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COVID-19 Related Tracheal Stenosis Requiring Tracheal Resection: A Case Series. 需要气管切除的 COVID-19 相关气管狭窄:病例系列。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-10 DOI: 10.1177/00034894241266489
Andrew Yousef, Isaac Solomon, George Cheng, Samir Makani, Joshua Boys, Philip A Weissbrod

Objective: To characterize the preoperative and intraoperative findings of symptomatic tracheal stenosis associated with COVID-19 related respiratory failure requiring tracheal resection.

Method: We performed a retrospective review identifying all patients with a history of tracheal stenosis secondary to COVID-19 related respiratory failure who subsequently received a tracheal resection at our institution between January 2020 and June 2023. Clinical, radiological, pathological, and surgical characteristics were recorded to describe and characterize pre-operative and intraoperative findings associated with tracheal stenosis in the setting of a previous COVID-19 infection.

Results: We retrospectively reviewed 11 patients with COVID-19 related tracheal stenosis that required open tracheal or cricotracheal resection. The mean age was 54.1. Patients were hospitalized for a mean of 49.5 days related to COVID-19 complications. Tracheotomy was completed in 10 patients (90.9%) during their initial hospitalization with COVID-19 related respiratory failure. Patients were intubated a mean of 18.6 days prior to tracheotomy completion. Ten patients (90.9%) underwent endoscopic operative interventions for their tracheal stenosis prior to open resection. Intraoperatively, the mean stenosis length was 3.33 cm. The mean tracheal resection length was 3.96 cm. Patients were hospitalized for a mean of 8.27 days post operatively with no significant post operative complications.

Conclusions: Symptomatic tracheal stenosis in the setting of prolonged intubation due to COVID-19 is an under-described etiology. This is one of the largest single institution retrospective reviews that identifies 11 patients with prolonged intubation who developed symptomatic tracheal stenosis refractory to conservative management and ultimately requiring tracheal resection.

目的描述与COVID-19相关的呼吸衰竭引起的无症状气管狭窄并需要进行气管切除术的术前和术中发现:我们进行了一项回顾性研究,确定了所有在2020年1月至2023年6月期间因COVID-19相关呼吸衰竭而继发气管狭窄并在我院接受气管切除术的患者。我们记录了这些患者的临床、放射学、病理学和手术特征,以描述和描述在既往感染 COVID-19 的情况下与气管狭窄相关的术前和术中发现:我们回顾性研究了11例与COVID-19相关的气管狭窄患者,这些患者需要进行开放性气管或环形气管切除术。患者平均年龄为 54.1 岁。患者因 COVID-19 并发症平均住院 49.5 天。10名患者(90.9%)在因COVID-19引起的呼吸衰竭首次住院期间完成了气管切开术。患者在完成气管切开术前平均插管 18.6 天。10名患者(90.9%)在气管切开术前接受了内窥镜手术治疗。术中平均狭窄长度为 3.33 厘米。气管切除的平均长度为 3.96 厘米。患者术后平均住院8.27天,术后无明显并发症:结论:COVID-19导致的长时间插管引起的症状性气管狭窄是一种未充分描述的病因。这是规模最大的单机构回顾性研究之一,共发现 11 例因长期插管导致症状性气管狭窄的患者,保守治疗无效,最终需要进行气管切除术。
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引用次数: 0
Clarifying the Diagnosis and Management of Acute Uncomplicated Pediatric Mastoiditis. 明确急性非并发症小儿乳突炎的诊断和处理。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI: 10.1177/00034894241261272
Antoinette R Esce, Samantha A Trujillo, Karen A Hawley

Introduction: Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis.

Methods: All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted.

Results: Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management.

Conclusion: Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis.

