Quantitative Evaluation of Subglottic Stenosis Using Ultrashort Echo Time MRI in a Rabbit Model

xlomafota13 shared this article with you from Inoreader Quantitative Evaluation of Subglottic Stenosis Using Ultrashort Echo Time MRI in a Rabbit Model Via The Laryngoscope Objective/Hypothesis To assess the ability of ultra‐short echo time (UTE)‐MRI to detect subglottic stenosis (SGS) and evaluate response to balloon dilation. To correlate measurements from UTE‐MRI with endotracheal‐tube (ETT)‐sizing and to investigate whether SGS causes change in airway dynamics. Study Design Animal research study. Methods Eight adult New‐Zealand white rabbits were used as they approximate neonatal airway‐size. The airways were measured using ETT‐sizing and 3D UTE‐MRI at baseline, 2 weeks post‐cauterization induced SGS injury, and post‐balloon dilation treatment. UTE‐MR images were acquired to determine airway anatomy and motion. Airways were segmented from MR images. Cross‐sectional area (CSA), major and minor diameters (D major and D minor), and eccentricity were measured. Results Post‐injury CSA at SGS was significantly reduced (mean 38%) compared to baseline (P = .003) using UTE‐MRI. ETT‐sizing correlated significantly with MRI‐measured CSA at the SGS location (r = 0.6; P < .01), particularly at the post‐injury timepoint (r = 0.93; P < .01). Outer diameter from ETT‐sizing (OD) correlated significantly with D major (r = 0.63; P < .01) from UTE‐MRI at the SGS location, especially for the post‐injury timepoint (r = 0.91; P < .01). Mean CSA of upper trachea did not change significantly between end‐expiration and end‐inspiration at any timepoint (all P > .05). Eccentricity of the upper trachea increased significantly post‐balloon dilation (P < .05). Conclusions UTE‐MRI successfully detected SGS and treatment response in the rabbit model, with good correlation to ETT‐sizing. Balloon dilation increased CSA at SGS, but not to baseline values. SGS did not alter dynamic motion for the trachea in this rabbit model; however, tracheas were significantly eccentric post‐balloon dilation. UTE‐MRI can detect SGS without sedation or ionizing radiation and may be a non‐invasive alternative to ETT‐sizing. Level of Evidence NA Laryngoscope, 131:E1971–E1979, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic Features in Intermediate‐Size Supraglottic Tumors Treated With Open Supraglottic Laryngectomy

xlomafota13 shared this article with you from Inoreader Prognostic Features in Intermediate‐Size Supraglottic Tumors Treated With Open Supraglottic Laryngectomy Via The Laryngoscope Objectives/Hypothesis We investigated growth patterns and pathological features in intermediate‐size laryngeal carcinoma amenable to supraglottic laryngectomy. Study design Retrospective cohort study. Methods We reviewed patients who underwent an open partial horizontal laryngectomy (OPHL) type I. We analyzed pathological data, tumor sizes, overall survival, disease‐specific survival, local control, and laryngeal preservation. Results were stratified between three groups: group I comprised patients with endolaryngeal carcinoma, group II comprised patients with anterior epilaryngeal carcinoma who underwent an OPHL type I + base of tongue (BOT), group III comprised patients with lateral epilaryngeal carcinoma who underwent an OPHL type I + pyriform sinus (PIR). Results Sixty‐eight patients were analyzed. The 5‐year rates of overall survival, disease‐specific survival, local control, and laryngeal preservation were 68.4%, 83.7%, 91.6%, and 98.3%, respectively. The tumor sizes at pathological examination were similar between the three groups (mean 27 mm, P = .80) and were associated with pathological features, notably pre‐epiglottic space (PES) invasion (24.9 mm vs. 32.2 mm, P = .01), occult invaded lymph nodes (22.6 mm vs. 29.9 mm, P = .03), and trends for margins status (26.5 mm vs. 29.3 mm, P = .45). The risks of PES invasion, occult lymph nodes, and positive margins, respectively, predominated in group I (41.7%), group II (56.3%), and group III (23.3%). Conclusion In intermediate‐size tumors amenable to supraglottic laryngectomy, pathological features are associated with tumor size according to group stratification based on tumor location. Level of Evidence 4 Laryngoscope, 131:E1980–E1986, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pediatric Post‐Tonsillectomy Opioid Prescribing Practices

