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Functional Language in Children from a Public Cochlear Implant Program in a Developing Country. 发展中国家公共人工耳蜗植入项目儿童的功能性语言。
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-05-25 eCollection Date: 2024-07-01 DOI: 10.1055/s-0044-1785205
Alice Lang Silva, Anderson Claudio Roberto, Maithe Antonello Ramos, Debora Milene Ferreira Alves, Isadora Martins Silva Stumpf, Laura Prolla Lacroix, Letícia Petersen Schmidt Rosito

Introduction  The World Health Organization (WHO) estimates that ∼ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective  To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods  We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results  A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion  The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence  Level 3 (cohort study).

导言 据世界卫生组织(WHO)估计,全球有 3200 万儿童受到听力损失(HL)的影响。人工耳蜗是治疗重度到极重度感音神经性听力损失的一线疗法。它被认为是迄今为止开发的最成功的假体之一。目的 评估在巴西南部一家治疗 HL 的参考医院接受人工耳蜗植入治疗的儿童舌前聋患者的口语发展情况。方法 我们对 2009 年 1 月至 2018 年 12 月期间接受人工耳蜗植入手术的患者病历进行了回顾性队列研究。通过回顾人工耳蜗植入组语言治疗专业人员的咨询,对语言发展进行评估。结果 共有152名儿童被纳入研究。人工耳蜗植入手术时的平均年龄为41个月(标准差 [SD]:±15)。根据患者在日常生活中最常用的语言类型将其分为六组。我们发现,36% 的儿童以口语为主要交流方式。在一项子分析中,我们观察到,与使用巴西手语(Língua Brasileira de Sinais,葡萄牙语为 LIBRAS)或没有发达语言的患者相比,口语发达或正在发展的患者接受人工耳蜗植入手术的时间更早。结论 人工耳蜗是一种最先进的技术,能够重建听觉和发展口语。然而,众所周知,语言发展是一个复杂的过程,需要一个关键时期才能正常进行。我们仍然看到许多患者接受诊断和治疗的时间较晚,这意味着他们的口语交流发展会被推迟,而且往往是不可能的。证据等级 3 级(队列研究)。
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引用次数: 0
Risk Factors for Recurrence after Surgical Resection of Sinonasal Inverted Papilloma. 鼻窦倒置乳头状瘤手术切除后复发的风险因素
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-05-25 eCollection Date: 2024-10-01 DOI: 10.1055/s-0044-1785206
Eugénie Delaine, François Gorostidi, Pierre Guilcher, Karma Lambercy, Yann Litzistorf, Luc Bron, Antoine Reinhard

Introduction  Sinonasal inverted papilloma (SNIP) is a rare benign epithelial tumor of the nasal cavity and paranasal sinuses that accounts for 0.4% and 4.7% respectively, of all tumors of this anatomical region. Objective  To analyze the outcomes after surgical resection of SNIP and identify the risk factors for recurrence in a Swiss tertiary center. Methods  We conducted a retrospective review of all cases of SNIP treated at the Lausanne university hospital between 2005 and 2018. All data available on the patients and tumors were collected for analysis. We studied the recurrence rate and looked for risk factors. Results  We included 57 patients with a mean age of 55.5 years. There were 46 primary cases (80.7%) and 11 recurrences (19.3%). Maxillary sinus was the most frequent location (33.3%). Approximately half of the patients (52.6%) presented with a T3 tumor according to the Krouse classification. The mean recurrence rate after surgery was of 17.5% and it was more frequent among the patients in the recurrence group (45.5%) than among the primary cases (10.9%), reaching statistical significance (odds ratio [OR] = 6.8; 95% confidence interval [95%CI]: 1.5-30.8; p  = 0.0165). Most patients were treated endoscopically (94.7%). Frontal sinus location, higher Krouse stage, and combined approach seemed to increase the risk of recurrence, but without statistical significance. Conclusion  Difficult surgical access, as in the case of tumors located in the frontal sinus, higher stage of the disease, and previously operated cases carry the higher risk of incomplete resection and recurrence.