导言:急性小儿乳突炎是乳突骨的细菌感染,最常与急性中耳炎相关。复杂性乳突炎的传统特征是颅内并发症或骨膜下脓肿,但文献中的定义并不一致。手术干预被认为是复杂性乳突炎的主要治疗方法,但也有一些证据支持对无并发症的乳突炎进行药物治疗。本研究旨在明确无并发症急性乳突炎的诊断标准和治疗方法:方法:研究人员从一家医疗机构找到了 16 年间所有急性小儿乳突炎病例,并审查了人口统计学和临床数据。比较了两种不同的无并发症乳突炎定义:一种是排除颅内并发症或骨膜下脓肿(SPA)患者的传统定义,另一种是排除任何骨侵蚀证据(包括凝聚)患者的建议定义,而不仅仅是 SPA。我们进行了单变量和多变量分析:结果:共发现 80 例病例。根据无并发症乳突炎的传统定义,46.3%的病例为无并发症,而根据建议的定义,这一比例为36.2%。根据建议的定义分类的真正无并发症患者得到的治疗更为一致:没有患者接受乳突切除术,他们接受长期抗生素治疗的可能性也更小。在多变量回归分析中,只有根据建议的无并发症乳突炎定义进行分类才与较少的长期抗生素治疗和非手术治疗有独立关联:结论:非复杂性急性乳突炎的定义应采用临床标准,并排除任何有骨侵蚀证据的病例,包括骨凝聚或骨膜下脓肿。这些真正不复杂的患者通常不需要乳突切除术,只需服用较短疗程的抗生素即可。有必要进一步研究治疗路径,以优化无并发症急性小儿乳突炎的治疗。
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引用次数: 0
Mucocutaneous Leishmaniasis Rhinology Complications: A Rare Presentation. 皮肤利什曼病鼻科并发症:罕见的表现。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1177/00034894241258859
Sujay Ratna, Shaun Edalati, Mohamed Darwish, Mingyang Gray, Alfred Marc Iloreta

Objective: This case report presents a unique manifestation of Mucocutaneous Leishmaniasis (MCL) in a 56-year-old woman with chronic nasal symptoms. Initially diagnosed with chronic sinusitis and septal perforation, the patient's history of a childhood sandfly bite and subsequent episodes of Leishmaniasis, revealed after nasal surgery, provided crucial information for accurate diagnosis.

Methods: A retrospective review was conducted on this patient's electronic medical record.

Results: The patient's life-long struggle with nasal obstruction, congestion, and a septal perforation initially masked the underlying MCL. Sinus surgery and persistent symptoms further complicated the diagnostic process. Only after postoperative complications, including grainy skin texture extending into the nasal passages, did the patient recall the sandfly bite, prompting reevaluation and diagnosis of MCL. The case highlights the challenges of diagnosing MCL due to its varied presentation and potential mimicry of other chronic nasal conditions. It emphasizes the importance of thorough patient history-taking, especially when symptoms are atypical or persistent. Additionally, the report underscores the potential for unexpected postoperative complications in MCL patients and the need for vigilance in recognizing and assessing them.

Conclusion: This case contributes to the understanding of MCL's diverse clinical presentation and the importance of early diagnosis and multidisciplinary management for prompt intervention and improved outcomes.

目的:本病例报告介绍了一名 56 岁女性因慢性鼻部症状而患粘膜皮肤利什曼病(MCL)的独特表现。患者最初被诊断为慢性鼻窦炎和鼻中隔穿孔,但其童年被沙蝇叮咬的病史以及随后的利什曼病发作(鼻腔手术后发现)为准确诊断提供了关键信息:方法:对该患者的电子病历进行了回顾性审查:患者终生与鼻塞、鼻塞和鼻中隔穿孔作斗争,最初掩盖了潜在的 MCL。鼻窦手术和持续的症状使诊断过程更加复杂。直到术后出现并发症,包括皮肤纹理延伸至鼻腔,患者才回忆起被沙蝇叮咬的经历,从而重新评估并确诊为 MCL。该病例强调了 MCL 诊断的挑战性,因为其表现形式多种多样,并可能与其他慢性鼻部疾病相似。它强调了全面采集患者病史的重要性,尤其是当症状不典型或持续存在时。此外,报告还强调了 MCL 患者术后出现意外并发症的可能性,以及在识别和评估这些并发症时保持警惕的必要性:本病例有助于人们了解 MCL 的多种临床表现,以及早期诊断和多学科管理对及时干预和改善预后的重要性。
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引用次数: 0
A Training Course for Simulating Head and Neck Ultrasound-Guided Procedures Using a Gelatin Phantom Model. 使用明胶模型模拟头颈部超声引导手术的培训课程。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-20 DOI: 10.1177/00034894241262113
Ping-Chia Cheng, Wu-Chia Lo, Chih-Ming Chang, Ming-Hsun Wen, Li-Jen Liao

Objectives: Ultrasound (US)-guided procedures can be used in the evaluation and treatment of neck masses. However, these procedures need to be practiced before being executed on humans. The aim of this study is to evaluate the efficacy of a training program using a gelatin phantom to practice US-guided procedures.

