Intraoral Hirudotherapy for Venous Congestion following Free Flap Head and Neck Reconstruction: Novel Intraoral Technique

xlomafota13 shared this article with you from Inoreader Intraoral Hirudotherapy for Venous Congestion following Free Flap Head and Neck Reconstruction: Novel Intraoral Technique Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free flap reconstruction. Many institutions and healthcare teams have been reluctant to use intraoral leech therapy due to risks such as migration into the airway, increased infection from intraoral manipulation, and patient discomfort. Several protocols recommend blocking the path to the oropharynx via gauze or leaving a tracheotomy in place to protect the airway. This report pre­sents a novel technique f or intraoral hirudotherapy that is safe and simple for treatment of free flap venous congestion. The base of a clear cup or a plastic lid is utilized, and the leech is attached onto the inside of the lid with 2 sutures near each end. Several cups with leeches attached are made at a time to reduce delay and difficulty of application by less experienced clinical staff. The leech is then applied onto the compromised flap and then simply removed once it has unlatched from the flap. This method allows the leech to be applied with ease by multiple members of the healthcare team, decreases the need for intraoral manipulation, and reduces the risk of migration into the aerodigestive tract. Future prospective studies are warranted to assess the efficacy of this technique. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ninety‐day mortality after radiotherapy for head and neck cancer: A population‐based comparison between rural and urban patients

xlomafota13 shared this article with you from Inoreader Ninety‐day mortality after radiotherapy for head and neck cancer: A population‐based comparison between rural and urban patients Via Head & Neck Abstract Background This study assesses whether 90-day mortality differs between patients living in rural and urban areas, as lower access to supportive care services in rural areas could result in higher mortality. Methods All patients with head and neck cancer (HNC) treated between 1998 and 2014 with radiotherapy in British Columbia were included. Patients were divided into rurality areas according to the Modified Statistics Canada (mSC) definition, which classifies a population <30 000 as rural and ≥30 000 as urban. Results Five thousand five hundred and fifty-four patients were included in this study, of which 68% lived in urban centers. The 90-day mortality for rural versus urban patients were 3.0% and 3.9% (p = 0.09), respectively. Univariate and multivariate analyses showed no association with 90-day mortality and rurality. Conclusion After controlling for potentially confounding factors, we did not find a significant association between 90-day mortality and rurality in patients who were treated with radiotherapy for HNC in British Columbia. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Survival impact of angiotensin‐converting enzyme inhibitors and angiotensin II receptor antagonists in head and neck cancer

xlomafota13 shared this article with you from Inoreader Survival impact of angiotensin‐converting enzyme inhibitors and angiotensin II receptor antagonists in head and neck cancer Via Head & Neck Abstract Background Preclinical evidence suggests a link between the renin-angiotensin system and oncogenesis. We aimed to explore the impact of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in head and neck cancer (HNC). Methods Over 5000 patients were identified from the Surveillance, Epidemiology, and End Results-Medicare linked dataset and categorized according to ACEi and ARB and diagnoses of chronic kidney disease (CKD) or hypertension (HTN). Overall survival (OS) and cancer-specific survival (CSS) were compared using Cox multivariable regression (MVA), expressed as hazard ratios (HR) with 95% confidence intervals (95%CI). Results No significant MVA associations for OS or CSS were found for ACEi. Compared to patients with CKD/HTN taking ARB, those with CKD/HTN not taking ARB experienced worse OS (HR 1.28, 95%CI 1.09–1.51, p = 0.003) and CSS (HR 1.23, 95%CI 1.00–1.50, p = 0.050). Conclusions ARB usage is associated with improved OS and CSS among HNC patients with CKD or HTN. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of Face Masks on Speech Acoustics and Vocal Effort in Healthcare Professionals

xlomafota13 shared this article with you from Inoreader Impact of Face Masks on Speech Acoustics and Vocal Effort in Healthcare Professionals Via The Laryngoscope Objectives/Hypothesis We investigated speech acoustics and self-reported vocal symptoms in mask-wearing healthcare professionals. We hypothesized that there would be an attenuation of spectral energies and increase in vocal effort during masked speech compared to unmasked speech. Study Design Within and between subject quasi-experimental design. Methods We prospectively enrolled 21 healthcare providers (13 cisgender female, 8 cisgender male; M = 32.9 years; SD = 7.9 years) and assessed acoustics and perceptual measures with and without a face mask in place. Measurements included: 1) acoustic Vowel Articulation Index (VAI); 2) cepstral and spectral acoustic measures; 3) traditional vocal measures (e.g., fundamental frequency, intensity); 4) relative fundamental frequency (RFF); and 5) self-reported ratings of vocal effort and dyspnea. Results During masked speech, there was a significant reduction in VAI, high-frequency information (>4 kHz), and RFF offset 10, as well as a significant increase in cepstral peak prominence and perceived vocal effort. Further analysis showed that high-frequency attenuation was more pronounced when wearing an N95 mask compared to a simple mask. Conclusions Face masks pose an additional barrier to effective communication that primarily impacts spectral characteristics, vowel space measures, and vocal effort. Future work should evaluate how long-term mask use impacts vocal health and may contribute to vocal problems. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study

