Management of patients with unilateral microtia and aural atresia: recent advances and updates

xlomafota13 shared this article with you from Inoreader Management of patients with unilateral microtia and aural atresia: recent advances and updates Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The management of patients with unilateral microtia and aural atresia is complex. Recent literature suggests significant strides in hearing habilitation and ear reconstruction. Recent findings Several options of hearing management are available and are associated with improved outcomes. Timelines for hearing habilitation and ear reconstruction vary by institution. We offer our timeline as a reference. Three dimensional (3D) printed models are increasingly used for training and reconstruction. Bioprinting is on the horizon, though safety and effectiveness studies are pending. Lastly, application of qualitative methods has provided a foundation on which to improve communication between physicians and patients and their families. Better understanding of the patient and family experiences will provide opportunities to target interventions to improve care. Summary Current developments include expanding options for hearing management, changing approaches to timing of atresiaplasty, utilization of 3D printed models, and focus on patient and family experience to improve reconstructive outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Functional laryngectomy for the dysfunctional larynx: indications and outcomes in setting of prior chemoradiotherapy

xlomafota13 shared this article with you from Inoreader Functional laryngectomy for the dysfunctional larynx: indications and outcomes in setting of prior chemoradiotherapy Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To review the recent literature on indications for and functional outcomes following laryngectomy for severe laryngeal dysfunction. Recent findings The use of functional laryngectomy as a definitive treatment for severe laryngeal dysfunction is increasing as more patients with head and neck cancer are treated with definitive chemoradiotherapy. Data are emerging on the efficacy of this technique as measured by aspiration, recurrent pneumonias, enteral tube feeding dependence, and surgical complication rates. Though most patients have marked improvement in aspiration and oral intake, difficulties in swallowing and voicing functions may persist. Summary Functional laryngectomy is an effective treatment for end-stage laryngeal dysfunction. There is a clear benefit with regard to prevention of aspiration and alleviation of nothing by mouth status. However, qualitative speech and swallowing outcomes are less well studied, though available data suggest that many patients still suffer some degree of continued chronic impairment. More research is needed on these outcomes in order to appropriately counsel patients regarding long-term functional outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pediatric allergic fungal rhinosinusitis: optimizing outcomes

xlomafota13 shared this article with you from Inoreader Pediatric allergic fungal rhinosinusitis: optimizing outcomes Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Allergic fungal rhinosinusitis (AFRS) is a debilitating condition for children. Despite there being several reviews on this topic in the adult population, there is a paucity of reviews of AFRS in the pediatric literature. This article reviews the recent evidence of pediatric AFRS with the aim to optimize outcomes of pediatric patients with this condition. Recent findings AFRS is clinically characterized by nasal polyposis, a type I hypersensitivity to fungal epitopes, very thick eosinophilic mucin, and peripheral eosinophilia. Pediatric AFRS has similar clinical characteristics to that in adults but is thought to have a more aggressive nature, with higher serum immunoglobulin E and more frequently bone erosion and malformation of facial bones. Diagnosis of pediatric AFRS is made by using the Bent and Kuhn's criteria developed for adult AFRS. The mainstay of treatment is surgery followed by postoperative corticosteroids. Adjunctive therapies, including topical/oral antifungal agents, allergen immunotherapy and biologics may improve outcomes in pediatric AFRS, but to date the current evidence is limited. Summary To optimize the outcome of pediatric AFRS, adequate and early diagnosis and treatment are essential. Appropriate and comprehensive endoscopic sinus surgery to open the sinuses, remove the fungal burden of disease and improve access of the sinuses to postoperative topical corticosteroid remains the standard of care. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current approaches to management of vocal fold scar

xlomafota13 shared this article with you from Inoreader Current approaches to management of vocal fold scar Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Vocal fold (VF) fibrosis remains an insoluble problem in most cases, with a severe impact on vocal quality and effort. This review examines current investigations and research strands that explore the understanding of VF wound healing and applied treatments for the management of VF scar. Recent findings Recent work focused on VF fibrosis has examined wound healing in the glottis, fibrosis-modifying medication, and tissue engineering approaches that span cytokine and growth factor therapy, scaffold and cell delivery platforms, seeded scaffolds, conditioned media and stem cell therapy. Many show promise and may deliver improvements in the wound bed favouring less fibrogenic healing patterns, ultimately with the goal of preserving or restoring VF vibration. Further collaborative research is required that examines combined approaches, long term outcomes, better three-dimensional modelling of cell-cell interactions and delivery modalities for molecular therapies. Summary VF fibrosis research continues to expand and explore a variety of mechanistic pathways in order to understand VF healing and identify novel and complementary targets for manipulation. Many different approaches show promise and may also offer synergistic benefits. Research continues to strive for healing that more closely resembles true VF architecture and function. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Vocal fold sulci – what are the current options for and outcomes of treatment?

