Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Message: Do children with nonsevere obstructive sleep apnea experience resolution of nocturnal enuresis after adenotonsillectomy? Findings In this econdary analysis of a randomized clinical trial including 393 of the 453 totally enrolled children, those with nonsevere obstructive sleep apnea, those who underwent adenotonsillectomy were more likely to experience resolution of nocturnal enuresis compared with children who did not receive surgery. Nocturnal enuresis was less frequent in girls; other clinical factors, such as age, obesity, and severity of sleep apnea, were not associated with improvement of nocturnal enuresis. Meaning The findings of this study suggest that it may be useful for clinicians to inquire about nocturnal enuresis in children with obstructive sleep apnea and counsel caregivers on the potential benefit associated with adenotonsillectomy. Abstract Importance Children with obstructive sleep apnea (OSA) are at increased risk for nocturnal enuresis (NE). However, randomized clinical trials assessing NE outcomes in children randomized to adenotonsillectomy (AT) vs watchful waiting are lacking. Objective To assess the outcomes of AT vs watchful waiting in children with nonsevere OSA who experience NE. Design, Setting, and Participants Secondary analysis of data from a multicenter randomized clinical trial conducted at tertiary children's hospitals was performed. Participants included 453 children aged 5.0 to 9.9 years with nonsevere OSA who were randomized to either watchful waiting or AT as part of the multicenter Childhood Adenotonsillectomy Trial. Caregivers completed the Pediatric Sleep Questionnaire, which includes a binary item on bed-wetting, at baseline and 7-month follow-up. The trial was conducted between October 2007 and June 2012. Evaluation in this secondary analysis involving NE occurred from October 2019 to March 2021. Interventions Adenotonsillectomy vs watchful waiting in children with NE. Main Outcomes and Measures Prevalence of NE as defined by parental response to the Pediatric Sleep Questionnaire bed-wetting item at baseline and 7-month follow-up. Results Of the 453 children enrolled, 393 were included in analysis; of these, 201 were girls (51.1%). Mean (SD) age at baseline was 6.54 (1.40) years. At baseline, the number of children with NE was similar (2.6%; 95% CI, −0.12% to 0.07%) between the AT (59 [30.7%]) and watchful-waiting (67 [33.3%]) groups. The odds of NE in the watchful-waiting group were approximately 2 times higher than the AT group after 7 months (odds ratio, 2.0; 95% CI, 1.3 to 3.1). Following AT, there was a decrease (−11.0%; 95% CI, −16.3% to −5.7%) in the number of children with NE (n = 38). The prevalence of NE did not change significantly (−0.5%; 95% CI, −5.4% to 6.4%) in the watchful-waiting group (n = 66) at follow-up. Although NE was less frequent in girls (adjusted odds ratio, 0.53; 95% CI, 0.33-0.85), other clinical factors, such as age, race and ethnicity, obesity, and apnea-hypopnea index, were not associated with improvement of NE. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, AT for the treatment of pediatric OSA appears to result in improvement in NE. Further research is needed to assess whether AT is associated with long-term benefits for NE compared with watchful waiting. Trial Registration ClinicalTrials.gov Identifier: NCT00560859 Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea Via JAMA Otolaryngology–Head & Neck Surgery Online First This secondary analysis of a randomized clinical trial of children who underwent adenotonsillectomy for nonsevere obstructive sleep apnea evaluates the prevalence of nocturnal enuresis after the operation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nodular Mass in the Earlobe of an 18-Month-Old Girl

xlomafota13 shared this article with you from Inoreader Message: An 18-month-old girl presented with a 1-year history of a slow-growing mass in the right earlobe. There were no symptoms, such as tenderness or discharge, associated with the mass. She had no history of underlying medical disease or trauma. On physical examination, a 1.5 × 1.0–cm, firm, nodular, angulated, pinkish, nontender mass was observed in the posterior aspect of the right earlobe (Figure, A). The skin over the mass was semitransparent, and the mass moved freely beneath the skin. Under suspicion of a tumorous lesion, complete excision was performed after the patient received general anesthesia. Histopathologic findings were characteristic for 2 cell types; basaloid cells with a nucleus were present in the periphery, and ghost cells without a nucleus were present in the center (Figure, B). Six months after surgery, the wound had healed well, and there has been no recurrence. Nodular Mass in the Earlobe of an 18-Month-Old Girl Via JAMA Otolaryngology–Head & Neck Surgery Current Issue An 18-month-old girl presents with a firm, nodular, angulated, pinkish, nontender mass in the posterior aspect of the right earlobe. What is your diagnosis? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pulsatile Tinnitus in a Patient With a Skull Base Lesion