简介:鼻窦倒置乳头状瘤(SNIP)是一种罕见的鼻腔和副鼻窦良性上皮肿瘤,分别占该解剖区域所有肿瘤的 0.4% 和 4.7%。目的 分析瑞士一家三级医疗中心鼻腔和副鼻窦良性上皮肿瘤手术切除后的疗效,并确定复发的风险因素。方法 我们对洛桑大学医院 2005 年至 2018 年间治疗的所有 SNIP 病例进行了回顾性研究。我们收集了患者和肿瘤的所有可用数据进行分析。我们研究了复发率,并寻找风险因素。结果 我们共收治了57名患者,平均年龄为55.5岁。原发病例 46 例(80.7%),复发病例 11 例(19.3%)。上颌窦是最常见的发病部位(33.3%)。根据克鲁斯(Krouse)分类法,约半数患者(52.6%)的肿瘤为T3。手术后的平均复发率为 17.5%,复发组患者(45.5%)的复发率高于原发病例(10.9%),达到统计学意义(比值比 [OR] = 6.8;95% 置信区间 [95%CI]:1.5-30.8;P<0.05):1.5-30.8; p = 0.0165).大多数患者接受了内窥镜治疗(94.7%)。额窦位置、较高的 Krouse 分期和联合方法似乎会增加复发风险,但无统计学意义。结论 手术入路困难(如肿瘤位于额窦)、疾病分期较高和曾接受过手术的病例切除不彻底和复发的风险较高。
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引用次数: 0
Pediatric Myringoplasty using the Periosteum: An Institutional Overview. 使用骨膜进行小儿耳廓成形术:机构概览。
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-05-25 eCollection Date: 2024-07-01 DOI: 10.1055/s-0043-1776001
Al Hussein Awad, Mahmood A Hamed

Introduction  Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective  In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods  A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results  The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB ( p  < 0.001). Conclusion  We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes.

导言:鼓膜成形术是一种常见的耳科手术,用于恢复外伤性或病理性鼓膜穿孔病例的鼓膜完整性。许多移植材料被用于不同的技术中。本研究评估了通过耳后切口在乳突皮质上进行骨膜移植的手术和听力效果。方法 我们开展了一项回顾性研究,研究对象是 2019 年 4 月至 2021 年 4 月期间在我院接受骨膜移植耳廓成形术治疗慢性化脓性中耳炎伴干性中枢性穿孔的所有 16 岁以下儿童。对所有患者进行为期一年的随访,通过比较术前和术后(六个月后)纯音测听(PTA)结果,评估解剖学成功率和功能效果。结果 样本由 36 名患者组成,其中女性 20 名(55.6%),男性 16 名(44.4%),年龄从 7 岁到 16 岁(平均 12.7 岁)不等。四名患者接受了双耳手术(间隔时间为 6 至 9 个月)。在 40 例手术中,有 38 例手术在解剖学上取得了成功(95%)。听力得到了非常明显的改善(PTA 术前和术后结果的平均差异为 14.6 ± 3.45 dB ( p 结论 我们提倡在儿童群体中使用骨膜移植,作为其他类型移植的良好替代品,其功能和解剖效果相当甚至更好。
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引用次数: 0
Mismatch Negativity in Children with Deficits in Auditory Abilities. 听觉能力缺陷儿童的错配负性。
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-05-25 eCollection Date: 2024-10-01 DOI: 10.1055/s-0044-1785458
Julia Dalcin Pinto, Déborah Aurélio Temp, Laís Ferreira, Amália El Hatal de Souza, Michele Vargas Garcia, Adriana Neves de Andrade, Eliara Pinto Vieira Biaggio

Introduction  Mismatch negativity (MMN) represents a negative component of event-related potentials, which is mentioned by guidelines as an important tool to provide measurable data regarding the functionality of the auditory system in acoustic processing. However, the literature still lacks reliable data that can support the clinical use of this potential in the complementary diagnosis of central auditory processing (CAP) disorder (CAPD). Objectives  To analyze whether MMN assessment might be associated with the CAP behavioral test battery, as well as to assess the effects of auditory ability deficits on MMN responses in the pediatric population. Methods  In total, 45 age-matched children participated in the study. They were submitted to the CAP behavior assessment and to MMN. The children were tested with a combination of speech contrast consisting of acoustic syllables [da] versus [ta], governed by the oddball paradigm. Results  Mismatch negativity did not show a direct association with a single test but with the combination of the four tests used as a behavioral test battery to identify CAPD. The results also indicated that the auditory ability deficits influenced the measurement of MMN latency ( p  = 0.003*), but not the amplitude ( p  = 0.857) or the area ( p  = 0.577). Conclusion  Mismatch negativity was shown to be statistically associated with the battery of tests used to identify deficits in auditory abilities in the studied sample rather than with a single behavioral test. The deficits in auditory abilities were observed in the MMN latency. Mismatch negativity can be used to assess children with CAPD.