xlomafota13 shared this article with you from Inoreader Pediatric Post‐Tonsillectomy Opioid Prescribing Practices Via The Laryngoscope Objective To evaluate the effect of discharge order sets on prescribing patterns of opioids after pediatric tonsillectomy. Secondary outcomes included encounters for postoperative pain, dehydration, and bleeding. Methods Retrospective chart review of pre‐ and post‐intervention in pediatric post‐tonsillectomy patients, 0–18 years old (n = 1486). Order sets were installed with age‐specific analgesic medication defaults and recommendation of concurrent alternating scheduled ibuprofen and acetaminophen. Time‐balanced pre‐ and post‐intervention cohorts were established. Opioid outcomes calculated in morphine milligram equivalents per kilogram (MME/kg) per dosage and total prescribed. Results Discharge order set intervention resulted in 17% reduction of opioid dose prescribed (0.095 MME/kg [95% CI, 0.092–0.099] vs. 0.079 [95% CI, 0.076–0.083], P < .001). Total number of opioid doses prescribed was reduced after order set implementation (46.4 [95% CI, 43.6–49.1] to 20.3 [95% CI, 19.1–21.5], P < .001). Patients <7 years old prescribed opioids remained rare in pre‐ and post‐intervention groups (1.6% and 1.8%, respectively, P = .86). Admissions and emergency department visits for postoperative dehydration and pain were significantly reduced. Post‐intervention group showed an increase in readmissions for post‐tonsillectomy hemorrhage (9.2% vs. 5.2%, P = .003) which was isolated to an increase in the older post‐intervention group after stratification by age. Conclusion Utilization of order sets with standardized analgesic medication regimen of acetaminophen, ibuprofen, and opioid helped effectively reduce opioid amount per dose, total opioid amount dispensed, and variability in the total opioid amount dispensed while maintaining pain control. An increase in post‐tonsillectomy hemorrhage was recognized following this implementation which did not persist after the study period despite continuation of intervention. Level of Evidence 4 Laryngoscope, 131:1386–1391, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Implantable Doppler Ultrasound Monitoring in Head and Neck Free Flaps: Balancing the Pros and Cons

xlomafota13 shared this article with you from Inoreader Implantable Doppler Ultrasound Monitoring in Head and Neck Free Flaps: Balancing the Pros and Cons Via The Laryngoscope Objectives/Hypothesis Free flap transfer offers a versatile option for reconstruction in head and neck surgery, with success rates over 95%. There remains a substantial re‐exploration rate of roughly 5% to 15%, with early recognition of compromise essential to flap survival. Monitoring techniques are highly desirable, with the gold standard being clinical monitoring. The Cook‐Swartz Doppler (CSD) probe utilizes Doppler technology to inform clinicians about real‐time flow. We aim to describe our adoption of this technology in 100 consecutive free flaps. Study Design Prospective case series. Methods Prospective data were collected from July 2014 to June 2015 on 100 consecutive free flaps performed at a head and neck unit in London, Ontario. All patients had a CSD inserted for arterial and venous monitoring. Results A total of 100 free flaps were performed on 99 patients. Sensitivity was 87.1% and specificity was 85.7%. Positive predictive value was 98.8% and negative predictive value was 33.3%. False‐negative and false‐positive rate were 1.0% and 12.0%, respectively. The exploration rate was 12%, with no flap loss and two partial debridements. The CSD was helpful in management in 9% of cases and was clinically unhelpful in 11% of cases, with 10 of 11 abnormal signals ignored. There were three unique CSD complications; one retained wire, one pedicle laceration during extraction, and one clot around the probe interrupting signal. Conclusions The CSD is a helpful adjunct to clinical monitoring but has unique complications, which were not previously described. Pros and cons must be considered for new centers adopting this technology. Level of Evidence 4 Laryngoscope, 131:E1854–E1859, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Changes of Laryngeal and Extralaryngeal Symptoms and Findings in Laryngopharyngeal Reflux Patients

