The Utility Of The Exoscope Compared To The Operating Microscope in Simulated Temporal Bone Surgery

xlomafota13 shared this article with you from Inoreader The Utility Of The Exoscope Compared To The Operating Microscope in Simulated Temporal Bone Surgery Via Clinical Otolaryngology Abstract Objective To objectively assess the utility of an exoscope during simulated otological surgery. Design Cohort study. Setting Tertiary referral otolaryngology centre. Participants Seven experienced otologists undertook simulated temporal bone surgery on plastic temporal bones using the Zeiss Kinevo microscope with both a microscope and exoscope facility. Outcome measures The utility of microscope and exoscope was compared using a Likert scale from 1 to 10 with and without PPE. Attributes assessed included image quality, depth perception, adequacy of view, exoscope positioning, surgeon comfort, surgeon safety and adequacy of image and protection for assistants and observers. Results The exoscope in 3D mode performed as well as or better than the microscope for image quality, field of view and manoeuvrability. It outperformed the microscope for compatibility with PPE, surgeon comfort and assistant/observer experience. It scored almost as highly as the microscope for depth perception. Conclusion There is likely to be a learning curve but this initial assessment of the exoscope shows significant potential as an alternative to the operating microscope in otological surgery but with the advantage of allowing the use of appropriate PPE and better ergonomics for both surgeon and assistant/observer. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta‐analysis

xlomafota13 shared this article with you from Inoreader Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta‐analysis Via Clinical Otolaryngology ABSTRACT Objectives The present meta-analysis sought to assess further evidence for the efficacy of steroids in vestibular neuritis (VN). Methods The PubMed, EMBASE and Cochrane Library databases were searched through August 30, 2019. The main outcome measure was dizziness handicap inventory (DHI) and secondary outcomes included complete caloric recovery and improvement of canal paresis (CP). The follow-up times were divided into short, mid, and long-term. Results Among 276 records identified, 5 studies (n = 253) were included in the analysis. The therapeutic effect of steroid on VN was confirmed (Hedges' g = 0.172, 95% CI 0.05 to 0.30, p = .006). Although there was no significant difference between steroids and control in the DHI score (Hedges' g = -0.323, 95% CI -0.533 to -0.113, p < 0.01), significant effect was seen on complete caloric recovery and improvement in CP (Hedges' g = 0.364, 95% CI 0.18 to 0.55, p < 0.0001; Hedges' g = 0.592, 95% CI 0.32 to 0.59, p < .0001) Conclusions The results suggest that corticosteroids have an effect on the results of caloric tests for VN recovery, especially in long-term follow-up. However, in the term of dizziness handicap, we did not find any evidence of positive effect of corticosteroid. More data are required before recommendations can be made regarding management in patients on corticosteroids. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Novel Adenoidectomy Training System

xlomafota13 shared this article with you from Inoreader A Novel Adenoidectomy Training System Via The Laryngoscope Objectives/Hypothesis Young residents find mirror-guided adenoidectomy difficult. Inexperienced trainees must learn to focus a headlight beam, work upside-down and backward in a small space and thoroughly ablate adenoid tissue—all new skills. We present an adenoidectomy training system that is low-cost, easy to construct, and is focused on these basic adenoidectomy skills. Study Design Prospective experimental study. Methods This training suite includes three stations each targeting a different skill. The first employs a mannequin head with exposed nasopharynx. It trains the student to coordinate a headlight and mirror while touching a series of targets with a curved probe. At the second station participants electrodessicate (or microdebride) an anchored piece of veal thymus. The third station combines both sets of skills as participants ablate thymus in a simulated nasopharynx (30 mm rectangular aluminum tube) constrained within a Crow-Davis retractor, using a headlight, mirror, and suction electrosurgical electrode (or microdebrider). To evaluate the training system's efficacy, we assessed the performance of 10 surgically naïve medical student volunteers before and after 15 minutes of practice using a validated rating scale used for adenoidectomy. Results There was significant improvement in adenoidectomy skill scores after practicing. Overall scores were higher, time taken to touch a series of targets with a headlight and mirror was less and amount of tissue ablated at the final station was greater (P < .05). Conclusion This novel adenoidectomy training system is inexpensive and easy to build. Practice with the model resulted in statistically significant improvement in adenoidectomy skill scores for inexperienced student surgeons. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Lymphocytic Thyroiditis and Aggressiveness of Pediatric Differentiated Thyroid Cancer