xlomafota13 shared this article with you from Inoreader Message: An 80-year-old woman presented with a 1-year history of right pulsatile tinnitus and aural fullness. Her symptoms were more prominent at night and in the quiet and improved when upright. Physical examination demonstrated an intact tympanic membrane with no middle ear mass; there was no neck mass palpated or bruit auscultated. The patient had further workup with magnetic resonance imaging (MRI) and a computed tomographic scan (Figure 1). The patient was taken to the operating room for a right transtemporal biopsy. Operative findings demonstrated extensive tumor extending along the posterior fossa dura and deep to the jugular foramen that filled the area of the skull base. The tumor was debulked and sent for pathologic evaluation. Pulsatile Tinnitus in a Patient With a Skull Base Lesion Via JAMA Otolaryngology–Head & Neck Surgery Current Issue An 80-year-old woman presented with a 1-year history of right pulsatile tinnitus and aural fullness; her symptoms were more prominent at night and in the quiet and improved when upright. What is your diagnosis? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Neck Pain After Oromandibular Reconstruction

xlomafota13 shared this article with you from Inoreader Message: Chronic Neck Pain After Oromandibular Reconstruction Lukas D. Dumberger, MD1; Leila J. Mady, MD, PhD, MPH1; Steven B. Cannady, MD1 Author Affiliations 1Department of Otolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia JAMA Otolaryngol Head Neck Surg. 2021;147(9):826-827. doi:10.1001/jamaoto.2021.1685 Full Text A 64-year-old woman with a history of hyperlipidemia, hypertension, HIV infection, coronary artery disease, and squamous cell carcinoma of the left mandible treated with composite resection, left neck dissection, and fibula free flap (FFF) reconstruction followed by postoperative radiotherapy presented with sharp, shooting left neck pain. Beginning 5 months after her reconstruction, the patient reported point tenderness on the left jaw, facial swelling, and electric pain with severity of 7 out of 10 in the left neck that occurred with talking or eating. Her postoperative course was complicated by osteoradionecrosis post-tracheostomy, plate removal, and left segmental mandibulectomy. She received regular physical therapy and lymphedema therapy and was seen by Physical Medicine and Rehabilitation, who treated her with onabotulinum toxin A injections; neither provided significant resolution of her symptoms. Review of a computed tomography scan of the head and neck (Figure 1) performed o n follow-up 5 years after initial reconstruction demonstrated a long, hyperdense structure in the left submental, submandibular region with accompanying soft-tissue thickening. On further review of prior imaging, this calcification appeared as a new finding in various scans dating back to 5 months after FFF reconstruction compared with preoperative imaging. There was no fluorodeoxyglucose avidity in the area of question on multiple positron emission tomography scans done during this follow-up window. Chronic Neck Pain After Oromandibular Reconstruction Via JAMA Otolaryngology–Head & Neck Surgery Current Issue A 64-year-old woman with a history of squamous cell carcinoma treated with resection, dissection, and flap reconstruction and radiotherapy presented with sharp left neck pain; imaging revealed a calcification. What is your diagnosis? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reducing Opioid Prescribing and Consumption After Surgery