Methods: This program included a lecture and practice with a gelatin phantom. We recruited doctors from different hospitals to practice US-guided procedures, including fine-needle aspiration (FNA), core needle biopsy (CNB), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA). We used a questionnaire with a 5-point scale to evaluate the effectiveness of practicing US-guided procedures under a gelatin phantom.

Results: Forty-four doctors participated, and 37 of them completed the questionnaires. After training, the mean (SD) scores of the doctors were 4.68 (0.47) for "Satisfaction with this course," 4.54 (0.61) for "Ease in practicing FNA&CNB using the phantom," 4.49 (0.61) for "Ease in practicing PEI using the phantom," 4.49 (0.65) for "Ease in practicing RFA using the phantom," and 4.57 (0.55) for "The course effectively familiarizing participants with US-guided procedures." Participants without experience in US examination had higher scores than those with previous US experience, but the difference was not statistically significant.

Conclusion: A combination of lectures and hands-on practice of US-guided procedures using a gelatin phantom is an effective educational method for doctors interested in head and neck US. After the training program, doctors gained a better understanding of the necessary steps and skills required for these procedures. They can correctly insert the instruments into the target lesion and perform different US-guided procedures.

目的:超声(US)引导程序可用于评估和治疗颈部肿块。然而,在人体上执行这些程序之前需要进行练习。本研究旨在评估使用明胶模型练习 US 引导手术的培训计划的效果:该项目包括讲座和使用明胶模型进行练习。我们招募了来自不同医院的医生来练习 US 引导手术,包括细针穿刺术 (FNA)、核心针活检术 (CNB)、经皮乙醇注射术 (PEI) 和射频消融术 (RFA)。我们采用了一份 5 分制的调查问卷来评估在明胶模型下进行 US 引导手术的效果:结果:44 名医生参加了培训,其中 37 人完成了问卷调查。培训结束后,医生们对 "本课程满意度 "的平均分(SD)为 4.68(0.47),对 "使用模型进行 FNA&CNB 操作的轻松程度 "的平均分(SD)为 4.54(0.61),对 "使用模型进行 FNA&CNB 操作的轻松程度 "的平均分(SD)为 4.49(0.61),"使用模型练习 PEI 的难易程度 "为 4.49(0.65),"使用模型练习 RFA 的难易程度 "为 4.49(0.65),"课程有效地使学员熟悉了 US 引导程序 "为 4.57(0.55)。没有 US 检查经验的学员得分高于有 US 经验的学员,但差异无统计学意义:结论:对于对头颈部 US 有兴趣的医生来说,使用明胶模型进行 US 引导手术的讲座和实践操作相结合是一种有效的教育方法。培训计划结束后,医生们对这些手术所需的必要步骤和技能有了更好的了解。他们可以正确地将器械插入目标病灶,并进行不同的 US 引导手术。
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引用次数: 0
Evaluating the Accuracy of ChatGPT in Common Patient Questions Regarding HPV+ Oropharyngeal Carcinoma. 评估 ChatGPT 在常见患者关于 HPV+ 口咽癌问题中的准确性。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-29 DOI: 10.1177/00034894241259137
Nikhil Bellamkonda, Janice L Farlow, Catherine T Haring, Michael W Sim, Nolan B Seim, Richard B Cannon, Marcus M Monroe, Amit Agrawal, James W Rocco, Hilary C McCrary

Objectives: Large language model (LLM)-based chatbots such as ChatGPT have been publicly available and increasingly utilized by the general public since late 2022. This study sought to investigate ChatGPT responses to common patient questions regarding Human Papilloma Virus (HPV) positive oropharyngeal cancer (OPC).

Methods: This was a prospective, multi-institutional study, with data collected from high volume institutions that perform >50 transoral robotic surgery cases per year. The 100 most recent discussion threads including the term "HPV" on the American Cancer Society's Cancer Survivors Network's Head and Neck Cancer public discussion board were reviewed. The 11 most common questions were serially queried to ChatGPT 3.5; answers were recorded. A survey was distributed to fellowship trained head and neck oncologic surgeons at 3 institutions to evaluate the responses.

Results: A total of 8 surgeons participated in the study. For questions regarding HPV contraction and transmission, ChatGPT answers were scored as clinically accurate and aligned with consensus in the head and neck surgical oncology community 84.4% and 90.6% of the time, respectively. For questions involving treatment of HPV+ OPC, ChatGPT was clinically accurate and aligned with consensus 87.5% and 91.7% of the time, respectively. For questions regarding the HPV vaccine, ChatGPT was clinically accurate and aligned with consensus 62.5% and 75% of the time, respectively. When asked about circulating tumor DNA testing, only 12.5% of surgeons thought responses were accurate or consistent with consensus.