xlomafota13 shared this article with you from Inoreader Chronic Lymphocytic Thyroiditis and Aggressiveness of Pediatric Differentiated Thyroid Cancer Via The Laryngoscope Objectives/Hypothesis Hashimoto's Thyroiditis (HT) is a common cause of hypothyroidism. Among adults with differentiated thyroid cancer (DTC), HT appears to be associated with less severe disease burden. In the absence of information regarding HT and disease burden among children with DTC, we assessed the relationship between pediatric DTC severity and HT. Study Design Retrospective cohort. Methods Charts from 90 pediatric patients who underwent surgical removal of DTC from 2002 to 2017 at tertiary-care children's hospital were reviewed. Demographic, clinical, surgical, pathology, and outcome details were compared between patients with and without HT. Consistency among diagnostic modalities of HT was also evaluated. Results Median age at presentation was 16.0 years (range 4.2–18.9 years). Twenty-two patients were male (24%). Forty-five patients (50%) had HT based on presence of thyroid autoantibodies and/or surgical pathology findings and 45 patients did not have HT. Patients with HT had increased odds of microcalcifications (odds ratio [OR]: 3.01, P = .031) and decreased odds of palpable nodules (OR: 0.212, P = .024) and T2 lesions (vs. T1) (OR: 0.261, P = .015) compared with non-HT. No significant differences in demographics and the incidence of multifocality, extrathyroidal extension, lymphovascular invasion, lymph node or pulmonary metastases, disease recurrence, or radioactive iodine treatment were found between the two groups. Thyroglobulin/thyroid peroxidase autoantibodies and surgical pathology indicative of HT were concordant in 82.4% (κ = 0.635, P < .001). Conclusion HT was present in 50% of children with DTC. Patients with DTC and HT presented with smaller tumors compared to non-HT patients. No significant differences in other markers of disease aggressiveness were found between the two groups. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predicting Maximal Costal Cartilage Graft Size for Laryngotracheal Reconstruction

xlomafota13 shared this article with you from Inoreader Predicting Maximal Costal Cartilage Graft Size for Laryngotracheal Reconstruction Via The Laryngoscope Objectives/Hypothesis Current methods of assessing rib cartilage dimensions for laryngotracheal reconstruction (LTR) are inexact, making surgical planning difficult. The purpose of this study was to determine the most appropriate rib for costal cartilage graft LTR to minimize the number of ribs harvested and improve surgical outcomes. Study Design Retrospective review. Methods Computed tomography imaging of chest scans in 25 children aged 1 to 18 years was evaluated. The lengths and widths of medial and lateral cartilaginous segments of ribs 4 to 7 were measured bilaterally. Right and left cartilaginous rib dimensions were compared using a two-sample t-test. Linear mixed-effect regression was performed to develop models quantifying the relationship between rib size and patient height, rib side, and rib number. Results Regression analysis established strong models for medial rib length (R 2 = 0.89) and for medial and lateral rib width (R 2 = 0.71, 0.77, respectively). There was no difference in rib dimensions across chest sides. Rib length and width increased with child height. Total cartilaginous rib length increased from superiorly to inferiorly, primarily due to an increase in the dimensions of the medial portion of each rib. Conclusion Cartilaginous rib lengths and widths were associated with patient height, with taller children having longer ribs. Inferior ribs were longer than superior ribs, suggesting that inferior ribs may be preferred for LTR. There was no difference in cartilaginous rib length across chest side. Results may help surgeons with preoperative planning. Level of Evidence Not applicable Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effects of Remote Signal Transmission and Recording on Acoustical Measures of Simulated Essential Vocal Tremor: Considerations for Remote Treatment Research and Telepractice

xlomafota13 shared this article with you from Inoreader The Effects of Remote Signal Transmission and Recording on Acoustical Measures of Simulated Essential Vocal Tremor: Considerations for Remote Treatment Research and Telepractice Via Journal of Voice Studies on medical and behavioral interventions for essential vocal tremor (EVT) have shown inconsistent effects on acoustical and perceptual outcome measures across studies and across participants. Remote acoustical and perceptual assessments might facilitate studies with larger samples of participants and repeated measures that could clarify treatment effects and identify optimal treatment candidates. Furthermore, remote acoustical and perceptual assessment might allow clinicians to monitor clients' treatment responses and optimize treatment approaches during telepractice. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lateral border and scapular tip free flaps: Old school versus new school

xlomafota13 shared this article with you from Inoreader Lateral border and scapular tip free flaps: Old school versus new school Via Head & Neck Abstract Free tissue transfer from the subscapular system provides a wide array of options for both soft tissue and bony reconstruction. When bone stock is required for head and neck reconstruction, both the lateral scapular border free flap (LSBFF), supplied by the circumflex scapular artery, and the scapular tip free flap (STFF), supplied by the angular artery, are excellent options. Issues with positioning had previously prevented the widespread use of these bony subscapular system flaps. However, through the use of a Spider Limb Positioner, current clinical practice patterns allow for two team approaches in both of these free flaps. The following pictorial essay compares and contrasts the specific positioning and harvesting technique used for both the LSBFF and STFF, while discussing the clinical advantages and drawbacks of each. Both the lateral border scapula and scapular tip free flaps provide excellent bone stock for head and neck reconstruction. By positioning with currently avail able technology, both of these free flaps can be harvested through a two team approach. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Posterior fossa decompression for children with Chiari I malformation and hydrocephalus