xlomafota13 shared this article with you from Inoreader Changes of Laryngeal and Extralaryngeal Symptoms and Findings in Laryngopharyngeal Reflux Patients Via The Laryngoscope Objectives/Hypothesis To assess the evolution of laryngeal and extralaryngeal symptoms and findings of laryngopharyngeal reflux (LPR) throughout a 3‐month to 9‐month treatment. Study Design Prospective Controlled Study. Methods One hundred twenty‐seven LPR patients and 123 healthy individuals were enrolled from four European hospitals. Patients were managed with a 3‐month personalized treatment considering the LPR characteristics at the impedance‐pH monitoring. Regarding the clinical therapeutic response, treatment was adapted for 3 to 6 additional months. Symptoms and findings were assessed throughout the therapeutic course with the Reflux Symptom Score (RSS) and the short version of the Reflux Sign Assessment (sRSA). The relationship between patient and reflux characteristics, symptoms, and findings was assessed. Results One hundred twenty‐one LPR patients completed the study. LPR patients exhibited more laryngeal and extralaryngeal symptoms and findings than healthy individuals. RSS significantly improved from baseline to 6 weeks posttreatment and continued to improve from 3 months to 6 months posttreatment. sRSA significantly improved from baseline to 3 months posttreatment. No further improvement was noted at 6 months posttreatment for pharyngeal and oral findings. Laryngeal findings continued to improve from 3 months to 6 months posttreatment. There was a significant association between patient stress level and RSS (P = .045). At 3 months posttreatment, 28.1% of patients had high or complete response, whereas 47.1% required 6 months or 9 months of treatment. Overall, 24.8% of patients had an LPR chronic course. Conclusions Laryngeal and extralaryngeal symptoms and findings significantly improved throughout treatment in LPR patients. The improvement of laryngeal findings was slower. Regarding the low prevalence of some digestive or otolaryngological symptoms, a short version of the RSS could be developed. Level of Evidence 3 Laryngoscope, 131:1332–1342, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Post‐Tonsillectomy Hemorrhage and the Diagnosis of Occult Pediatric Coagulopathies

xlomafota13 shared this article with you from Inoreader Post‐Tonsillectomy Hemorrhage and the Diagnosis of Occult Pediatric Coagulopathies Via The Laryngoscope Objectives/Hypothesis The primary objective of this investigation was to determine rates of abnormal coagulation panels and diagnoses of coagulopathies in children with post‐tonsillectomy hemorrhage (PTH). Secondary objectives identified patient demographics and hemorrhage event characteristics that correlated with a coagulopathy diagnosis. Study Design Case series with chart review. Methods Patients requiring operative control of PTH at a tertiary children's hospital between 2015 and 2019 were included. Details of tonsillectomy procedures and hemorrhage events were reviewed along with screening labs for coagulopathy, referrals to hematology and bleeding disorder diagnoses. Results There were 250 children included. Mean age was 8.8 years (95% CI: 8.2–9.4) and 53.6% were males. PTH events occurred at a median of postoperative day six (mean: 5.9, 95% CI: 5.4–6.3), and 14.8% occurred within 24 hours of surgery. In this series, 23 patients (9.2%) had a second PTH, and three (1.2%) had a third PTH. Single and multiple PTH patients were similar with respect to age, gender, postoperative day, and technique (P > .05). Screening coagulation panels were obtained on presentation in 67.8% of children with one PTH and abnormally elevated in 38.3%. All children with multiple PTHs had labs drawn with 34.8% having elevated levels. No child with a single PTH was diagnosed with a bleeding disorder. Conversely, 87.0% of children with multiple PTHs saw hematology and three (13.0%) were diagnosed with a bleeding disorder (P < .001). Conclusions Obtaining coagulation panels in pediatric patients presenting with PTH is rarely useful and diagnosing a coagulopathy is uncommon. However, among children with a second PTH, referral to hematology is reasonable as this group has a significantly higher, albeit small, incidence of undiagnosed bleeding disorders. Level of Evidence 4 Laryngoscope, 131:E2069–E2073, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radiotherapy in Metastatic Oropharyngeal Cancer