导言:错配负性(MMN)是事件相关电位的一种负性成分,被指南称为一种重要工具,可提供有关听觉系统在声音处理过程中功能的可测量数据。然而,文献中仍缺乏可靠的数据支持临床使用该电位辅助诊断中枢听觉处理(CAP)障碍(CAPD)。目的 分析 MMN 评估是否可能与 CAP 行为测试相关联,并评估听觉能力缺陷对 MMN 反应的影响。方法 共有 45 名年龄匹配的儿童参与研究。他们接受了 CAP 行为评估和 MMN 测试。在奇球范式下,儿童接受了由声学音节[da]和[ta]组成的语音对比组合测试。结果 错配负性与单项测试没有直接联系,但与作为行为测试组合的四项测试有直接联系,可用于识别 CAPD。结果还表明,听觉能力缺陷会影响 MMN 的测量延迟(p = 0.003*),但不会影响振幅(p = 0.857)或面积(p = 0.577)。结论 研究表明,错配负性在统计学上与用于识别研究样本听觉能力缺陷的一系列测试有关,而不是与单一的行为测试有关。听觉能力的缺陷可从 MMN 潜伏期中观察到。错配负性可用于评估患有儿童听觉障碍的儿童。
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引用次数: 0
Vestibular Disorders Limited to the Vertical Semicircular Canals. 仅限于垂直半规管的前庭失调。
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-05-25 eCollection Date: 2024-10-01 DOI: 10.1055/s-0044-1786047
Pedro Luiz Mangabeira Albernaz, Flavia Salvaterra Cusin, Bernardo Faria Ramos, Renato Cal, Francisco Carlos Zuma E Maia

Introduction  The advent of the video head impulse test (vHIT) enables the study of each one of the six semicircular canals. In the present study, certain patients present disorders related only to the vertical semicircular canals, and they were carefully evaluated. Objective  To investigate vestibular disorders limited to the vertical semicircular canals. Methods  In total, 9,891 patients were submitted to the vHIT in our clinic; 26 (2.63%) of them, 11 men and 15 women, showed reduced vestibulo-ocular reflex (VOR) limited to the vertical canals. All of these patients had vestibular symptoms. Results  These patients presented different disorders of the vestibular system, and ten of them presented vestibular neuritis. Conclusion  Now, vestibular disorders limited the vertical canals can be evaluated through the vHIT. These disorders, however, may relate do different labyrinthine diseases.

引言 视频头脉冲试验(vHIT)的出现使得对六个半规管中每一个半规管的研究成为可能。在本研究中,某些患者仅表现出与垂直半规管有关的障碍,我们对他们进行了仔细评估。目的 研究仅限于垂直半规管的前庭疾病。方法 本诊所共有 9891 名患者接受了 vHIT 检查,其中 26 人(2.63%)(11 名男性和 15 名女性)表现出仅限于垂直半规管的前庭-眼反射(VOR)减弱。所有这些患者都有前庭症状。结果 这些患者的前庭系统出现了不同的疾病,其中 10 人患有前庭神经炎。结论 现在,可以通过 vHIT 对限制垂直管道的前庭疾病进行评估。不过,这些疾病可能与不同的迷宫疾病有关。
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引用次数: 0
Evaluation of Quality of Life After Use the Virtual Reality in Patients with Neurodegenerative Disease. 评估神经退行性疾病患者使用虚拟现实技术后的生活质量。
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-04-30 eCollection Date: 2024-07-01 DOI: 10.1055/s-0044-1785681
Jéssica Spricigo Malisky, Bianca Lopes Cavalcante-Leão, Maria Izabel Severiano, Geslaine Janaina Bueno Dos Santos, Hélio Augusto Guizoni Teive, Maria Renata José, Cristiano Miranda de Araújo, Bianca Simone Zeigelboim

