patel,Christopher T. Wootten,Ryan H. Belcher
Publicatie 30-11-2024
Branchial cleft cysts are pediatric congenital anomalies that can present as sinus tracts to the neck. Intraoperative methylene blue dye with fibrin glue has been suggested as an effective tool for tracking the tract's depth to help definitively excise. In this large retrospective study of 118 patients spanning a decade, we aim to elucidate outcomes of branchial cleft anomaly excision without methylene blue dye. A retrospective review was conducted with patients who received branchial cleft anomaly (BCA) with sinus tract excision at Monroe Carrell Jr. Children's Hospital from June 2012 to June 2022. We collected demographic variables, BCA characteristics, perioperative care variables (ie, prior drainage, imaging, and concurrent procedure), and perioperative outcomes (ie, intra- and post-operative complications). Median and interquartile range (IQR) were calculated for continuous demographic variables, and average and standard deviation (SD) were calculated for sinus tract length. Two-tailed Chi-square or Fisher's exact tests were performed to compare categorical samples where applicable with a statistical significance threshold set a priori at The sample included 118 patients with an average tract length of 3.3 cm (SD = 1.7 cm). Incision/drainage was performed before definitive excision in 16 (13.6%) patients and was associated with age above the median (aOR = 5.29, 95% CI = 1.39-20.09, Patients with branchial cleft sinus tracts that were surgically excised without intraoperative dye achieved definitive resection with no recurrence and limited post-operative complications. While not a direct comparison, these results suggest that using intraoperative dye may be associated with unnecessary costs without benefit in outcomes.
Pubmed PDF WebMiray-Su Yılmaz Topçuoğlu,Peter K. Plinkert,Angelika Seitz,Ahmed El Damaty,Heidrun Bächli,Ingo Baumann
Publicatie 29-11-2024
Midline nasal masses are rare and challenging for surgeons. This study examined the site with the highest risk of recurrence following midline nasal mass excisions. Surgical outcomes were retrospectively reviewed following excision of midline nasal masses between 2010 and 2022 in the predominantly pediatric patient cohort. The primary outcome measure was the recurrence rate. Overall, 22 nasal masses were resected from 20 patients. Of these masses, 16 were nasal dermoid sinus cysts (NDSC), 2 were hamartomas, 1 was an epidermoid cyst, and 1 was a mature teratoma. Five of the nasal masses were classified as intracranial lesions, 11 were classified as intraosseous lesions, and 6 were classified as superficial lesions. The open rhinoplasty approach was chosen in 65% of the surgeries. For the intracranially extended lesions, a combined nasocranial approach was performed. Four revision surgeries were performed due to superficial recurrences at the nasal dorsum of lesions, that were primarily classified as intraosseous lesions. All recurrences had a superficial extension and were easily excised. Intraosseous NDSC have the highest risk of recurrence, but conversely, they also occur most frequently.
Pubmed PDF WebShi Liang,Nikhil Bellamkonda,Benton Tullis,Jason P. Hunt
Publicatie 28-11-2024
Superselective lateral neck dissection (SSND), defined as dissection of 2 or less contiguous lateral cervical nodal levels, has emerged as a treatment option for metastatic papillary thyroid carcinoma (PTC), in place of a selective neck dissection (SND). There are few studies exploring outcomes of SSND compared to SND in this context. This was a single institution retrospective study. All patients who were diagnosed with PTC and had a lateral neck dissection from 2019 to 2022 were reviewed. Patient demographics and outcomes were compared. A total of 136 patients met inclusion criteria. About 106 (78%) had a SND and 30 (22%) had a SSND. There was no significant difference between patients who underwent SND versus SSND regarding frequency of post-operative complications, length of stay (2.49 vs 2.31 days), post-operative thyroglobulin >10 ng/mL (21 vs 3 patients), regional recurrence (14% vs 17%), reoperation rates (16.7% vs 17.4%), or adjuvant radioactive iodine therapy (75% vs 63%; SSND for PTC had similar short-term clinical outcomes when compared to SND.