xlomafota13 shared this article with you from Inoreader Radiotherapy in Metastatic Oropharyngeal Cancer Via The Laryngoscope Objectives The role of locoregional radiotherapy for metastatic oropharyngeal squamous cell cancer (OPSCC) is unclear. We investigated the impact of head and neck radiotherapy on survival in de novo metastatic OPSCC patients who received systemic therapy. Methods We queried the NCDB from 2004–2015 for metastatic OPSCC patients at diagnosis with known HPV‐status who received systemic therapy. The association of head and neck radiotherapy with overall survival was analyzed using the Kaplan–Meier method, Cox proportional hazards model, and propensity score‐matched analysis adjusting for demographic and disease‐specific prognostic factors. Results Of the 2,139 patients with metastatic OPSCC who presented with metastases and received systemic treatment, we identified 556 patients with known HPV‐status. Among these 556 patients, 49% were HPV‐positive and 56% received head and neck radiotherapy. With a median follow‐up of 17.5 months (IQR 6.0–163.4 months), radiotherapy was associated with significantly improved 1‐year OS (67% vs 58%, log‐rank P < .001) which remained significant on MVA (HR 0.78 95% CI 0.62–0.97 P = .029). In HPV‐status subgroup analysis, a survival benefit was identified in HPV‐positive patients (1‐year OS 77% vs 67%, log‐rank P < .001) but not in HPV‐negative patients. Results were consistent on a propensity score‐matched analysis of 212 HPV‐positive matched patients (HR 0.66, 95% CI 0.49–0.83, P < .001). Conclusion The survival of metastatic OPSCC remains limited. In this large series of patients with known HPV‐status, head and neck radiotherapy was associated with longer survival in those with HPV‐associated disease. These data could guide management of this challenging group of patients for head and neck cancer practitioners. Level of Evidence 3 Laryngoscope, 131:E1847–E1853, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Novel Adaptation of a Validated Tactile Aesthesiometer to Evaluate Laryngopharyngeal Sensation

xlomafota13 shared this article with you from Inoreader Novel Adaptation of a Validated Tactile Aesthesiometer to Evaluate Laryngopharyngeal Sensation Via The Laryngoscope Objectives To evaluate laryngopharyngeal sensation at specific subsites using a novel adaptation of a buckling force aesthesiometer for delivery of calibrated tactile stimuli. Study Design Cross‐sectional. Methods Twenty‐two healthy adults (12 men, 10 women) were tested for responses to tactile forces, using 30‐mm 6‐0, 5‐0, and 4‐0 nylon monofilaments to map sensation of the aryepiglottic (AE) fold, lateral pyriform sinus (PS), and medial PS bilaterally. The outcome measures were the laryngeal adductor reflex (LAR) and patient reported rating of perceptual strength. Results Rates of triggered LAR response grew monotonically with increasing tactile force at a mean (SD) stimulus duration of 663 (164) msec across all three subsites. The AE fold and medial PS had similar profiles and were the most responsive, while the lateral PS was the least responsive. Low force (6‐0) response rate was ≤14% for all subsites. High force (4‐0) response rate was 91% for AE fold and medial PS, and 23% for lateral PS. The perceptual strength gradient was in the lateral to medial trajectory. Conclusion Normative data for LAR response rates to low, medium, and high stimulation forces will be useful to assess sensory dysfunction in a variety of laryngopharyngeal disorders, including aspiration, dysphagia, chronic cough, and spasmodic dysphonia. In turn, that information will guide the creation of innovative treatments. LAR response profiles to low and high force stimuli will inform the development of screening tools to diagnose laryngopharyngeal hypersensitivity and hyposensitivity conditions. Level of Evidence 3b Laryngoscope, 131:1324–1331, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration

xlomafota13 shared this article with you from Inoreader Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration Via The Laryngoscope Objective Liquid thickeners are commonly recommended in individuals with dysphagia and recurrent aspiration as a strategy for pneumonia prevention. The goal of this study was to examine the effects of small amounts of aspirated liquid thickener on the lungs. Study design Animal model. Prospective small animal clinical trial. Methods Adult Sprague Dawley rats (n = 19) were divided into two groups and underwent three intratracheal instillations of either xanthan gum‐based nectar‐thick water (0.1–0.25 mL/kg) or water‐only control over the course of 8 days. Blood was collected from a peripheral vein on days 1 and 8 and submitted for complete blood count (CBC) analysis. Rats were euthanized 10 days after the last instillation, and the lungs were harvested. Histopathology was conducted on lung specimens by a blinded licensed veterinary pathologist and scored for evidence of lung injury and pneumonia. Results Fifteen animals (8 nectar‐thickener group, 7 control group) survived until the endpoint of the study (day 18). Serum CBC did not show abnormalities at any timepoint in either group. Histological evidence of lung inflammation and edema were significantly greater in the nectar‐thick group compared to controls (P < .05). Signs of inflammation included aggregates of foamy macrophages, expansion of bronchiolar lymphoid tissue, and large numbers of eosinophilic intraalveolar crystals. Histiocytic and neutrophilic pneumonia was noted in one animal that received thickened liquids. Conclusion Recurrent aspiration of small amounts of thickened water resulted in significant pulmonary inflammation in a murine model of aspiration. Results of this study support the need for further investigation of liquid thickener safety and its efficacy in reducing the pulmonary complications of swallowing disorders. Level of Evidence NA Laryngoscope, 131:1223–1228, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Detection of Respiratory Pathogens Does Not Predict Risks After Outpatient Adenotonsillectomy