xlomafota13 shared this article with you from Inoreader Vocal fold sulci – what are the current options for and outcomes of treatment? Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Sulcus vocalis is a benign condition of the vocal folds that, according to its severity, can affect the quality of the voice of those who have it. Voice symptoms can range from mild to severe, affecting the quality of life of patients with this condition. Although different surgical and no surgical options have been described, no gold standard treatment has been described. Recent findings New evidence supports congenital, inflammatory, and acquired theories for sulcus vocalis. Also, recent literature demonstrated the role of the epithelium in the pathogenesis, which makes the absence of superficial lamina propria no longer the only accepted hypothesis. Technological developments improved the in-office diagnostics capabilities for this condition, but vocal fold palpation remains the gold standard. Different benign laryngeal conditions are associated with sulcus vocalis and knowing when to treat those is very important. Different treatment options are available for sulcus vocalis, however, results are diverse and no strong recommendations for one over the other can be made. Summary Progress continues to be made in our understanding of sulcus vocalis from diagnosis to treatment. Novel and promising therapeutic strategies have been recently developed for this condition; however, more data and investigations are needed to improve their accuracy and reproducibility. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current approaches to reporting pharyngo-laryngeal secretions

xlomafota13 shared this article with you from Inoreader Current approaches to reporting pharyngo-laryngeal secretions Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Accumulated secretions in the pharynx and larynx are associated with dysphagia, aspiration and pneumonia, as well as increased social, health and economic burden. This article reviews developments in the instrumental reporting of pharyngo-laryngeal secretions over the last 2 years. Recent findings Although the healthy pharynx and larynx is moist, accumulation of secretions is indicative of abnormality. Using standardized secretion scales allows early identification, quantification of risk in patients, and sensitive monitoring of patients over time. Nonstandardized and subjective secretion reporting is common in recently published research despite the validation of a number of publicly available tools. Research characterizing accumulated secretions has contributed to our understanding of pathophysiology associated with poor secretion management and may inform future treatment studies. Summary Routine and standardized reporting of secretions is critical for patient assessment and should be reported in the most standardized way possible. Further research investigating the clinical relevance and treatment of accumulated secretions relies on quantitative pharyngolaryngeal secretions reporting. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The cepstral spectral index of dysphonia, the acoustic voice quality index and the acoustic breathiness index as novel multiparametric indices for acoustic assessment of voice quality

xlomafota13 shared this article with you from Inoreader The cepstral spectral index of dysphonia, the acoustic voice quality index and the acoustic breathiness index as novel multiparametric indices for acoustic assessment of voice quality Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The objective assessment of voice quality using acoustic measures is an important pillar of voice diagnostics. This article reviews three recent acoustic measures and their clinical use in phoniatrics and laryngology. Recent findings Two acoustic parameters, the cepstral spectral index of dysphonia (CSID) and the acoustic voice quality index (AVQI), have gained importance as validated multiparametric indices in the objective assessment of hoarseness because they include both continuous speech and sustained vowels. The acoustic breathiness index (ABI), another multiparametric index, assesses breathiness admixture during phonation and identifies it robustly, unaffected by other characteristics of dysphonia such as roughness. Summary Acoustic measurements are useful diagnostic tools when used correctly with an appropriate recording system, consideration of environment and use of software programs. CSID, AVQI and ABI objectively improve the detection of voice quality abnormalities. In addition to their proven validity, their application is simple and their usability for clinicians is high. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

How can we make better decisions about dystonic voice management?

