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Τρίτη 17 Νοεμβρίου 2020

Management of Laryngopharyngeal Reflux

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Objective

To investigate worldwide practices of otolaryngologists in the management of laryngopharyngeal reflux (LPR).

Methods

An online survey was sent on the management of LPR to members of many otolaryngological societies. The following aspects were evaluated: LPR definition, prevalence, clinical presentation, diagnosis, and treatment.

Results

A total of 824 otolaryngologists participated, spread over 65 countries. The symptoms most usually attributed to LPR are cough after lying down/meal, throat clearing and globus sensation while LPR‐related findings are arytenoid erythema and posterior commissure hypertrophy. Irrespective to geography, otolaryngologists indicate lack of familiarity with impedance pH monitoring, which they attribute to lack of knowledge in result interpretation. The most common therapeutic regimens significantly vary between world regions, with a higher use of H2 blocker in North America and a lower use of alginate in South America. The duration of treatment also significantly varies between different regions, with West Asia/Africa and East Asia/Oceania otolaryngologists prescribing medication for a shorter period than the others. Only 21.1% of respondents are aware about the existence of nonacid LPR. Overall, only 43.2% of otolaryngologists believe themselves sufficiently knowledgeable about LPR.< /p>

Conclusions

LPR knowledge and management significantly vary across the world. International guidelines on LPR definition, diagnosis, and treatment are needed to improve knowledge and management around the world.

Level of Evidence

N.A. Laryngoscope, 2020

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Internal Auditory Canal Diverticula in Children: A Congenital Variant

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Objectives/Hypothesis

Internal auditory diverticula in adults have been found to exist independent of otosclerosis, and in the presence of otosclerosis. We sought to determine the prevalence of internal auditory canal (IAC) diverticula in a pediatric cohort, to assess whether IAC diverticula are a risk factor for hearing loss, and the co‐occurrence of otic capsule hypoattenuation.

Study Design

Retrospective review.

Methods

A single‐site retrospective review of high‐resolution temporal bones computed tomography (CT) scans including the presence and size of diverticula and hypoattenuation of the otic capsule. Demographic, imaging, and audiometric data were collected and descriptively analyzed. Bivariate analysis of collected variables was conducted. Comparisons between sides in unilateral cases were also performed.

Results

16/600 (2.7%; 95% CI [2.0%, 3.4%]) were found to have IAC diverticula. Six were bilateral. Thirty‐one patients (5.2%) were found to have hypoattenuation of the otic capsule. There were no coincident cases of IAC diverticulum and hypoattenuation of the otic capsule. There was no association between the presence of IAC diverticula and age (P = .13). In six patients with unilateral diverticula, pure tone average (P = .42), and word recognition (P = .27) scores were not significantly different when compared to the normal, contralateral side.

Conclusions

The prevalence of IAC diverticula in children is lower than the prevalence in adults. IAC diverticula in children likely represent congenital variants of temporal bone anatomy. Similar to adult populations, there is evidence that IAC diverticula in children are likely not an independent risk factor for hearing loss.

Level of Evidence

4 Laryngoscope, 2020

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Sialographic Analysis of Radioiodine‐Associated Chronic Sialadenitis

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Objectives/Hypothesis

To apply a novel sialography classification system to identify parotid and submandibular ductal findings following I‐131 therapy and to assess correlates to dose and duration of symptoms.

Study Design

Retrospective single‐center case series.

Methods

Patients who underwent sialography between February 2008 and February 2019 after previously receiving I‐131 treatment were identified via a retrospective chart review. Their sialograms were systematically evaluated and scored by applying the Iowa parotid sialogram scale to also include submandibular gland analysis.

Results

From 337 sialograms, 30 (five submandibular, 25 parotid) underwent analysis. Ductal stenosis was identified in all sialograms and was graded as moderate (>50%–75%) in 7/30 cases and severe (>75%) in 15/30 cases. The distal (main) duct was narrowed in 23/30 cases. No association was identified between degree of ductal stenosis and I‐131 dose (P = .39), age (P = .81), or time from I‐131 therapy to sialogram (P = .97).

Conclusions

The Iowa parotid sialogram scale was successfully applied to report abnormalities of the parotid and submandibular ductal system. The most common manifestation of I‐131‐associated sialadenitis was a severe stenosis within the distal salivary duct. No statistically significant association was found between degree of ductal stenosis and dose of I‐131, age, or duration of symptoms.

Level of Evidence

4 Laryngoscope, 2020

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Development and Application of the Average Pelvic Shape in Virtual Pelvic Fracture Reconstruction

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Abstract

Background

With unilateral pelvic fractures, the contralateral hemipelvis can be used as a template in virtual reconstruction, however, this cannot be applied for bilateral fractures. Therefore, statistical shape modelling was used to build average pelvic shapes that can serve as templates when reconstructing bilaterally fractured pelvises.

Methods

Four average shape models were created for male and female, left and right hemipelves from 20 male and 20 female subjects. They were used as templates to reconstruct 8 unilaterally fractured pelvises.