xlomafota13 shared this article with you from Inoreader Reducing Opioid Prescribing and Consumption After Surgery Via JAMA Otolaryngology–Head & Neck Surgery Current Issue Many patients receive their first opioid prescription from a surgeon. While surgery is a large concern for most patients, receiving an opioid prescription may seem more incidental. Yet 1 of every 17 patients who uses an opioid after otolaryngologic surgery continues to require opioids long after postoperative care has been completed. Overall, 1 of every 25 adults in the US regularly uses prescription opioid medications. For years, opioids have been assumed to be the de facto choice for pain management after surgery, but evidence is accumulating that nonopioid medications are highly effective for postoperative pain and may offer substantial advantages compared with opioids in improved safety. Despite this growing awareness, in a 2018 survey of American Rhinological Society members, 94% of respondents reported prescribing opioids after end oscopic sinus surgery, with an average of 27 opioid tablets prescribed. If prescribing opioids means opening a Pandora's box without additional efficacy, then what should be their legitimate role after surgery? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Unilateral aberrant anatomy of the hypoglossal nerve

xlomafota13 shared this article with you from Inoreader Unilateral aberrant anatomy of the hypoglossal nerve Via radiol anat Surg Radiol Anat. 2021 Sep 9. doi: 10.1007/s00276-021-02828-0. Online ahead of print. ABSTRACT PURPOSE: Neck dissection is often performed in patients with oral cancer to both treat and reduce the risk of subsequent neck metastases. Injury to the hypoglossal nerve may result in dysarthria, dysphagia, and profound difficulty with upper airway control. Although surgical landmarks facilitate intra-operative identification of vital structures to be preserved, they should not be an absolute measure, due to anatomical variants. We present a rare case of unilateral aberrant anatomy of the hypoglossal nerve, passing superficial to the internal jugular vein. METHODS: A 70-year-old female presented to the emergency department with an indurated and ulcerated floor of mouth lesion, later confirmed to be a squamous cell carcinoma. She was treated with wide local excision, bilateral selective neck dissection of levels I to III, surgical tracheostomy, anterior mandibulectomy and reconstruction with a left composite radial forearm free flap. RESULTS: A nerve-like structure was identified crossing superficially and perpendicular to the internal jugular vein within the left neck, which was later determined to be an anatomical variant of the hypoglossal nerve. This was carefully dissected and preserved, and the remainder of the surgery completed uneventfully. On the right, the hypoglossal nerve followed its normal anatomical course. The patient made a good re covery and suffered no neurological complications. CONCLUSION: Identification, meticulous dissection and preservation of the hypoglossal nerve is essential in lymphadenectomy involving levels I and II. Detailed knowledge of both normal and variant anatomy is fundamental for surgeons, which will allow for identification and protection of important neurovascular structures, thereby minimising surgical morbidity. PMID:34498101 | DOI:10.1007/s00276-021-02828-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gingival Ulceration

xlomafota13 shared this article with you from Inoreader Message: A 50-year-old man presented to the dental clinic with a 1-month history of fever, nasal congestion, and an enlarging ulcer between his front teeth. Biopsy revealed extranodal natural killer T-cell lymphoma. Xin Lyu, D.D.S. Xiaobing Guan, D.D.S. Beijing Stomatological Hospital, Beijing, China guanxbing2013@qq.com Gingival Ulceration Via The New England Journal of Medicine: Otolaryngology Figure 1. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

xlomafota13 shared this article with you from Inoreader Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1733974 Objective This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas. Study Design This study is a retrospective volumetric analysis. Setting This study was conducted at a single institution. Participants Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007–July 1, 2017). Main Outcome Measure The main outcome was radiographic tumor progression. Results Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm3. Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV (p = 0.01) and history of more than 1 previous surgery (p = 0.03) as independent predictors of tumor progression. In a Kaplan–Meier analysis for PFS, the RTV threshold of 3 cm3 maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm3 thresholds (p < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm3 and >3 cm3 were 76.2 and 32.1%, respectively. When RTV >3 cm3 was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression (p < 0.01). Conclusion RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm3 was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quality improvement intervention to reduce time to postoperative radiation in head and neck free flap patients

