Annals of Otology Rhinology and Laryngology最新文献

Objectives: Determine frequencies of conditions causing unilateral clear thin rhinorrhea (UCTR), and assess whether certain clinical features are associated with CSF rhinorrhea.

Methods: This was a retrospective review identifying all patients presenting with UCTR to one rhinologist over a 6-year period. The conditions causing UCTR were recorded, and the following demographic or clinical variables were collected when available: body-mass index (BMI, kg/m2), gender, age, race, and self-reported drainage volume (whether the UCTR dripped out the nose and could be collected, or it felt like a wet nostril with intermittent running down lip that was unlikely to be collectable).

Results: Of 3,041 patients, 146 were identified with at least UCTR (4.8%). Mean age was 56.2 ± 17.6 years, and 65.8% were female. Amongst UCTR, nonallergic rhinitis (NAR) was the most common cause (45%), followed by CSF rhinorrhea (30%). On multivariate analysis, the following were significantly positively associated with CSF rhinorrhea: BMI≥30 (OR=4.95), ages 45-54 years (OR=3.67) and 55-64 years (OR=4.15), and self-reported UCTR dripping with collectability (OR=5.96)).

Conclusions: NAR was the most common cause of UCTR, representing nearly 50% of cases. However, CSF rhinorrhea still represented 30% of cases, reinforcing that UCTR should be worked up for CSF rhinorrhea, ideally with B2-Tf testing. BMI ≥30, ages 45-64 years, and patient-reported higher volume UCTR were positively associated with CSF rhinorrhea. If B2-Tf testing is negative or unobtainable, or clinical suspicion for CSF leak is low, clinicians can consider starting medical therapy for rhinitis or rhinosinusitis before pursuing further invasive CSF confirmatory testing.

Introduction: Mandibular advancement devices (MADs) are a treatment option for obstructive sleep apnea/hypopnea syndrome (OSAHS); however, the ideal patient selection criteria continue to be refined.

Objectives: To determine the overall efficacy of a custom titratable MAD in treating a subset of OSAHS patients. A secondary objective was to determine predictive factors affecting treatment outcome for MAD therapy.

Methods: Retrospective analysis of a single otolaryngologist's (DCU) experience in 86 patients with Friedman Stages 2 to 4 treated with a MAD (Thornton Adjustable Positioner) at an academic medical center.

Results: Therapeutic success as measured by type 3 home apnea test (HSAT) before and after proper MAD titration was defined as a 50% reduction in initial AHI or reduction of AHI to a mild severity below 15 events/hour. The 50% AHI reduction rate after MAD titration was 64% and the overall success rate inclusive of patients with reduction below 15 events/hour was 72.1%. MAD therapy significantly reduced the mean AHI (-10.4 ± 12.6), P < .001) and improved the minimum oxygen saturation (1.88 ± 5.79, P = .003). Significant reduction of OSAHS severity was seen across all treatment groups regardless of initial OSAHS severity: mild (55.9%), moderate (85%), severe (75%; P < .001 for all 3 groups). High BMI, advanced age, concentric velopharyngeal collapse pattern, prior pharyngeal surgery, and male sex were not statistically significant predictors of ineffectiveness.

Conclusions: MAD therapy for OSAHS in patients with Friedman Stages 2 to 4 is an effective treatment in 72% of cases and should be considered as an initial treatment option within this subset of patients, inclusive of those with initially severe, moderate, and mild OSAHS.

Objectives: To develop, describe, and validate a novel hybrid training model for endoscopic septoplasty that combines pig ears with a 3D-printed model.

Methods: The pig ear was chosen for its similarity to the human septum and wide availability. A frame for the nasal septum substitute was designed to mimic the appearance of a human nose, securely anchor the septum, and create a bend to simulate a deviated septum. The external nose was 3D-printed using polylactic acid (PLA) filament. The model underwent validation with a group of 13 junior and 7 senior trainees who performed endoscopic septoplasties on the simulator and completed a subjective assessment tool; recordings of their procedures were also analyzed and graded in a blind manner.