Conclusion: ChatGPT 3.5 performed poorly with questions involving evolving therapies and diagnostics-thus, caution should be used when using a platform like ChatGPT 3.5 to assess use of advanced technology. Patients should be counseled on the importance of consulting their surgeons to receive accurate and up to date recommendations, and use LLM's to augment their understanding of these important health-related topics.

目的:基于大语言模型(LLM)的聊天机器人,如 ChatGPT,自 2022 年末以来已经公开可用,并越来越多地被公众使用。本研究旨在调查 ChatGPT 对患者关于人乳头状瘤病毒(HPV)阳性口咽癌(OPC)常见问题的回答:这是一项前瞻性、多机构研究,数据收集自每年经口机器人手术例数大于 50 例的大医院。研究人员查阅了美国癌症协会癌症幸存者网络头颈癌公共讨论板上包含 "HPV "一词的100条最新讨论主题。在 ChatGPT 3.5 中连续查询了 11 个最常见的问题,并记录了答案。向 3 家机构受过研究培训的头颈部肿瘤外科医生发放了调查问卷,以评估回复情况:共有 8 名外科医生参与了这项研究。对于有关 HPV 感染和传播的问题,ChatGPT 的答案被评为临床准确,并分别有 84.4% 和 90.6% 的时间与头颈部肿瘤外科界的共识一致。对于涉及 HPV+ OPC 治疗的问题,ChatGPT 的临床准确性和符合共识的比例分别为 87.5% 和 91.7%。对于有关 HPV 疫苗的问题,ChatGPT 的临床准确性和与共识一致的比例分别为 62.5% 和 75%。当被问及循环肿瘤 DNA 检测时,只有 12.5% 的外科医生认为回答准确或符合共识:ChatGPT 3.5 在涉及不断发展的疗法和诊断的问题上表现不佳,因此在使用 ChatGPT 3.5 这样的平台评估先进技术的使用情况时应谨慎。应建议患者咨询他们的外科医生,以获得准确和最新的建议,并使用 LLM 增强他们对这些重要健康相关主题的了解。
{"title":"Evaluating the Accuracy of ChatGPT in Common Patient Questions Regarding HPV+ Oropharyngeal Carcinoma.","authors":"Nikhil Bellamkonda, Janice L Farlow, Catherine T Haring, Michael W Sim, Nolan B Seim, Richard B Cannon, Marcus M Monroe, Amit Agrawal, James W Rocco, Hilary C McCrary","doi":"10.1177/00034894241259137","DOIUrl":"10.1177/00034894241259137","url":null,"abstract":"<p><strong>Objectives: </strong>Large language model (LLM)-based chatbots such as ChatGPT have been publicly available and increasingly utilized by the general public since late 2022. This study sought to investigate ChatGPT responses to common patient questions regarding Human Papilloma Virus (HPV) positive oropharyngeal cancer (OPC).</p><p><strong>Methods: </strong>This was a prospective, multi-institutional study, with data collected from high volume institutions that perform >50 transoral robotic surgery cases per year. The 100 most recent discussion threads including the term \"HPV\" on the American Cancer Society's Cancer Survivors Network's Head and Neck Cancer public discussion board were reviewed. The 11 most common questions were serially queried to ChatGPT 3.5; answers were recorded. A survey was distributed to fellowship trained head and neck oncologic surgeons at 3 institutions to evaluate the responses.</p><p><strong>Results: </strong>A total of 8 surgeons participated in the study. For questions regarding HPV contraction and transmission, ChatGPT answers were scored as clinically accurate and aligned with consensus in the head and neck surgical oncology community 84.4% and 90.6% of the time, respectively. For questions involving treatment of HPV+ OPC, ChatGPT was clinically accurate and aligned with consensus 87.5% and 91.7% of the time, respectively. For questions regarding the HPV vaccine, ChatGPT was clinically accurate and aligned with consensus 62.5% and 75% of the time, respectively. When asked about circulating tumor DNA testing, only 12.5% of surgeons thought responses were accurate or consistent with consensus.</p><p><strong>Conclusion: </strong>ChatGPT 3.5 performed poorly with questions involving evolving therapies and diagnostics-thus, caution should be used when using a platform like ChatGPT 3.5 to assess use of advanced technology. Patients should be counseled on the importance of consulting their surgeons to receive accurate and up to date recommendations, and use LLM's to augment their understanding of these important health-related topics.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"814-819"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative Analysis of Nebulized Versus Intravenous Fentanyl for Pain Control After Tonsillectomy: A Double-Blind, Randomized, Controlled Trial. 用于扁桃体切除术后止痛的雾化芬太尼与静脉注射芬太尼的比较分析:双盲随机对照试验。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI: 10.1177/00034894241259376
Chanitda Pantabtim, Saowapark Chumpathong, Phongthara Vichitvejpaisal, Wilawan Limsettho, Peerachatra Mangmeesri