Introduction  Spinocerebellar ataxias (SCAs) are a heterogeneous group of neurodegenerative diseases. Objective  To evaluate the living standard of patients with SCA, by applying the Vestibular Disorders Activities of Daily Living Scale (VADL) and Activitiesspecific Balance Confidence Scale (ABC) questionnaires. Methods  An uncontrolled clinical trial study was conducted with 28 patients who underwent anamnesis, ENT evaluation, and vestibular assessment and the application of questionnaires VADL and ABC before and after rehabilitation with virtual reality. Results  The vestibular exam was altered in 64.3% of the cases. The result between the correlation of the VADL and ABC questionnaires showed significant results in all cases (p < 0.005). The correlation between the ages and disease length with the VADL and ABC questionnaires was significant in the T3 assessment (p = 0.015). The correlation between the disease length and the VADL questionnaire was significant in all cases (p < 0.005). The comparison of the vestibular rehabilitation result (T1 to T2) showed a significant difference for all the applied games, except for the ski slalom. The comparison of the vestibular rehabilitation result (T1 to T3) showed significant difference for all the applied games (p < 0.005) (1st assessment before the start of rehabilitation designated T1, after 10 rehabilitation sessions, considered T2 and, at the end of 20 rehabilitation sessions, called T3). Conclusion  We can point out a direct improvement in the living standard, reflected by the reduction of falls, better balance, and march, contributing to a higher self-confidence in patients in daily activities.

导言脊髓小脑性共济失调(SCA)是一种异质性神经退行性疾病。目的 通过应用前庭障碍日常生活活动量表(VADL)和特定活动平衡信心量表(ABC)问卷,评估 SCA 患者的生活水平。方法 对 28 名患者进行了一项非对照临床试验研究,这些患者在使用虚拟现实技术进行康复治疗之前和之后,接受了病史、耳鼻喉科评估、前庭评估以及 VADL 和 ABC 问卷调查。结果 64.3% 的病例的前庭检查有变化。在所有病例中,VADL 和 ABC 问卷的相关性结果均显示出显著的效果(p 结论 我们可以指出,跌倒次数的减少、平衡能力的提高和行进能力的增强,直接提高了患者的生活水平,有助于增强他们在日常活动中的自信心。
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引用次数: 0
The Use of Rhinomanometry in Mouth Breathing: A Systematic Review of the Literature. 鼻测量法在口呼吸中的应用:文献系统回顾。
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-03-27 eCollection Date: 2024-10-01 DOI: 10.1055/s-0044-1785199
Merly Fernanda Illera Castellanos, Hilton Justino da Silva, Silvio Ricardo Couto de Moura, Luciana de Barros Correia Fontes, Niedje Siqueira de Lima, Thiago Freire Pinto Bezerra, Daniele Andrade da Cunha

Introduction  Mouth breathing generates imbalances in the musculature, in craniofacial morphofunctionality, and in the stomatognathic system. Therefore, it is essential to make a diagnosis of mouth breathing through the quantitative assessment of nasal permeability, which can be performed through rhinomanometry. Objective  To investigate the effectiveness of rhinomanometry in the diagnosis of mouth breathing in pediatric patients through a systematic review of the literature. Data synthesis  The guiding question was: "Is the use of rhinomanometry as an assessment tool effective in the diagnosis of mouth breathing in pediatric patients?". We conducted a search on the following databases: Latin American and Caribbean Center on Health Sciences Information (BIREME), Latin American and Caribbean Health Sciences Literature (LILACS), PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Web of Science, and Science Direct. The Health Sciences Descriptors (Descritores em Ciências da Saúde, DECS, in Portuguese) and Medical Subjects Headings (MESH) were combined with the Boolean operator AND in the search strategy: rhinomanometry AND mouth breathing AND diagnosis AND nasal pressure AND nasal airflow AND nasal resistance . Observational cohort and cross-sectional studies that addressed the effectiveness of rhinomanometry in the diagnosis of mouth breathing were included. The reviewers independently extracted the information and scored the review quality based on the Physiotherapy Evidence Database (PEDro) scale and the grading of evidence levels according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Of the 1,536 articles identified, only 3 were selected for the present review after the application of the eligibility criteria. Conclusion  There is great concern regarding the assessment of nasal function. There was a lack of standardization of rhinomanometry to test the effectiveness of nasal resistance as an aid in the diagnosis of breathing mode.