Pubmed PDF WebEvan S. Chernov,Anthony Ghanem,Leonardo Gonzales Parilla,William W. Carroll
Publicatie 27-11-2024
Silent sinus syndrome (SSS) is a rare condition involving idiopathic maxillary sinus underdevelopment, orbital floor resorption, enophthalmos, and hypoglobus. SSS is more commonly described in adults, with only very limited literature in the pediatric population. Given the rarity of the condition, there is a lack of consensus regarding proper diagnostic criteria and treatment strategies. We present a case of pediatric SSS and a review of other cases in the literature. Case report and systematic review. A 12-year-old female patient was referred for incidental MRI findings suggestive of SSS. Examination revealed minimal enophthalmos with some hypoglobus. A CT scan of the sinuses confirmed the diagnosis of SSS, and the patient underwent a right sided endoscopic modified medial maxillectomy/mega-antrostomy with image guidance given the significant maxillary hypoplasia. A literature review of CINAHL, PubMed, and Scopus identified 15 studies that referenced pediatric SSS cases. This article reports a case of pediatric SSS and compares the presenting symptoms, diagnostic criteria, and surgical intervention to other cases of pediatric SSS. As pediatric SSS is a very rare disease, this case offers a possible treatment strategy for a severely atelectatic maxillary sinus.
Pubmed PDF WebNicole G. DeSisto,Chloe Verducci,Amy L. Pittman,Shiayin F. Yang
Publicatie 22-11-2024
Surgical management of head and neck cancer (HNC) can result in significant functional deficits. Large tumors of the oral cavity may require extensive resection and the need for microvascular free-flap reconstruction involving the use of adynamic tissue. This may result in oral incompetence, drooling, and unsatisfactory esthetic outcomes. Maintenance of the orbicularis oris and function of the oral sphincter are important objectives in the reconstruction of large defects. When this cannot be accomplished, secondary local flaps can be employed to restore the orbicularis oris. We present 2 cases of oral incompetence following microvascular free- flap reconstruction for large resections of HNC. All cases were managed with debulking of flap, modified Karapandzic flaps, and advancement of composite skin, muscle, and buccal mucosa to restore the function of the oral sphincter and improve oral competence. The surgical techniques demonstrated in our cases resulted in improvement in both functional and esthetic outcomes. Restoring continuity of the orbicularis oris muscle is a critical functional and esthetic consideration in microvascular free flap reconstruction where the lip is involved or disrupted. However, when this cannot be achieved, restoration of the oral sphincter and oral commissure can be achieved with a secondary reconstructive procedure.
Pubmed PDF WebRichard Antonio Pellizzari,Julia Wei,Elias Saba,Swapnil Shah,LaBryson Greene,Quynh-Lam Tran,Peter Debbaneh,Alexander Rivero
Publicatie 22-11-2024
This study aims to report otologic manifestations in a cohort of patients with aspirin exacerbated respiratory disease (AERD) to determine if severity of sinonasal inflammation is associated with presence of otologic sequalae (OS). All AERD patients treated at a tertiary care center between 2009 and 2016 were included in analysis. Demographics, history of hearing loss, Lund-Mackay (LMK) scores, number of previous sinus procedures, CT findings, and pure tone averages (PTA) were compared between patients with and without OS using chi-square test, Fisher's exact test, and Wilcoxon rank sum test. Of 255 AERD patients, 58.4% were female with a mean age of 48.9 (SD: 13.4) years. The majority (52.2%) had otologic manifestations, most commonly: otitis media requiring antibiotics (n = 89, 34.9%), peripheral vertigo (n = 59, 23.1%), and middle ear effusion (n = 44, 17.3%). A total of 74 patients (29.0%) had hearing loss. PTA ranged from 13.3 to 61.7 dB for the cohort, with no significant difference between those with and without OS. There was no significant difference in LMK in both groups. Patients with OS had a significantly greater number of sinus procedures than those without OS (median = 2.4 and 1.8 respectively; Otologic manifestations are common in patients with AERD. While there was an increased number of sinonasal surgeries performed in the patients with OS, there was no correlation between sinonasal inflammation, and the presence of OS as measured by LMK score or PTA. Otologic signs and symptoms should be considered in patients with AERD to help mitigate patient morbidity. III.