Objectives: Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients.

Methods and methods: In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria.

Results: From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group (P = .009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups.

Conclusion: Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients.

目的:有效的扁桃体切除术后镇痛对患者的舒适和康复至关重要。芬太尼以其药效强、作用迅速和亲油性而著称,已通过多种给药途径成功用于各种手术。然而,将其雾化形式用于扁桃体切除术后疼痛的研究尚未广泛开展。本研究旨在比较雾化芬太尼和静脉注射芬太尼对扁桃体切除术后患者的镇痛效果、起效时间和并发症:在这项随机对照试验中,接受扁桃体切除术的成年患者被分配到静脉注射芬太尼组(1 mcg/kg)或雾化芬太尼组(4 mcg/kg)。在这两组中,当疼痛评分超过 3 分时就会使用芬太尼。每 5 分钟监测一次疼痛程度,直到疼痛程度降至 4 分以下。研究还记录了下次镇痛请求前的持续时间,并记录了 24 小时内的并发症(如呼吸抑制、心动过缓、胸闷、嗜睡、恶心、瘙痒、出汗和潮红)。根据预先确定的标准排除患者:在最初的 59 名患者中,有 22 名静脉注射组患者和 27 名雾化吸入组患者在适用排除标准后符合分析条件。雾化吸入组距下一次镇痛请求的时间明显较长,中位数为 683.5 分钟(四分位间范围为 260-1440),而静脉注射组为 326.7 分钟(145.0-504.7)(P = .009)。两组患者达到疼痛评分小于 4 分的时间和副作用发生率没有显著差异:结论:在扁桃体切除术后疼痛治疗中,雾化芬太尼比静脉注射芬太尼的镇痛时间更长,起效时间和副作用情况相似。这些发现强调了雾化芬太尼作为扁桃体切除术后患者止痛的有效替代品的潜力。
{"title":"Comparative Analysis of Nebulized Versus Intravenous Fentanyl for Pain Control After Tonsillectomy: A Double-Blind, Randomized, Controlled Trial.","authors":"Chanitda Pantabtim, Saowapark Chumpathong, Phongthara Vichitvejpaisal, Wilawan Limsettho, Peerachatra Mangmeesri","doi":"10.1177/00034894241259376","DOIUrl":"10.1177/00034894241259376","url":null,"abstract":"<p><strong>Objectives: </strong>Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients.</p><p><strong>Methods and methods: </strong>In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria.</p><p><strong>Results: </strong>From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group (<i>P</i> = .009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups.</p><p><strong>Conclusion: </strong>Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"776-782"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Variability in Inner Ear Morphology Among a Family With Pendred Syndrome Due to a SLC26A4 Gene Variant. 由 SLC26A4 基因变异导致的彭德综合征家族的内耳形态变异。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI: 10.1177/00034894241261491
Yung-Hsuan Chen, Wei-Che Lin, Chung-Feng Hwang, Meng-Han Tsai, Chao-Hui Yang

Objectives: Pendred syndrome, an autosomal recessive disorder, is often associated with pathogenic variants of the SLC26A4 gene that encodes the pendrin protein. Given its autosomal recessive inheritance, tracing the family history and screening siblings become crucial once a diagnosis of Pendred syndrome is confirmed. This case report aims to underscore the variability in inner ear morphology within a family diagnosed with Pendred syndrome, all carrying the same SLC26A4 gene mutation.

Methods: A chart review and a review of the literature.

Results: We present a family of 4, all of whom possess sensorineural hearing loss due to the same homozygous SLC26A4 variant c.919-2A>G. Intriguingly, clinical manifestations, especially inner ear deformities, displayed variability among family members. Notably, 1 family member exhibited a normal cochleovestibular structure morphology, which was rarely reported in the literature.