Results: Overall, residents agreed that the simulator is a good training tool for knowledge of the steps of a septoplasty (mean = 4.67 ± 0.59), as well as for the skills required of the procedure (mean rating = 4.61 ± 0.50). Residents also agreed that the simulator had adequately realistic characteristics and features (mean = 4.13 ± 0.81). Junior residents more strongly agreed than the senior residents that the simulator improved their knowledge of performing a septoplasty (4.50 ± 0.90 vs 3.40 ± 0.55, P < .01). Senior residents performed significantly better in all assessed domains and completed the procedure significantly faster than junior residents.

Conclusion: This study describes the first endoscopic septoplasty simulator to combine a pig ear with a 3D-printed model. The model provides realistic tactile feedback of the human nasal septum while offering a precise, standardized, and reproducible construction at an affordable cost. Our findings support the validity of this simulator that can provide an opportunity for otolaryngology trainees to improve their septoplasty skills in a safe and effective manner.

Objectives: Tracheobronchial foreign body (TFB) extraction in premature neonates poses unique challenges due to their delicate respiratory system, making the TBF extraction a critical and high-stakes intervention. TFBs in this patient population are mostly iatrogenic. There are only a few reports in the literature describing the management of TFBs in premature neonates. To the best of our knowledge, this represents the first report using a flexible choledochoscope for TFB extraction.

Methods: A retrospective chart review was conducted on a case of a preterm infant who underwent successful extraction of a tracheobronchial foreign body.

Results: A premature neonate born at 25 weeks 2/7 days gestation with a birth weight of 780 g was intubated after delivery. Following extubation to non-invasive ventilation, a control chest radiograph revealed atelectasis of the right lower lobe and a TFB of tubular structure measuring 20 mm × 1.5 mm in the right main bronchus. Diagnostic flexible bronchoscopy was performed and extraction with graspers via rigid bronchoscope was attempted but failed. Subsequently, a bedside procedure in the Neonatal intensive care unit (NICU) was performed using a 7.5 Fr flexible choledochoscope through the endotracheal tube (ETT). TFB was successfully extracted with graspers and upon extraction, it was confirmed to be the distal 2 cm segment of the closed-circuit endotracheal suction system. The infant made full recovery.

Conclusion: We report a method that provides a safe means of TFB extraction with a successful outcome. The insights gathered from this review are intended to contribute valuable knowledge that can enhance the management of TFBs in preterm infants.

Purpose: There is emerging evidence showing even a single episode of transient acute kidney injury (AKI) in children can have negative long-term health consequences. AKI may be under-recognized in children undergoing tonsillectomy because of unique risk factors, such as recommended use of NSAIDs and restricted oral intake pre- and postoperatively.

Methods: A consecutive case series with chart review was performed for patients under age 18 years at a single tertiary care institution who underwent tonsillectomy between July 1, 2013 and May 17, 2024, identified by CPT codes for tonsillectomy. ED visits within 30 days of surgery were documented. Serum creatinine values at ED visit were recorded, if available, and incidence of elevated serum creatinine and AKI were determined.

Results: Charts of 3018 pediatric tonsillectomy patients were reviewed. About 295 (9.8% of 3018) had an ED visit within 30 days for any reason, of whom 110 (37.3% of 295) had a serum creatinine value at this ED visit. Of these, 13 (11.8% of 110) had elevated serum creatinine, and 8 (7.3% of 110) had AKI by standardized criteria. One patient had a follow-up serum creatinine performed within 1 year which showed resolution of AKI.

Conclusion: Incidence of AKI following tonsillectomy has not been previously well recognized. Identification of previously unrecognized risks from post-tonsillectomy AKI represents an important potential area for quality improvement, including careful patient selection for use of non-steroidal anti-inflammatory drugs, close monitoring of those at higher risk for dehydration after surgery, and follow-up care for those diagnosed with AKI.

Objectives: The primary aim of this study is to determine the effects of associating local and systemic corticosteroids on electrical impedance of electrode contacts during the 6 months following cochlear implantation in children. We assessed the effect of this association along the electrode array to evaluate its impact on both basal and apical electrodes.