Pubmed PDF WebBrendan K. Tao,Fahad Alotaibi,Alastair McAlpine
Publicatie 21-11-2024
Gradenigo Syndrome (GS), a rare complication of petrous apicitis secondary to acute otitis media, is characterized by (an often incomplete) triad of otorrhea, abducens nerve palsy, and facial pain along the trigeminal nerve distribution. There are several causative pathogens of petrous apicitis, including This is case report. A previously healthy 5-year-old boy with a history of swimming presented with esotropia and acute otitis media. Initial symptoms included otorrhea, otalgia, and pruritis, which were refractory to ciprofloxacin-dexamethasone drops. He subsequently developed a right sixth nerve palsy, suggestive of Gradenigo Syndrome, and neuroimaging showed evidence of petrous apicitis, clival osteomyelitis, and internal carotid artery stenosis. The causative organism was not elucidated to laboratory error. Given this uncertainty, he was successfully treated with empiric intravenous ceftazidime and cefazolin. After 16 weeks, he recovered fully without the need for surgery. In the setting of delayed or absent culture results with suspicion of skull-base infection, our case supports the use of empiric antibiotic therapy with sufficient coverage of all common pathogens including
Pubmed PDF WebGian Marco Pace,Francesco Giombi,Francesca Pirola,Michele Cerasuolo,Enrico Heffler,Giovanni Paoletti,Francesca Puggioni,Giuseppe Mercante,Giuseppe Spriano,Luca Malvezzi
Publicatie 20-11-2024
Although the effectiveness of molecular antibodies has been established, evidence is still lacking on objective predictors of response. The aim of this study was to assess whether the extent of previous endoscopic sinus surgeries, assessed by means of the Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) score, may influence clinical outcomes in refractory CRSwNP patients treated with dupilumab. A consecutive sample of patients treated with dupilumab for previously operated recalcitrant CRSwNP were enrolled in the study. Every patient was required to undergo a CT scan at baseline (T0), at 3 (T1), and 12 (T2) months after treatment start. ACCESS score was calculated at baseline, whilst at every timepoint patients underwent assessment of Nasal-Polyp-Score (NPS), Lund-Kennedy-Score (LKS), and had to fill in the 22-item Sinonasal-Outcome-Test (SNOT-22) and Visual-Analog-Scales (VAS) for sinonasal symptoms. Favorable outcome was considered based on EUFOREA guidelines, namely improving at least 3 of the followings: (i) NPS; (ii) SNOT-22; (iii) VAS-olfaction; and (iv) need for systemic corticosteroids. Overall favorable outcome was achieved in 69.1% (n = 38/55) of cases at T1, while in 89.1% (n = 49/55) at T2. There were no differences in baseline characteristics between responders and non-responders at both timepoints. At T1, out of all the included variables, no statistically significant predictor of favorable outcome was observed. Conversely, at T2, ACCESS score was the only confirmed independent predictive factor of response to dupilumab treatment (OR = 0.81 [95% CI = 0.67-0.92], Our findings suggest that the extent of previous endoscopic sinus surgeries may have a role in influencing clinical outcomes in patients with refractory CRSwNP undergoing treatment with dupilumab.
Pubmed PDF WebHannah Kavookjian,Emily Y. Huang,Lee M. Akst,Simon R. Best,Alexander Hillel,Kevin Motz
Publicatie 20-11-2024
The primary objective was to assess incidence and severity of acute laryngeal injury (ALgI) following intubation at time of tracheostomy using a proposed grading scale. The secondary objective was to evaluate what factors influence the rate of decannulation. Single institution cohort study with review of prospectively maintained database including patients from October 2021 to October 2022 who underwent tracheostomy for prolonged intubation/critical illness. Severity of ALgI was graded as mild, moderate, or severe based on intraoperative endoscopic findings (laryngeal mucosal ulceration and/or granulation tissue). Rates of tracheostomy decannulation were collected as the secondary outcome measure. Twenty-eight patients met criteria for inclusion. About 60.7% (n = 17) patients were female. Average age was 59.0 ± 13.2 years old. Average body mass index was 32.3 ± 14.0 kg/m ALgI is highly prevalent in patients undergoing tracheostomy for prolonged intubation. Severe injury is associated with reduced rates of decannulation. Direct laryngoscopy at time of tracheostomy is warranted to diagnose ALgI and guide interventions. Determining the extent of laryngeal injury is prognostic and could help tailor follow-up and management strategies. 4.