Conclusions: This report highlights the significance of genetic testing and familial consultation when a proband exhibits typical Pendred syndrome symptoms. It also underscores that the inner ear morphology can exhibit variability among family members, even with the same homozygous SLC26A4 variant.

目的:彭德综合征是一种常染色体隐性遗传疾病,通常与编码pendrin蛋白的SLC26A4基因的致病变异有关。鉴于该病为常染色体隐性遗传,一旦确诊为彭德综合征,追查家族史和筛查兄弟姐妹就变得至关重要。本病例报告旨在强调一个被诊断为彭德综合征的家族中内耳形态的变异性,该家族成员均携带相同的 SLC26A4 基因突变:方法:病历回顾和文献综述:有趣的是,家族成员的临床表现,尤其是内耳畸形,存在差异。值得注意的是,有一名家族成员表现出正常的耳蜗前庭结构形态,这在文献中鲜有报道:本报告强调了当原告表现出典型的彭德综合征症状时,进行基因检测和家族咨询的重要性。结论:本报告强调了当原告表现出典型的彭德综合征症状时,进行基因检测和家族咨询的重要性,同时也强调了即使是同一种 SLC26A4 基因变异体,其家族成员之间的内耳形态也可能存在差异。
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引用次数: 0
Management of Parapharyngeal Metastatic Medullary Thyroid Carcinoma Via a Combined Trans-Cervical and Trans-Oral Robotic Approach. 通过经颈部和经口腔机器人联合方法治疗咽旁转移性甲状腺髓样癌
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI: 10.1177/00034894241261630
Clémentine Hyvrard, Florent Couineau, Tiffany Rigal, Serena Louerat, Stéphane Hans, Robin Baudouin

Introduction: Medullary thyroid carcinoma constitutes 5% to 10% of all thyroid cancers. Metastatic adenopathies may pose challenges in intricate anatomical locations, such as the parapharyngeal space. A rare case of metastatic medullary thyroid carcinoma in the parapharyngeal space has been treated in our unit using combined trans-cervical trans-oral robotic surgery. Our objective was to provide a detailed description of the surgery performed on this patient.

Method: We reported a singular case report worth of interest.

Result: A 42-year-old woman was addressed in our unit for the management of a medullary thyroid carcinoma adenopathy located in the right parapharyngeal space. A parapharyngeal 40.0 mm × 25.0 mm × 12.0 mm adenopathy was removed using a combined trans-cervical and trans-oral robotic approach without sacrifice or injury of vascular or nervous structure. Neither the tracheostomy nor the feeding tube was implemented. Feeding was resumed on postoperative day 1 and hospitalization spanned 7 days.

Conclusion: An innovative combined trans-cervical and trans-oral robotic surgery approach was conducted to address a metastatic medullary thyroid carcinoma in the parapharyngeal space. This surgical technique allowed us to circumvent the need for a trans-mandibular approach, tracheostomy, and feeding tube and enabling successful tumor removal without fragmentation. Postoperative care was significantly eased. The sole complication observed was dysphonia, likely resulting from intra-operative stretching of the vagus nerve during the dissection of the carotid artery.

简介甲状腺髓样癌占所有甲状腺癌的5%到10%。转移性腺病可能会给咽旁间隙等复杂解剖位置带来挑战。本单位采用经颈经口机器人联合手术治疗了一例罕见的咽旁间隙转移性甲状腺髓样癌。我们的目的是对该患者的手术进行详细描述:我们报告了一例值得关注的病例:结果:一名 42 岁的女性因右侧咽旁间隙甲状腺髓样癌腺瘤在我科接受治疗。采用经颈和经口机器人联合方法切除了咽旁 40.0 mm × 25.0 mm × 12.0 mm 的腺瘤,没有牺牲或损伤血管或神经结构。既没有实施气管造口术,也没有插喂食管。术后第1天即可恢复进食,住院7天:我们采用了创新的经颈和经口机器人联合手术方法来治疗咽旁间隙的转移性甲状腺髓样癌。这项手术技术使我们避免了经下颌入路、气管造口和喂食管的需要,并成功地切除了肿瘤,没有造成碎裂。术后护理明显减轻。观察到的唯一并发症是发音障碍,可能是术中解剖颈动脉时拉伸了迷走神经所致。
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引用次数: 0
Endotype and Phenotype Related Postoperative Effects of Bacterial Lysate in Chronic Rhinosinusitis. 细菌裂解物对慢性鼻炎术后影响的内型和表型相关性
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-23 DOI: 10.1177/00034894241264459
Seung-No Hong, Seung Koo Yang, Su Geun Kim, Sun A Han, Jin-A Park, Hyunkyung Cha, Joon Kon Kim, So Yeon Yoon, Kyoung Mi Eun, Dae Woo Kim