Methods: In 2 different patient groups, the evolution of electrical impedances was investigated during 6 months post-implantation. Children in Group 1 received systemic corticosteroids (1 ml injection of 4 mg/ml Dexamethasone (DXM) intravenously 12 hours before the procedure followed by an injection of 1 ml of 4 mg/ml de DXM during the induction of anesthesia). Group 2 received the same systemic corticosteroids with local corticosteroid (intratympanic injection [ITI] of Methylprednisolone (MP) 40 mg/1 ml given at the start of the procedure). Impedances were assessed perioperatively, on the third post-operative day, at 1 week, 1 month, 2 months, 3 months, and 6 months after implantation. We compared the mean impedance values and the average impedance at the apical and basal electrodes between both groups.

Results: Impedances in Group 1 were significantly higher than those in Group 2, both perioperatively (P = .037) and on the third post-operative day (P = .027). Starting from the first week and throughout the 6 months post-implantation, the difference between both groups was not significant. When comparing impedances at the apical and basal electrodes between both groups, the mean impedance at the basal electrodes was significantly higher in Group 1 compared to Group 2 at 1 month (P = .042).

Conclusion: The association of intratympanic and intravenous corticosteroids results in significantly reduced impedances during the early postoperative period. The basal electrodes have a more pronounced effect from this association. Based on these findings, this protocol is effective in lowering impedances in the short term but not in the medium term following cochlear implantation.

Objectives: The goal of this scoping review is to investigate the efficacy of sucralfate on postoperative pain following oropharyngeal surgery in the pediatric population using pain scales, analgesic use, diet toleration, and bleeding. Furthermore, we wanted to highlight the clinical importance of the limitations in the current literature.

Review methods: The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. Results of included studies and a narrative summary of our findings are presented through descriptive statistics (frequency [%] for categorical variables and mean [range] for continuous variables with 95% confidence intervals [CI]).

Results: Of the 195 abstracts identified, 3 studies (N = 241) pertaining to sucralfate and post-operative pain in the pediatric population were included. Sucralfate group had a mean age of 6.13 (range = 3-12) versus 6.82 (range = 3-12) for control group. Sucralfate group had statistically significant reduction in pain scores than control group. Analgesic use was consistently lower in the sucralfate group compared to the control group. Two studies also showed a difference in diet tolerance between the 2 groups.

Conclusions: Tonsillectomy is one of the most frequently performed procedures on children and the procedure results in an extended and painful recovery. The literature shows promising results of sucralfate in the reduction of post-tonsillectomy pain in the pediatric population; however, the literature is limited, and further investigation is warranted.

Level of evidence: 2.

Objective: Characterize radiographic findings and co-existing pathologic processes in the parotid glands of patients with swelling or pain identified on radiographic review to be consistent with sialosis (sialadenosis) employing dynamic infusion digital sialography correlated with computed tomography (CT).

Methods: Retrospective chart review of a consecutive series of 578 sialograms performed by the senior investigator over a 16-year period identified 39 patients with 1 or both parotid gland sialograms recorded as "sialosis" by radiologists' interpretation. After inclusion and exclusion criteria were applied, 20 patients remained for evaluation. A review of sialograms was conducted by a senior radiologist to identify co-existing pathologies (ex: stricture, sialectasis, sialolith) as well as characterize an overall aggregate impression and specific findings of ductal curvature, splaying, and truncation on a numerical scale from 1 (absent finding) to 10 (severely abnormal). Two normal sialograms served as controls. The density of each gland was assessed through CT measurement of Hounsfield units (HU). Variables collected included sex, age, symptoms, BMI, alcohol use, and comorbidities.

Results: Twenty patients with a total of 27 glands classified as "sialosis" on sialography and 2 patients with normal sialography findings were evaluated. Indications for sialography included pain (90%), fluctuation in swelling of the parotid gland(s) (65%), or xerostomia (35%). Sialographic analysis identified 7 glands (26%) with sialosis to have an additional co-existing pathology (2 with strictures, 5 with sialectasis). Consistent features in glands with sialosis included ductal curvature, splaying, and truncation. CT analysis of glands with sialosis identified a median HU measurement of -36 compared to +30 for glands identified as normal (P = .03).

Conclusion: Sialography is useful in selected patients to evaluate for co-existing pathologies contributing to salivary symptoms. Sialography additionally demonstrates consistent findings (ductal curvature, splaying, and truncation) associated with sialosis that correlate with fat infiltration identified on CT imaging.