Pubmed PDF WebRaisa Chowdhury,Ahmad Aldajani,Hamad Almhanedi,Dana Al Majid,Marc A. Tewfik,Lamiae Himdi
Publicatie 19-11-2024
Paranasal sinus mucoceles, by virtue of extension into the orbit or cranial vault, can lead to significant ocular, nasal, or neural complications. There is limited comprehensive data on the presentation, management, and outcomes of cases with intraorbital or intracranial extension. A thorough analysis is essential to enhance clinical practices and improve patient outcomes. This retrospective case series investigates the clinical presentations, radiological features, and surgical outcomes of 10 patients with paranasal sinus mucoceles exhibiting intraorbital or intracranial extensions. Ten diagnosed cases of paranasal sinus mucoceles with intraorbital or intracranial extensions, as identified on CT or MRI imaging, were selected and retrieved from the electronic database of an academic-affiliated hospital from July 2013 to December 2023. Data were analyzed using descriptive statistics with IBM SPSS version 23.0 software. The study revealed a mean patient age of 65 years, with females (60%) affected more than males (40%). The ethmoidal and frontal sinuses were predominantly involved, with varied clinical symptoms ranging from periorbital pain to visual disturbances. Radiologically, CT and MRI scans depicted extensive sinus involvement, often with intraorbital (50%), intracranial (20%), or combined (30%) extensions. Surgical interventions, primarily endoscopic sinus surgery, resulted in favorable outcomes, including symptom resolution, minimal complications, and no recurrence. This case series emphasizes the importance of thorough preoperative evaluation, individualized surgical approaches, and vigilant postoperative care in managing mucoceles with orbital and cranial involvement. Further research with larger cohorts and extended follow-up periods is essential to refine treatment strategies and enhance patient outcomes for this complex pathology.
Pubmed PDF WebEmily Kent,Leo Gundle,Imogen Jones
Publicatie 13-11-2024
Current common practice for patients with idiopathic epistaxis which requires nasal packing is to admit as an in-patient for overnight observation. Anecdotally, many patients do not re-bleed, so admissions may be unnecessary. Several factors have been suggested to be associated with an increased risk of re-bleeding, such as hypertension, anticoagulant use, and male gender. We set out to investigate these factors, to create a local guideline to identify patients who may be safe to discharge with a pack in situ. We collected the data on the most recent admissions in our department, who each received a non-absorbable nasal pack for idiopathic epistaxis (n = 100). Data points included age, gender, anticoagulation status, and comorbidities. Data from 100 patients were audited. Of those, 13 were found to have re-bled through their packing (13%). Statistically significant predictors of re-bleed were as follows: Male sex (OR = 9.81, Re-bleed in patients managed with non-absorbable packing for idiopathic epistaxis is uncommon. Risk factors may include male sex, hypertension, and aspirin use. ENT departments nationally may consider discharging patients' home with pack in situ, for removal as an outpatient, in the absence of these risk factors.
Pubmed PDF WebAshaka Patel,Katrina Cirone,Sami Khoury,Edward Madou,Agnieszka Dzioba,Dhandapani Ashok,Julie E. Strychowsky,M. Elise Graham
Publicatie 12-11-2024
This systematic review was conducted to assess if there are changes in gastroesophageal reflux (GER) outcomes after frenotomy in infants with ankyloglossia. Systematic Review. CINAHL, Cochrane, EMBASE, Pubmed, and Scopus were searched from inception to May 20, 2023. Inclusion criteria consisted of all study designs, infants ≤12 months of age with ankyloglossia, and use of quantitative GER measures (esophageal pH manometry (pH) or multi-channel intraluminal impedance (MII), and/or patient-reported symptom scores) pre- and post-frenotomy. Quality assessment and data extraction were performed in duplicate. Of 37 articles screened, 7 met inclusion criteria (6 prospective cohort studies and 1 RCT). No studies utilized objective measures to quantify reflux, that is MII or pH. The number of infants with ankyloglossia ranged from 47 to 237 (mean age of 4.4-8.3 weeks). Qualitative analysis included all 7 studies which used the GIGER, I-GERQ-R, and GSQ-I scales to assess GER. Parent-reported GER scores decreased post-frenotomy. However, the lack of control groups in the prospective cohort studies precludes conclusive findings that changes are related to frenotomy. Meta-analysis was not possible due to the high risk of bias from limited sample sizes, poor methodology, and lack of adequate control groups. Limited work has been conducted on the relationship between frenotomy and GER in infants with ankyloglossia. The lack of high-quality studies precludes definitive conclusions, as GER symptoms are known to improve spontaneously with time. Future RCT studies are warranted to further elucidate the effect of frenotomy on symptoms of GER in infants with ankyloglossia. III.