Objectives: Chronic rhinosinusitis (CRS) endotypes have demonstrated clinical value in guiding treatment decisions. Bacterial lysates are immunomodulators that have shown beneficial effects in various respiratory inflammatory diseases. This study aimed to evaluate the effect of postoperative bacterial lysate therapy on different CRS endotypes.

Methods: Patients diagnosed with CRS who underwent endoscopic sinus surgery were recruited. Bacterial lysates were administered postoperatively for 10 days per month for 3 months to the experimental group comprising patients with a history of frequent upper respiratory infections without adverse reactions. The remaining participants were allocated to the control group. The results of the postoperative 3-, 6-, and 12-month assessments, including the modified Lund-Kennedy (mLK) endoscopic and Sinonasal Outcome Test (SNOT) 22 scores, for the groups were compared. The tissue samples obtained from the participants were evaluated to detect the presence of relevant inflammatory mediators.

Results: Among the 92 participants, 47 started bacterial lysate therapy 2 weeks after the surgery. The tissue cytokine profiles and clinical parameters, such as the disease severity and blood eosinophil percentage, of the bacterial lysate and control groups were comparable before treatment. The mLK endoscopic and SNOT-22 scores did not differ after 3, 6, and 12 months of follow-up. The subgroup analysis revealed that the bacterial lysate group had significantly lower mLK endoscopic scores than the control group for CRS without nasal polyps, while there was a tendency toward significance for the interleukin (IL)-5 negative group after 6 months.

Conclusion: Postoperative bacterial lysate therapy has some beneficial effects on the endoscopic findings of patients with CRS without nasal polyps or those who are negative for IL-5.

目的:慢性鼻窦炎(CRS)内型在指导治疗决策方面具有临床价值。细菌裂解物是一种免疫调节剂,在各种呼吸道炎症疾病中显示出有益的作用。本研究旨在评估术后细菌裂解液疗法对不同 CRS 内型的影响:方法:招募被诊断为 CRS 并接受内窥镜鼻窦手术的患者。实验组由经常上呼吸道感染且无不良反应的患者组成,术后每月给药 10 天,为期 3 个月。其余参与者被分配到对照组。比较两组患者术后 3 个月、6 个月和 12 个月的评估结果,包括改良伦德-肯尼迪(MLK)内窥镜评分和鼻窦结果测试(SNOT)22 分。对参与者的组织样本进行了评估,以检测相关炎症介质的存在:结果:92 名参与者中,47 人在术后 2 周开始接受细菌裂解液治疗。细菌溶胞物治疗组和对照组的组织细胞因子谱和临床参数(如疾病严重程度和血液中嗜酸性粒细胞百分比)在治疗前具有可比性。随访 3、6 和 12 个月后,mLK 内镜评分和 SNOT-22 评分没有差异。亚组分析显示,对于无鼻息肉的 CRS,细菌溶胞液组的 mLK 内镜评分明显低于对照组,而白细胞介素(IL)-5 阴性组在 6 个月后的评分有显著性趋势:结论:术后细菌溶解物疗法对无鼻息肉或 IL-5 阴性的 CRS 患者的内窥镜检查结果有一定的益处。
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引用次数: 0
Association of Medical School Gap Year Research and Degree Programs With Otolaryngology Interview and Match Outcomes. 医学院空档年研究和学位课程与耳鼻喉科面试和匹配结果的关联。
IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-17 DOI: 10.1177/00034894241261821
Trinithas Boyi, William J Benjamin, Nicholas R Lenze, Michael J Brenner, Angela P Mihalic, Robbi A Kupfer, Benjamin L Judson, Yan H Lee

Objective: To investigate whether a gap year for either research or a master's degree is associated with interview offers or match outcomes among otolaryngology applicants.

Methods: Using the Texas Seeking Transparency in Application to Residency (Texas STAR) database, we conducted a cross-sectional analysis of otolaryngology applicants from 2018 to 2022. Applicants were stratified based on the presence and type of gap year during medical school. Applicant characteristics, signaling, research productivity, and application costs were analyzed, with primary outcomes including number of interview offers and match status.