引言 口呼吸会导致肌肉组织、颅面部形态功能和口颌系统失衡。因此,必须通过鼻腔通透性的定量评估对口呼吸进行诊断,而鼻腔通透性的定量评估可通过鼻测量法进行。目的 通过对文献进行系统性回顾,研究鼻测量法在诊断儿童患者口呼吸方面的有效性。数据综述"使用鼻测量仪作为评估工具对诊断儿科患者的口呼吸是否有效?我们在以下数据库中进行了搜索:拉丁美洲和加勒比海健康科学信息中心 (BIREME)、拉丁美洲和加勒比海健康科学文献 (LILACS)、PubMed/医学文献分析和检索系统在线 (MEDLINE)、科学电子图书馆在线 (SciELO)、Web of Science 和 Science Direct。在检索策略中,将健康科学描述符(Descritores em Ciências da Saúde,葡萄牙语为 DECS)和医学主题词表(MESH)与布尔运算符 AND 结合在一起:鼻测量和口呼吸和诊断和鼻压力和鼻气流和鼻阻力。纳入了针对鼻测量法在口呼吸诊断中有效性的观察性队列研究和横断面研究。审稿人独立提取信息,并根据物理治疗证据数据库 (PEDro) 量表对综述质量进行评分,同时根据建议评估、发展和评价分级 (GRADE) 系统对证据等级进行分级。在确定的 1,536 篇文章中,只有 3 篇在适用资格标准后被选入本次综述。结论 鼻腔功能评估备受关注。鼻测量法缺乏标准化,无法测试鼻阻力作为呼吸模式诊断辅助工具的有效性。
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引用次数: 0
Assessment of Tracheostomy Tube Placement and Late Change Practices in an Academic Tertiary Care Center. 评估一家学术性三级护理中心的气管造口术置管和晚期更换实践。
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-03-27 eCollection Date: 2024-07-01 DOI: 10.1055/s-0043-1776723
Christophe Abi Zeid Daou, Elsa Maria Chahine, Randa Barazi

Introduction  The optimal time for tracheostomy changes is unknown. Most surgeons opt to wait until five to seven days postoperatively, while more recent studies suggest that changes occurring as early as two to three days postoperatively are also safe. Objective  To evaluate the safety of changing the tracheostomy tube later than 14 days postoperatively. Methods  The charts of patients who underwent tracheostomy placement and change at a tertiary care center from 2015 to 2019 were retrospectively reviewed, and the subjects were divided into 2 cohorts (late and very late), depending on the time of the first tracheostomy change. Results  The study included 198 patients, 53 of whom aged between 0 and 18 years, and 145, aged > 18 years. The time until the first tracheostomy change was on average of 131.1 days. The most common indication for tracheostomy tube placement was prolonged intubation. Adverse events were observed in 30.8% of the cases (the most common being the formation of granulation tissue), a rate that does not differ much from the incidence reported in the literature (of 34% to 77%) when tracheostomy tubes are changed as early as 3 to 7 days postoperatively. There was no significant difference in the incidence of complications between patients undergoing late and very late changes ( p  = 0.688), or between pediatric and adult subjects ( p  = 0.36). There were no significant correlations regarding the time of the first or second change and the incidence of complications (r = -0.014; p  = 0.84 for the first change; and r = -0.57; p  = 0.64 for the second change). Conclusion  The late first tracheostomy tube change was safe and could save resources and decrease the financial burden of frequent changes. It is always crucial to provide adequate information about home tracheostomy care for patients.