xlomafota13 shared this article with you from Inoreader Posterior fossa decompression for children with Chiari I malformation and hydrocephalus Via leak of cerebrospinal fluid Childs Nerv Syst. 2021 Oct 20. doi: 10.1007/s00381-021-05377-4. Online ahead of print. ABSTRACT INTRODUCTION: Chiari I malformation (CMI) and hydrocephalus often coexist, with no clear understanding of the cause-and-effect relationship. In the absence of other associated etiologies, the traditional teaching has been to treat the hydrocephalus first, partly to minimize the risk of cerebrospinal fluid (CSF) leak from CMI decompression in the setting of elevated ICP. We describe a series of consecutive pediatric patients with CMI and hydrocephalus, the majority of whom were managed with posterior fossa decompression. METHODS: A retrospective review was conducted on consecutive children who presented to the senior author with both hydrocephalus and CMI, with emphasis on rationale for and outcomes of surgical intervention, including the need for additional surgery. RESULTS: There were 14 patients aged 2 weeks to 16 years (median 2 year s) who presented with Chiari I and hydrocephalus. Four of these underwent posterior fossa decompression without duraplasty (PFD) as first-line therapy (one of whom eventually required duraplasty), 7 had PFD with duraplasty (PFDD), 1 received a ventriculoperitoneal shunt (VPS), and two had endoscopic third ventriculostomy (ETV). Of the 11 who had PFD/D, 9 (90%) had significant symptom improvement/resolution, 7 (55%) showed decrease in ventricle size, and 1 (10%) required VPS placement for persistent hydrocephalus. Both ETV patients improved clinically, and 1 showed decrease in ventricle size. There were no pseudomeningoceles, infections, or neurological deficits. One CSF leak occurred after an ETV and was successfully treated with wound revision. CONCLUSION: In patients with both CMI and hydrocephalus, treating the CMI first in an effort to avoid a shunt can be safe and effective. In this series, PFDD in the setting of hydrocephalus did not result in CSF leak or pseudomeningoce le. While limited by a small sample size, these data support a causative relationship between CMI and hydrocephalus. PMID:34671850 | DOI:10.1007/s00381-021-05377-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Late recurrence of post-dural puncture headache

xlomafota13 shared this article with you from Inoreader Late recurrence of post-dural puncture headache Via leak of cerebrospinal fluid Agri. 2021 Oct;33(4):261-264. doi: 10.14744/agri.2019.44711. ABSTRACT The term post-dural puncture headache (PDPH) refers to a common complication that occurs after accidental dural puncture. One of the diagnostic symptoms of PDPH is a postural headache, which worsens dramatically while sitting or standing and is relieved mostly by lying down. This symptom is caused by a cerebrospinal fluid (CSF) leak, leading to decreased CSF pressure or low CSF volume, which provokes a shift of intracranial contents and traction on pain-sensitive structures in the upright position. PDPH is commonly a self-limited condition and remits spontaneously within 2 weeks, or becomes less severe after surgical intervention to seal the leak with autologous epidural blood patch (EBP). Although recurrence of spontaneous intracranial hypotension following an EBP is not rare, spontaneously late recurrence of PDPH has been rarely reported. The purpose of this paper is to d iscuss this case with late recurrence of PDPH after 10 months following EBP. PMID:34671953 | DOI:10.14744/agri.2019.44711 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Granulomatous Disease of the Upper Airway

xlomafota13 shared this article with you from Inoreader Chronic Granulomatous Disease of the Upper Airway Via ear nose throat Ear Nose Throat J. 2021 Oct 21:1455613211054635. doi: 10.1177/01455613211054635. Online ahead of print. NO ABSTRACT PMID:34670444 | DOI:10.1177/01455613211054635 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Iatrogenic Cervical Epidermoid Cyst Following Tracheostomy

xlomafota13 shared this article with you from Inoreader Iatrogenic Cervical Epidermoid Cyst Following Tracheostomy Via ear nose throat Ear Nose Throat J. 2021 Oct 20:1455613211053423. doi: 10.1177/01455613211053423. Online ahead of print. ABSTRACT Epidermoid cysts are generally benign lesions surrounded by squamous epithelium with cystic contents. The lining of the cysts produce keratin, which resemble a cheese-like material. They typically occur in the skin and mucous membranes and are congenital in origin; iatrogenic epidermoid cysts are rare. Epidermoid cysts are usually painless and asymptomatic, and the ir diagnosis is based on histological examination. This paper aims to present the case report of a 23-year-old patient with an iatrogenic epidermoid cyst that occurred following tracheostomy. The importance of preoperative radiological imaging in the diagnosis of epidermoid cysts is also highlighted. PMID:34670428 | DOI:10.1177/01455613211053423 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The efficacy of peritonsillar injection of bupivacaine vs intravenous acetaminophen on post-tonsillectomy pain in children'

xlomafota13 shared this article with you from Inoreader The efficacy of peritonsillar injection of bupivacaine vs intravenous acetaminophen on post-tonsillectomy pain in children" 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 Oct 20. doi: 10.1007/s00405-021-07146-0. Online ahead of print. NO ABSTRACT PMID:34671857 | DOI:10.1007/s00405-021-07146-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.