Results

The average root‐mean‐square of deviations between the reconstructed and intact hemipelves was 1.46 ± 0.32 mm, which is less than the 2 mm threshold for causing hip joint complications.

Conclusion

This indicates that the reconstructions are reliable and the average shape models can be used to reconstruct bilaterally fractured pelvises. The proposed technique can potentially pro vide quick and accurate treatment plans for pelvic fracture patients, which is necessary for recovery.

This article is protected by copyright. All rights reserved.

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A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery

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A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era.

Eur Arch Otorhinolaryngol. 2020 Nov 16;:

Authors: Viera-Artiles J, Mato D, Valdiande JJ, Lobo D, Pedraja J, López-Higuera JM, Ospina J

Abstract
PURPOSE: To provide a novel solution to reduce aerosol exposure in the operating room during endoscopic sinus and skull base procedures in the COVID-19 era.
METHODS: We have designed a 3D printable midfacial mask that partially seals the nose, while allowing instrumentation during endoscopic transnasal surgery. The mask when connected to a vacuum system creates a constant negative pressure inside it, sucking out aerosols and gases generated during surgical procedures. Its effectiveness was tested using vapour exhalations by a human volunteer and drilling bone in a head model. The physical barrier effect was measured using fluorescein atomization in a head model.
RESULTS: The pressure and airflow measured remained negative inside it in all the different situations tested. The mask was capable of completely evacuating human adult exhalation, and was more effective than the hand suction instrument. However, it was as effective as hand suction instrument at preventing aerosol spread from bone drilling. The physical barrier effect achieved a 72% reduction in the splatter created from the fluorescein atomization.
CONCLUSIONS: The mask effectively prevented the spread of aerosols and reduced droplet spread during simulated transnasal endoscopic skull base surgery in laboratory conditions. This device has potential benefits in protecting surgical personnel against airborne transmission of COVID-19 and could be useful in reducing chronic exposure to the hazard of surgical smoke.

PMID: 33191442 [PubMed - as supplied by publisher]

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Far Lateral Approach for Malignant, Severely Calcified Cerebellopontine Angle Tumor

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0040-1705164

Background The far-lateral approach is an effective skull base technique that provides access to the lower clivus and premedullary area. This approach is also useful for maximal visualization and resection of large posterior fossa tumors with extensive medial extension, especially when aggressive resection is ideal for a malignant tumor in a young patient, or it is technically challenging because of tumor calcification. We demonstrate a microsurgical operative video to describe technical pearls in this difficult situation. Case Presentation A 45-year-old man with history of "hoarseness" for up to two decades was presented with imbalance and mild dysphagia over 3 years. Imaging demonstrated a 55-mm left cerebellopontine angle (CPA) tumor extending medially across the midline with severe calcification (Figs. 1 and 2). His neurological examination revealed left facial numbness, complete left facial weakness, left deafness, complete left vocal paralysis, as well as severe left hemibody ataxia. The tumor was resected via a left suboccipital craniotomy with far lateral approach including drilling to the occipital condyle and C1 laminectomy. Initial manipulation of the inferior pole of the tumor resulted in asystole which was managed successfully with glycol pyrolate. Pathology demonstrated IDH-1 wild type, MGMT-methylated glioblastoma. The patient subsequently underwent adjuvant chemoradiation. Conclusion The far-lateral approach is an effective approach for maximal safe resection of a malignant brainstem, cerebellar, and CPA tumor.The link to the video can be found at: https://youtu.be/AIGebJPJEnw.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  open access Full text

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Clival Meningioma Removal through a Suboccipital Retrosigmoid Approach: Operative Video and Technical Nuances

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0040-1705163

Background Clival meningiomas are challenging lesions that need to be managed according to the displacement of the adjacent structures. Lateral skull base approaches are needed to achieve their radical removal; however, they are associated with significant morbidity, especially when the tumor involves the basilar artery, its perforators, brainstem, and lower cranial nerves. Design This is a case of a 79-year-old female patient, diagnosed with a large lower clival meningioma after suffering from headaches. It was offered a conservative treatment but on serial MRI, an increase in the meningioma's size was observed, so it was decided to remove the meningioma using a left suboccipital retrosigmoid approach. Settings On a left three-quarter prone position, with facial nerve, auditory brainstem response, lower cranial nerves, and motor-evoked potentials and somatosensory-evoked potentials neurophysiologic monitoring, a right suboccipital retrosigmoid craniotomy with opening of the foramen magnum was performed, giving enough lateral visualization of the tumor. Broad base tumor pushing backward and aside the vertebral and basilar arteries, cranial nerves (7th–12th), and the brainstem was exposed and removed. Results Near total resection of the meningioma was achieved, leaving a microscopic residual in the entry points of the low cranial nerves without complications. There was no neurological deficit after the surgery. Postoperative MRI revealed no signs of residual tumor. Conclusion: In this case, the regular retrosigmoid approach, extended into the foramen magnum was enough for the removal of this pure clival meningioma.The link to the video can be found at: https://youtu.be/3d6Uj4gjmDU.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  open access Full text

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IBCC chapter & cast – Ventilator Associated Pneumonia (VAP)

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VAP is a perennial riddle in the intensive care unit.  There are numerous murky diagnostic tests, but no single gold-standard diagnostic test.  Consequently, we are usually left wondering whether or not the patient truly has a VAP.  This makes VAP an unsatisfying diagnosis, as we are continually walking a blurred line between undertreatment and overtreatment. […]

EMCrit Project by Josh Farkas.