xlomafota13 shared this article with you from Inoreader How can we make better decisions about dystonic voice management? Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The optimal diagnosis and management of dystonic voice disorders are rooted in the nuanced understanding of their phenomenology. Distinguishing between subtypes of vocal dystonia is challenging, not only because the audible and physical presentations of these dystonia's can seem similar, but also because there is a lack of scientific consensus regarding the diagnostic criteria for these conditions. To help improve the clinician's acumen we focus on outlining the classification of the top three neurological voice disorders, notably: spasmodic dysphonia, (2) spasmodic dysphonia with tremor, and essential tremor of the voice. We also provide an algorithmic approach based on current evidence-based literature to guide practitioners through the clinical diagnosis and management of each possible etiology. Recent findings Much remains unknown about the subtypes of vocal dystonia, and this gap in our knowledge likely limits our ability to advance clinical management. Still, continued experience evaluating and treating these patients yields refined clinical evaluations and decision making. Summary Improvements in our clinical decision-making can be made by acknowledging that our limited understanding of vocal dystonia may hinder what therapeutic interventions we can offer, yet our ability to accurately diagnose the dystonia is central to providing optimal patient management. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of coronavirus disease-2019 on voice: our experience of laryngeal complications following mechanical ventilation in severe coronavirus disease-2019 pneumonitis and review of current literature

xlomafota13 shared this article with you from Inoreader Effects of coronavirus disease-2019 on voice: our experience of laryngeal complications following mechanical ventilation in severe coronavirus disease-2019 pneumonitis and review of current literature Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Dysphonia has been described as a major symptom of coronavirus disease-2019 (COVID-19). A literature review examining this topic was undertaken and is presented here, combined with insights from our experience in managing patients with laryngeal complications following mechanical ventilation for severe COVID-19 pneumonitis. Recent findings Naunheim et al. reported that patients who are most at risk of needing intubation with COVID-19 disease are those with patient-specific risk factors and these are at an increased risk for subsequent laryngotracheal injury following intubation (1). In our cohort of 105 patients referred with laryngological symptoms postintubation for COVID-19 pneumonitis, 40% presented as urgent reviews, of which almost half had severe postintubation complications requiring surgery. Perceptual voice ratings and patient-reported voice ratings varied widely, but there was no significant change in voice scores postoperatively. The reflux symptom index (RSI) scores did improve significantly (p = 0.0266). The need for surgery was associated with the presence of comorbidities for instance hypertension, diabetes and obesity in our cohort. This is in support of reported association of comorbidity as a risk factor for intubation and subsequent development of postintubation airway complications. Summary Dysphonia following COVID-19 infection may have multiple causes. Literature reports demonstrate intubation injury, sensory neuropathy, and postviral neuropathy are associated with voice changes. Our personal experience has confirmed postintubation injury markedly affects glottic function with resultant dysphonia attributable to scar formation, posterior glottic stenosis, granulation and subglottic stenosis. Frequent surgical intervention is required for airway patency and may have short-term further deleterious effects on phonation, although in our cohort this is not statistically significant analysing Grade, Roughness, Breathiness, Asthenia, Strain, Voice Handicap Index-10 or Airway, Voice, Swallow scores. Maximal antireflux medications and advice statistically improved RSI scores postoperatively. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pediatric otolaryngology in the coronavirus disease 2019 pandemic: what have we learned?

xlomafota13 shared this article with you from Inoreader Pediatric otolaryngology in the coronavirus disease 2019 pandemic: what have we learned? Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Coronavirus disease 2019 (COVID-19) has changed the face of healthcare. The current review is to discuss the major aspects that have changed in pediatric otolaryngology, from surgical operations management, to clinic workflow, to procedural precautions. Recent findings There have been many studies over the past year describing different ways to improve the safety of healthcare delivery in pediatric otolaryngology amidst a global pandemic, as well as ways to improve clinic and surgical logistics along with guidelines for telehealth of a surgical specialty. Summary COVID-19 has forever altered how healthcare is viewed and practiced, and pediatric otolaryngology was not exempt. With an increased focus on provider safety, as well as novel ways of utilizing changes in methods of communication, the practice of pediatric otolaryngology has evolved with the rest of healthcare to take on the new challenges brought on by this global pandemic. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

xlomafota13 shared this article with you from Inoreader Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 8:S1748-6815(21)00466-6. doi: 10.1016/j.bjps.2021.09.028. Online ahead of print. ABSTRACT BACKGROUND: The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF. METHODS: A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies fro m 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure. RESULTS: Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively. CONCLUSION: The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFF F. Future studies should therefore focus on the prognostic factors and preventive measures of neuropathic pain to further improve clinical outcomes of this widely used flap. PMID:34736849 | DOI:10.1016/j.bjps.2021.09.028 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.