xlomafota13 shared this article with you from Inoreader Detection of Respiratory Pathogens Does Not Predict Risks After Outpatient Adenotonsillectomy Via The Laryngoscope Objectives/Hypothesis To determine whether the presence of detectable upper respiratory infections (URIs) at the time of adenoidectomy/adenotonsillectomy is associated with increased morbidity, complications, and unexpected admissions. Study Design Prospective double‐blinded cohort. Methods In this prospective cohort study, nasopharyngeal swabs were obtained intraoperatively from 164 pediatric patients undergoing outpatient adenoidectomy/tonsillectomy with or without pressure equalization tubes (PETs) and were analyzed with PCR for the presence of 22 known URIs, including SARS‐CoV‐2. Surgeons and families were blinded to the results. At the conclusion of the study, rates of detectable infection were determined and intraoperative and postoperative events (unexpected admissions, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, and postoperative presentation to an emergency department) were compared between infected and uninfected patients. Results Of the 164 patients (50% male, 50% female, ages 8 mo‐18 y), 136 patients (82.9%) tested positive for one or more URI at the time of surgery. Forty one patients (25.0%) tested positive for three or more URIs concurrently, and 11 (6.7%) tested positive for five or more URIs concurrently. There were no significant differences in admission rates, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, or postoperative presentation to an emergency department between positive and negative patients. No patients tested positive for SARS‐CoV‐2. Conclusions A recent positive URI test does not confer any additional intraoperative or postoperative risk in the setting of outpatient adenoidectomy/tonsillectomy in healthy patients. There is no utility in preoperative URI testing, and delaying surgery due to a recent positive URI test is not warranted in this population. Level of Evidence 3 Laryngoscope, 131:E2074–E2079, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Meta‐Analysis of 67 Studies with Presenting Symptoms and Laboratory Tests of COVID‐19 Patients

xlomafota13 shared this article with you from Inoreader A Meta‐Analysis of 67 Studies with Presenting Symptoms and Laboratory Tests of COVID‐19 Patients Via The Laryngoscope Objectives/Hypothesis The objective of this meta‐analysis was to look at the pooled prevalence of symptoms, laboratory tests, and imaging of all COVID‐19 infected patients. This will allow better identification of potential COVID‐19 patients and take appropriate precautions. Study design Meta analysis. Methods We searched three databases, PubMed, EMBASE, and Ovid to identify studies published between Dec‐2019 and May‐2020. All studies reporting upper‐aerodigestive symptoms of COVID‐19 infection were included. The meta‐analysis was conducted following meta‐analyses of observational studies in epidemiology (MOOSE) guidelines, which have evaluated the pooled prevalence of 14 symptoms and nine laboratory investigations. Results Based on inclusion criteria, 67 publications consisting of 8302 patients were included. Among adults, the pooled proportion of hypertensive and diabetic patients was 18% and 7%. Cough (53% [0.46–0.61]), anosmia (38% [0.19–0.58]), loss/distortion of taste (31% [0.17–0.45]), and nasal obstruction (26% [0.12–0.39]) were the most common ear, nose & throat (ENT) symptoms. Fever (69% [0.62–0.76]) and fatigue (31% [0.26–0.37]) were the commonest generalized symptoms. C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were raised in 56% (0.41–0.71) and 49% (0.21–0.77), respectively. Interestingly, lymphopenia (41% [0.30–0.53]) and leucopenia (22% [0.16–0.29]) were more common than lymphocytosis (33% [0.02–0.64]) and leucocytosis (12% [0.09–0.16]). Fever (69% vs. 44%), cough (53% vs. 33%), and dyspnea (20% vs. 4%) were more common in adults as compared to the pediatric population. Diarrhea was more common among the pediatric cases (12%) versus ( 9%). The pooled estimate of fatality was 4%. Conclusions The most commonly experienced ENT symptom was cough followed by anosmia and dysguesia. Raised ESR and CRP with leukopenia and lymphopenia are common laboratory findings. Majority of the infected patients had abnormal computed tomography findings. COVID infection is less severe in pediatric patients. Laryngoscope, 131:1254–1265, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.