导言:气管造口更换的最佳时间尚不清楚。大多数外科医生选择等到术后五到七天,而最近的研究表明,术后两到三天内更换气管造口管也是安全的。目的 评估术后 14 天后更换气管造口管的安全性。方法 回顾性审查 2015 年至 2019 年在一家三级医疗中心接受气管造口置入和更换的患者病历,并根据首次更换气管造口的时间将受试者分为 2 个队列(晚期和极晚期)。结果 研究共纳入 198 名患者,其中 53 人年龄在 0 至 18 岁之间,145 人年龄大于 18 岁。首次更换气管造口的时间平均为 131.1 天。放置气管造口管最常见的适应症是长时间插管。30.8%的病例出现了不良反应(最常见的是肉芽组织的形成),这一比例与文献中报道的术后3至7天就更换气管造口管的发生率(34%至77%)相差不大。晚换和极晚换气管造口管的患者并发症发生率无明显差异(P = 0.688),儿科和成人受试者的并发症发生率也无明显差异(P = 0.36)。第一次或第二次更换气管造口的时间与并发症的发生率无明显相关性(第一次更换气管造口的相关性为 r = -0.014;p = 0.84;第二次更换气管造口的相关性为 r = -0.57;p = 0.64)。结论 延迟首次气管造口管更换是安全的,可节省资源并减轻频繁更换的经济负担。为患者提供充分的家庭气管造口护理信息始终是至关重要的。
{"title":"Assessment of Tracheostomy Tube Placement and Late Change Practices in an Academic Tertiary Care Center.","authors":"Christophe Abi Zeid Daou, Elsa Maria Chahine, Randa Barazi","doi":"10.1055/s-0043-1776723","DOIUrl":"10.1055/s-0043-1776723","url":null,"abstract":"<p><p><b>Introduction</b>  The optimal time for tracheostomy changes is unknown. Most surgeons opt to wait until five to seven days postoperatively, while more recent studies suggest that changes occurring as early as two to three days postoperatively are also safe. <b>Objective</b>  To evaluate the safety of changing the tracheostomy tube later than 14 days postoperatively. <b>Methods</b>  The charts of patients who underwent tracheostomy placement and change at a tertiary care center from 2015 to 2019 were retrospectively reviewed, and the subjects were divided into 2 cohorts (late and very late), depending on the time of the first tracheostomy change. <b>Results</b>  The study included 198 patients, 53 of whom aged between 0 and 18 years, and 145, aged > 18 years. The time until the first tracheostomy change was on average of 131.1 days. The most common indication for tracheostomy tube placement was prolonged intubation. Adverse events were observed in 30.8% of the cases (the most common being the formation of granulation tissue), a rate that does not differ much from the incidence reported in the literature (of 34% to 77%) when tracheostomy tubes are changed as early as 3 to 7 days postoperatively. There was no significant difference in the incidence of complications between patients undergoing late and very late changes ( <i>p</i>  = 0.688), or between pediatric and adult subjects ( <i>p</i>  = 0.36). There were no significant correlations regarding the time of the first or second change and the incidence of complications (r = -0.014; <i>p</i>  = 0.84 for the first change; and r = -0.57; <i>p</i>  = 0.64 for the second change). <b>Conclusion</b>  The late first tracheostomy tube change was safe and could save resources and decrease the financial burden of frequent changes. It is always crucial to provide adequate information about home tracheostomy care for patients.</p>","PeriodicalId":13731,"journal":{"name":"International Archives of Otorhinolaryngology","volume":"28 3","pages":"e407-e414"},"PeriodicalIF":1.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cephalometric Evaluation in Patients with Obstructive Sleep Apnea undergoing Lateral Pharyngoplasty. 对接受侧咽喉成形术的阻塞性睡眠呼吸暂停患者进行头颅测量评估。
IF 1.1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-03-06 eCollection Date: 2024-04-01 DOI: 10.1055/s-0043-1776718
Stephanie Regiane Prata Ferreira Zanco, Bruno Bernardo Duarte, Aurélio Rochael Almeida, José Alexandre Mendonça

Introduction  Lateral pharyngoplasty (LP) has shown promising results. Craniofacial deformity reduces the pharyngeal space, contributing to the etiopathogenesis. The analysis of craniofacial features can be performed using cephalometry. Objective  To verify if craniofacial deformity is associated with worse polysomnographic data in patients with obstructive sleep apnea (OSA), and to verify if the preoperative cephalometric parameters can interfere with the surgical success of the LP. Methods  The study included 21 patients with OSA aged between 18 and 65 years who underwent LP in a university hospital from 2015 to 2019. Polysomnography was performed postoperatively, after a minimum period of 6 months from the surgical procedure. In addition, a cephalometric evaluation was performed to assess craniofacial deformity, and to correlate it with the polysomnographic results. Results  The mean and median of all polysomnographic respiratory parameters improved postoperatively, especially the apnea-hypopnea index (AHI), which went from 40.15 to 16.60 events per hour ( p  = 0.001). Of the 21 patients, 15 showed improvements in the AHI postoperatively. As for the cephalometric evaluations, we found that the longer the distance between the hyoid bone and the mandibular plane, the greater the patient's preoperative AHI ( p  = 0.011). When assessing whether cephalometric changes related to craniofacial deformities influence the surgical outcome of LP, no correlation was found for any cephalometric measurement. Conclusion  The longer the distance between the hyoid bone and the mandibular plane, the greater the preoperative AHI, and LP was an effective OSA treatment. Cephalometric variables are not able to modify or determine the success of LP in apneic patients in the population assessed.