xlomafota13 shared this article with you from Inoreader Quality improvement intervention to reduce time to postoperative radiation in head and neck free flap patients Via Head & Neck Abstract Background Best-practice guidelines for head and neck cancer patients advise postoperative radiation therapy (PORT) initiation within 6 weeks of surgery. We report our institutional experience improving timeliness of adjuvant radiation in free-flap patients. Methods Thirty-nine patients met inclusion criteria in the 2017–2019 study period. We divided into "Early" (n = 19) and "Late" (n = 20) time-period groups to compare performance over time. The primary endpoint was time to PORT initiation, with success defined as <6 weeks. Results The number of patients achieving timely PORT improved from 10.5% in the Early group to 50.0% in the Late group (p = 0.014). Patients undergoing concurrent adjuvant chemoradiation were more likely to meet the PORT target in the Late group (p = 0.012). Conclusions We ascribe this quality improvement in free-flap patients to increased communication among multidisciplinary care teams, proactive consultation referrals, and a targeted patient-navigator intervention. Though work is needed to further improve performance, insight gained from our experience may benefit other teams. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Supra-normal skills in processing of visuo-auditory prosodic information by cochlear-implanted deaf patients

xlomafota13 shared this article with you from Inoreader Supra-normal skills in processing of visuo-auditory prosodic information by cochlear-implanted deaf patients Via Laryngologie Hear Res. 2021 Aug 6;410:108330. doi: 10.1016/j.heares.2021.108330. Online ahead of print. ABSTRACT Cochlear implanted (CI) adults with acquired deafness are known to depend on multisensory integration skills (MSI) for speech comprehension through the fusion of speech reading skills and their deficient auditory perception. But, little is known on how CI patients perceive prosodic information relating to speech content. Our study aimed to identify how CI patients use MSI between visual and auditory information to process paralinguistic prosodic information of multimodal speech and the visual strategies employed. A psychophysics assessment was developed, in which CI patients and hearing controls (NH) had to distinguish between a question and a statement. The controls were separated into two age groups (young and aged-matched) to dissociate any effect of aging. In addition, the oculomotor strategies used when facing a speaker in this prosodic de cision task were recorded using an eye-tracking device and compared to controls. This study confirmed that prosodic processing is multisensory but it revealed that CI patients showed significant supra-normal audiovisual integration for prosodic information compared to hearing controls irrespective of age. This study clearly showed that CI patients had a visuo-auditory gain more than 3 times larger than that observed in hearing controls. Furthermore, CI participants performed better in the visuo-auditory situation through a specific oculomotor exploration of the face as they significantly fixate the mouth region more than young NH participants who fixate the eyes, whereas the aged-matched controls presented an intermediate exploration pattern equally reported between the eyes and mouth. To conclude, our study demonstrated that CI patients have supra-normal skills MSI when integrating visual and auditory linguistic prosodic information, and a specific adaptive strategy developed as it participates directly in speech content comprehension. PMID:34492444 | DOI:10.1016/j.heares.2021.108330 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Health‐Related Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety After Total Laryngectomy

xlomafota13 shared this article with you from Inoreader Health‐Related Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety After Total Laryngectomy Via The Laryngoscope Objectives/Hypothesis The aims were to determine health-related quality of life (HRQoL), including voice problems, dysphagia, depression, and anxiety after total laryngectomy (TL), and investigate the associations between HRQoL and the late effects. Study Design Cross-sectional study. Methods 172 participants having received a TL 1.6 to 18.1 years ago for laryngeal/hypopharyngeal cancer filled in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, Core and Head and Neck module (EORTC QLQ-C30, EORTC QLQ-H&N35), Voice-Related Quality of Life questionnaire (V-RQOL), M.D. Anderson Dysphagia Inventory (MDADI), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Results Participants scored worse than normative reference populations on all scales/items of the EORTC questionnaires, except one, and almost half of the scales/items showed a clinically relevant difference. Moderate/severe dysphagia was present in 46%, moderate/severe voice problems in 57%, depression in 16%, and anxiety in 20%. Decreasing age, increasing numbers of comorbidities, increasing voice problems, increasing dysphagia, and increasing depression symptoms, were associated with a lowered EORTC QLQ-C30 summary score. Conclusion A substantial proportion of participants experienced clinically significant late effects and increasing levels of these were associated with a lowered HRQoL. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.