Pubmed PDF WebSteven Duncan,Andrey Finegersh,Ryan K. Orosco,Nathaniel Wu,Kevin T. Brumund,Joseph A. Califano,Charles S. Coffey,William J. Moss
Publicatie 12-11-2024
To further characterize the clinicopathologic features of oral verrucous carcinoma. In accordance with PRISMA guidelines, a systematic review of the Medline, Web of Science, Embase, and Cochrane databases was performed in search of articles evaluating clinicopathologic features of oral verrucous carcinoma. Primary outcomes of interest included tumor subsites, T-staging, rates of cervical lymph node metastases, rates of distant metastases, 5-year survival (overall, disease-free, or disease-specific), and recurrence rates. Meta-analysis was performed using a random effects model. Nineteen articles with a total of 1458 subjects were ultimately included in the analysis. There were 17 studies with a total of 1353 patients reporting verrucous carcinoma subsites and the buccal mucosa (59.2%, 55.1%-63.3%) ( An international collection of evidence supports that pure oral verrucous carcinoma is a relatively indolent, non-metastasizing malignancy associated with areca nut consumption. A reliance on traditional squamous cell carcinoma staging and treatment algorithms for verrucous carcinoma patients can predispose to overtreatment.
Pubmed PDF WebTommaso Saccardo,Valentine Nicolas,Emilien Chebib,Stefano Manca di Villahermosa,Benjamin Verillaud,Alessandro Vinciguerra,Philippe Herman
Publicatie 12-11-2024
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a strong impact on the quality of life (QoL) which treatment is based on local intranasal corticosteroids (ICS) and iterative courses of systemic corticosteroids (SCS) in case of relapse. When medical treatment is insufficient, surgery is indicated. We investigated the impact of enlarged frontal sinusotomies (EFS: Draf IIb or Draf III) on QoL and annual SCS consumption of patients with severe uncontrolled CRSwNP. This is a retrospective cohort study of 38 patients, who underwent EFS at Lariboisière University Hospital (CHU) in Paris, France, between 2006 and 2020. All patients were asked to complete SNOT-22 questionnaires concerning pre- and post-op status. Patients' medical and sinus surgery history as well as the number of SCS treatments per year before and after surgery were also collected. Of the 38 patients, 33 underwent a Draf III procedure and 5 a Draf IIb, with no major complications reported. Surgery resulted in a significant improvement in SNOT-22 scores (-32.7 ± 19.3, EFS appears to be an effective and durable therapeutic option to improve the QoL of patients with severe CRSwNP and to reduce their SCS consumption without major complications.
Pubmed PDF WebLauren R. Ottenstein,Christina Shipp,Mihir Patel,Mark El-Deiry,Merry Sebelik
Publicatie 09-11-2024
Tracheoesophageal voice puncture and prosthesis (TEP) is a common method of voice restoration following total laryngectomy. A variety of complications, both minor and major, can be associated with the TEP and require timely intervention/management. Some of those complications include premature leakage, periprosthetic leakage, granulation tissue growth, TEP dislodgement, or embedding of the TEP. Patients may present with problems and/or complications with the voice prosthesis in an emergency setting or after clinic hours when a trained speech pathologist is not present or readily available for evaluation and management. This manuscript aims to provide guidance for management of acute TEP complications to otolaryngology responders, especially those who may be less familiar with TEP troubleshooting. Experiential and literature review was undertaken by a group of head and neck specialized Speech Language Professionals in high volume Head & Neck Oncology practices, to develop consensus guidelines for emergency TEP management. TEP emergencies were categorized as (1) leakage through, (2) leakage around, (3) sudden loss of voicing, (4) loss of prosthesis, still in tract, (5) loss of prosthesis, not in tract. Management strategies for each form of emergency were developed to achieve patient safety and stability until definitive measures could be performed by the patient's Speech Language Professional. The goals of emergency management of TEP problems focused on minimizing risk of aspiration pneumonia, risk of foreign body aspiration, risk of wound complications at the puncture site. A simple management algorithm was developed for emergency or on-call otolaryngology responders.
Pubmed PDF WebPublicatie 07-10-2024