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Oral mucosal calcified nodule requiring palatoplasty.

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Related Articles

Oral mucosal calcified nodule requiring palatoplasty.

Int J Pediatr Otorhinolaryngol. 2020 Oct 28;139:110476

Authors: Panico E, Robinette K, Kelly D, Wiatrak B

Abstract
Calcinosis cutis describes a condition of pathologic calcium deposition in the dermis. Several subtypes exist, including the subepidermal calcified nodule. The oral mucosal calcified nodule (OMCN) was posited in 1992 as a specific term for a subepidermal calcified nodule occurring in the oral cavity, and since that time only six such lesions have been described in the literature. This report explores a case of OMCN on the palate of a 3-month-old infant with the goal of supplementing extant literature, providing a consideration of the differentials of palatal lesions in the pediatric population, and describing a unique instance in which OMCN resulted in a full-thickness defect requiring palatoplasty for repair.

PMID: 33166754 [PubMed - as supplied by publisher]

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Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: A systematic review.

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Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: A systematic review.

Int J Pediatr Otorhinolaryngol. 2020 Nov 04;139:110482

Authors: Saniasiaya J, Kulasegarah J

Abstract
INTRODUCTION: Paediatrics obstructive sleep apnoea have been discussed to a great degree over the recent years and remains a conundrum till date. The advent of instrumentation has aided upper airway evaluation in determining the site and degree of upper airway collapse for targeted and effective surgical planning. The literature was reviewed to determine the outcome of Drug Induced Sleep Endoscopy (DISE) directed surgery in children with obstructive sleep apnoea.
MATERIAL AND METHODS: A literature search was conducted for the period from January 2000 to December 2019 by using a number of medical literature data bases including Scopus, PubMed and Embase. The following search words were used either individually or in combination: drug-induced sleep endoscopy, sleep endoscopy directed surgery, paediatrics sleep apnoea. The search was conducted over a month period (December 2019). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed when possible.
RESULTS: Seven clinical research articles were selected based on our objective and selection criteria. Seven studies were of level III evidence: retrospective, case-control and prospective series. Altogether, there were 996 patients with male predominance; 61%. Over 10% of patients (133 patients) were found to have comorbidities or were syndromic. The mean age of patient was 6 years and majority (87.6%) of our patients were found to be surgically naïve, that is, no previous surgical procedures were performed for OSA. Surgical decision was changed in 295 patients (30%) following DISE. Post intervention outcomes were objectively revealed in 4 studies. Most of our patients underwent a multilevel surgery based on DISE (86%). Complications were documented in 3 studies.
CONCLUSIONS: Analysis of the results indicated that DISE directed surgery was an effective, safe therapeutic approach to treating paediatrics obstructive sleep apnoea. DISE directed surgery has shown to have changed surgical management in most studies.

PMID: 33166755 [PubMed - as supplied by publisher]

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A new dimension of success in the management of airway disease in children with neurological deficit.

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A new dimension of success in the management of airway disease in children with neurological deficit.

Int J Pediatr Otorhinolaryngol. 2020 Nov 04;139:110483

Authors: Kokje VBC, Mermod M, Bertinazzi M, Sandu K

Abstract
OBJECTIVES: Anomalies of the larynx and trachea can cause respiratory distress in infants and older children. Depending on its nature, degree and extent of the disease invasive open surgery is indicated. Non-airway-related co-morbidities increase the challenges in its treatment. Neurological deficit poses a great challenge as it is associated with hypotonia and causes diminished laryngeal coordination. The definition of success in treatment of laryngotracheal disease has always focused on the post-operative functional outcomes: breathing, voice swallowing. The aim of this study is to describe a new dimension of success in the management of laryngotracheal disease in children with moderate neurological deficit, where the expected functional gain is less than in otherwise healthy children.
METHODS: This retrospective observational study includes all patients who have undergone open reconstructive airway surgery between 2012 and 2017. Control patients without neurological deficit and cases with moderate neurological deficit were included. Functional outcome data was obtained from clinical records and two questionnaires were filled in by the parents of the children: one the pediatric voice-handicap index (pVHI) and a quality of life questionnaire.
RESULTS: Thirty-two children were included of which ten had moderate neurological deficit. Both groups revealed post-operatively an improvement in the functional outcomes: breathing, voice and swallowing, however, as expected, a trend was observed towards less functional improvement in children with neurological deficit. Both groups reveal a remarkable gain in quality of life (QoL).
CONCLUSION: Indicating the QoL to be an unidentified, dimension of success in the management of laryngotracheal disease in children with moderate neurological deficit.

PMID: 33166756 [PubMed - as supplied by publisher]

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