xlomafota13 shared this article with you from Inoreader Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 21. doi: 10.1007/s00405-021-06993-1. Online ahead of print. ABSTRACT PURPOSE: In chronic otitis media (COM), disease chronicity and severity of middle ear inflammation may influence the development of inner ear deficits, increasing the risk of vestibular impairment. This secondary analysis of the multinational collaborative Chronic Otitis Media Questionnaire-12 (COMQ-12) dataset sought to determine the prevalence of vestibular symptoms in patients with COM and identify associated disease-related characteristics. METHODS: Adult patients with a diagnosis of COM in outpatient settings at nine otology referral centers across eight countries were included. We investigated the presence of vestibular symptoms (dizziness and/or disequilibrium) using participant responses to item 6 of a native version of the COMQ-12. Audiometric data and otoscopic assessment were also recorded. RESULTS: This analy sis included 477 participants suffering from COM, with 56.2% (n = 268) reporting at least mild inconvenience related to dizziness or disequilibrium. There was a significant association between air conduction thresholds in the worse hearing ear and presence of dizziness [adjusted odds ratio (AOR), 1.01; 95% CI 1.00-1.02; p = 0.0177]. Study participants in European countries (AOR 1.53; 95% CI 1.03-2.28; p = 0.0344) and Colombia (AOR 2.48; 95% CI 1.25-4.92; p = 0.0096) were more likely to report dizziness than participants in Asian countries. However, ear discharge and cholesteatoma showed no association with dizziness in the adjusted analyses. CONCLUSION: Vestibular symptoms contribute to burden of disease in patients with COM and associates with hearing disability in the worse hearing ear. Geographical variation in presentation of dizziness may reflect financial barriers to treatment or cultural differences in how patients reflect on their health state. PMID:34291348 | DOI:10.1007/s00405-021-06993-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Proposing a surgical algorithm for graduated orbital decompression in patients with Graves' orbitopathy

xlomafota13 shared this article with you from Inoreader Proposing a surgical algorithm for graduated orbital decompression in patients with Graves' orbitopathy Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 21. doi: 10.1007/s00405-021-07003-0. Online ahead of print. ABSTRACT PURPOSE: To determine the outcome after orbital decompression using a graduated technique, adapting the surgical technique according to individual patients' disease characteristics. METHODS: We retrospectively examined the postoperative outcome in patients treated with a graduated balanced orbital decompression regarding reduction of proptosis, new onset diplopia and improvement in visual function. 542 patients (1018 orbits) were treated between 2012 and 2020 and included in the study. Clinical examinations including visual acuity, exophthalmometry (Hertel) and orthoptic evaluation were performed preoperatively and at minimum 6 weeks postoperatively. Mean follow-up was 22.9 weeks. RESULTS: Mean proptosis values have significantly decreased after surgery (p < 0.01). In 83.3% of the patients Hertel measurement normalize d (≤ 18 mm) after surgery, New onset diplopia within 20° of primary position occurred in 33.0% of patients, of whom 16.0% had preoperative double vision in secondary gaze. Patients suffering from dysthyroid optic neuropathy (DON) had a significant increase in visual acuity (p < 0.01). CONCLUSION: We demonstrated that individually adapted graduated orbital decompression successfully improves key disease parameters of Graves' orbitopathy with low morbidity. PMID:34291345 | DOI:10.1007/s00405-021-07003-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinicopathological Study of Intradural Extramedullary Spinal Tumors and Its Correlation With Functional Outcome

xlomafota13 shared this article with you from Inoreader Clinicopathological Study of Intradural Extramedullary Spinal Tumors and Its Correlation With Functional Outcome Via leak of cerebrospinal fluid Cureus. 2021 Jun 18;13(6):e15733. doi: 10.7759/cureus.15733. eCollection 2021 Jun. ABSTRACT Introduction Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of largely benign intraspinal neoplasms. These are amenable to gross total excision and usually carry a good functional outcome. Methods In this study, we reviewed the surgical outcomes of 35 patients who underwent excision of intradural extramedullary tumors. Patient demographics, severity and duration of symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were collected. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel and Nurick grading. The back pain was assessed with help of the Denis pain scale (DPS). Results The histopathological outcomes of the study were as follows: six patients of neurofibroma, 12 cases of s chwannoma, nine cases of meningiomas, three cases of ependymoma, one case of dorsal neurenteric cyst, two cases of epidermoid cyst, one case of cauda equina paraganglioma, and one case of filum terminale dermoid cyst. Paresthesia/numbness were the commonest symptoms (88.6%), weakness of limbs in (80%), sphincter dysfunction in 15 patients (42.9%), and paraplegia was seen in three patients (8.57%). The complications encountered were - one case each of cerebrospinal fluid (CSF) leak, surgical site infection, and pseudomeningocele. The percentage of spinal canal occupied ranged from 71-94%. The mean percentage of the spinal canal occupied by the tumor was 81.8%. In our series, 77.14% of patients (p<0.0001) had good functional outcomes as per improvement in Frankel score. The DPS and Nurick score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significant functional improvement was noted at the one-week, one-month, and on e-year follow-up, with a p-value of <0.0001. Conclusions The IDEM tumors are usually benign and are readily detected by contrast-enhanced MRI scans. These have excellent surgical outcomes with some exceptions. Greater canal occupancy and a longer duration of symptoms are usually seen to correspond with suboptimal functional outcomes. PMID:34285844 | PMC:PMC8286542 | DOI:10.7759/cureus.15733 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.