导言:侧咽成形术(LP)已经取得了良好的效果。颅面畸形缩小了咽部空间,是导致咽喉炎的病因之一。头颅测量法可对颅面特征进行分析。目的 验证颅面畸形是否与阻塞性睡眠呼吸暂停(OSA)患者较差的多导睡眠图数据有关,并验证术前头颅测量参数是否会干扰 LP 手术的成功。方法 该研究纳入了 21 名 OSA 患者,他们的年龄在 18 岁至 65 岁之间,于 2015 年至 2019 年期间在一家大学医院接受了 LP 手术。术后至少 6 个月后进行多导睡眠图检查。此外,还进行了头颅测量评估,以评估颅面畸形,并将其与多导睡眠图结果相关联。结果 所有多导睡眠图呼吸参数的平均值和中位数在术后均有所改善,尤其是呼吸暂停-低通气指数(AHI),从每小时 40.15 次下降到 16.60 次(P = 0.001)。在 21 名患者中,有 15 名患者的 AHI 在术后有所改善。在头颅测量评估方面,我们发现舌骨与下颌骨平面之间的距离越长,患者术前的 AHI 就越大(p = 0.011)。在评估与颅面畸形相关的头测量变化是否会影响 LP 的手术效果时,没有发现任何头测量值与之相关。结论 舌骨与下颌骨平面之间的距离越长,术前 AHI 越大,LP 是一种有效的 OSA 治疗方法。在所评估的人群中,头颅测量变量无法改变或决定对呼吸暂停患者进行 LP 治疗的成功与否。
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引用次数: 0
Endoscopic Evaluation after Conventional Adenoid Curettage. 传统腺样体切除术后的内窥镜评估
IF 1 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-02-16 eCollection Date: 2024-07-01 DOI: 10.1055/s-0044-1779434
Ahmed Abdelfattah Bayomy Nofal, Mohamed Abdelmohsen Alnemr, Ahmed Hassan Sweed, Alsayed Abdulmageed

Introduction  Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective  To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods  The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results  Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion  Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome.

导言:腺样体切除术是耳鼻喉科医生最常见的手术之一。传统的腺样体刮除术是盲目进行的,可能导致腺样体切除不充分和周围结构损伤。目的 通过经鼻内窥镜检查评估传统腺样体刮除术后的鼻咽部情况。方法 本前瞻性研究包括 100 名儿童,平均年龄为 4.2 ± 3.07 岁。研究包括两个步骤:由一名住院受训者进行常规刮治腺样体切除术;通过0°望远镜对鼻咽部进行内窥镜评估,以评估腺样体残留、手术区域或邻近结构的损伤以及出血点。结果 42% 的病例在常规腺样体刮除术后多个部位观察到腺样体残留,如鼻咽顶部咽喉部(24%)、输卵管扁桃体(12%)、咽后壁(4%)和鼻中隔后端(2%)。46%的病例观察到手术区域和邻近结构受到损伤(咽后壁:23%;咽侧壁:11%; Passavant脊:5%):咽后壁:23%;咽侧壁:11%;咽嵴:10%;咽鼓管口:2%):2%).29%的病例观察到内镜下出血,其中13%来自腺样体残留物,10%来自粘膜,6%来自咽部肌肉。19%的病例为轻度出血,9%为中度出血,1%为严重出血。结论 传统腺样体刮除术后的鼻咽部内窥镜评估提供了有关腺样体残留、手术区域或附近结构损伤以及出血点的重要数据,有助于提供最佳护理和取得更好的疗效。
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引用次数: 0
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International Archives of Otorhinolaryngology
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