Results: Among 564 otolaryngology applicant respondents to the Texas STAR survey, 160 (28%) reported a gap year, including 64 (40%) applicants participating in a research year, 65 (41%) completing a Master of Public Health or Science (MPH and MSc), and 31 (19%) completing a Master of Business Administration, Education, or other degree (MBA and MEd). Gap-year applicants who completed a research year or MPH/MSc degree received more interview offers (P < .01) than MBA, MEd applicants, or those without a gap year. Applicants with a research year had the most publications, oral presentations, abstracts, posters, and research experiences (all P < .01). When controlling for USMLE scores, clerkship honors, and applications submitted, applicants completing a research year or an MPH/MSc-degree received increased interview offers (P < .01). No significant differences were seen in expenditures or match rates.

Conclusions: Research and MPH/MSc gap years were associated with increased residency interview offers but not increased match success. Further longitudinal studies are needed to assess how yearlong experiences affect long-term career outcomes.

目的调查耳鼻喉科申请者中,研究或硕士学位的间隔年是否与面试机会或匹配结果有关:利用德克萨斯州寻求住院医师申请透明度(Texas STAR)数据库,我们对 2018 年至 2022 年的耳鼻喉科申请者进行了横截面分析。根据申请人在医学院期间是否有空档年以及空档年的类型对其进行了分层。我们对申请人的特征、信号、研究效率和申请成本进行了分析,主要结果包括面试通知数量和匹配状态:在德克萨斯州 STAR 调查的 564 名耳鼻喉科申请者中,有 160 人(28%)报告说自己在读医学院期间有空档年,其中 64 人(40%)参加了研究年,65 人(41%)完成了公共卫生或科学硕士学位(MPH 和 MSc),31 人(19%)完成了工商管理硕士、教育硕士或其他学位(MBA 和 MEd)。完成研究年或获得公共卫生硕士/理学硕士学位的间隔年申请者获得了更多的面试机会(P P P 结论):研究年和公共卫生硕士/理学硕士间隔年与住院医师面试机会的增加有关,但与匹配成功率的增加无关。需要进一步开展纵向研究,以评估一年的经历对长期职业结果的影响。
{"title":"Association of Medical School Gap Year Research and Degree Programs With Otolaryngology Interview and Match Outcomes.","authors":"Trinithas Boyi, William J Benjamin, Nicholas R Lenze, Michael J Brenner, Angela P Mihalic, Robbi A Kupfer, Benjamin L Judson, Yan H Lee","doi":"10.1177/00034894241261821","DOIUrl":"10.1177/00034894241261821","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether a gap year for either research or a master's degree is associated with interview offers or match outcomes among otolaryngology applicants.</p><p><strong>Methods: </strong>Using the Texas Seeking Transparency in Application to Residency (Texas STAR) database, we conducted a cross-sectional analysis of otolaryngology applicants from 2018 to 2022. Applicants were stratified based on the presence and type of gap year during medical school. Applicant characteristics, signaling, research productivity, and application costs were analyzed, with primary outcomes including number of interview offers and match status.</p><p><strong>Results: </strong>Among 564 otolaryngology applicant respondents to the Texas STAR survey, 160 (28%) reported a gap year, including 64 (40%) applicants participating in a research year, 65 (41%) completing a Master of Public Health or Science (MPH and MSc), and 31 (19%) completing a Master of Business Administration, Education, or other degree (MBA and MEd). Gap-year applicants who completed a research year or MPH/MSc degree received more interview offers (<i>P</i> < .01) than MBA, MEd applicants, or those without a gap year. Applicants with a research year had the most publications, oral presentations, abstracts, posters, and research experiences (all <i>P</i> < .01). When controlling for USMLE scores, clerkship honors, and applications submitted, applicants completing a research year or an MPH/MSc-degree received increased interview offers (<i>P</i> < .01). No significant differences were seen in expenditures or match rates.</p><p><strong>Conclusions: </strong>Research and MPH/MSc gap years were associated with increased residency interview offers but not increased match success. Further longitudinal studies are needed to assess how yearlong experiences affect long-term career outcomes.</p>","PeriodicalId":50975,"journal":{"name":"Annals of Otology Rhinology and Laryngology","volume":" ","pages":"783-791"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Annals of Otology Rhinology and Laryngology
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