Nicolas J. Casellas, Eytan Keidar, Mursalin M. Anis, D. Rosow
A recent innovation in the management of tracheostomy‐dependent patients with laryngotracheal stenosis (LTS) has been the customizable laryngotracheal stent, made by dividing a T‐tube in half (“L stent”). These L stents can be placed into the subglottis as well as the posterior glottis to prevent rapid re‐stenosis following surgery, and they are easily removed in the office. We sought to review our experience with these stents and analyze patterns of success and failure.Retrospective chart review was performed of all tracheostomy‐dependent patients who underwent L stent placement from January 2019 through February 2024. Clinical and demographic data were reviewed, with decannulation as the primary endpoint. Patients were assessed as having comorbid conditions (diabetes, coronary artery disease, morbid obesity, prior radiation) or not.A total of 16 patients underwent stent placement. Six patients had posterior glottic stenosis (PGS), six had subglottic stenosis (SGS), and four had multilevel stenosis. Of these 16 patients, 9 were ultimately decannulated (56.2%). Three of the successes were PGS (33.3%), four were SGS (44.4%), and two had both SGS and PGS (22.2%). Patients who were decannulated were statistically less likely to have comorbid conditions than patients who failed decannulation (p = 0.0350).For tracheostomy‐dependent patients who have failed first‐line therapy, endoscopic surgery paired with L stent placement offers a reasonable alternative to open airway reconstruction or more destructive arytenoidectomy or cordotomy procedures. As with most airway surgeries, patient selection is important, as the presence of multilevel stenosis and/or comorbid conditions can predict a higher failure rate.
最近，在治疗依赖气管造口术的喉气管狭窄（LTS）患者方面出现了一种创新技术，即通过将 T 型管一分为二制成的可定制喉气管支架（"L 支架"）。这些 L 型支架既可以放置在声门下，也可以放置在声门后部，以防止术后迅速再次狭窄，而且可以在诊室中轻松取出。我们试图回顾使用这些支架的经验，分析成功和失败的模式。我们对 2019 年 1 月至 2024 年 2 月期间接受 L 支架置入术的所有气管造口依赖患者进行了回顾性病历审查。我们对临床和人口统计学数据进行了回顾性分析，并将解除封管作为主要终点。患者被评估为是否患有合并症（糖尿病、冠心病、病态肥胖、曾接受过放射治疗）。共有 16 名患者接受了支架置入手术，其中 6 名患者为声门后狭窄（PGS），6 名患者为声门下狭窄（SGS），4 名患者为多层次狭窄。在这 16 名患者中，有 9 人（56.2%）最终解除了声门狭窄。其中 3 例为 PGS（33.3%），4 例为 SGS（44.4%），2 例同时患有 SGS 和 PGS（22.2%）。对于一线治疗失败的气管造口依赖患者，内窥镜手术与 L 支架置入术的搭配为开放式气道重建或破坏性更强的杓状动脉切除术或脐带切开术提供了合理的替代方案。与大多数气道手术一样，患者的选择非常重要，因为存在多层次狭窄和/或合并症可预示较高的失败率。
{"title":"Using a customizable L stent for laryngotracheal stenosis: Patterns of success and failure","authors":"Nicolas J. Casellas, Eytan Keidar, Mursalin M. Anis, D. Rosow","doi":"10.1002/wjo2.204","DOIUrl":"https://doi.org/10.1002/wjo2.204","url":null,"abstract":"A recent innovation in the management of tracheostomy‐dependent patients with laryngotracheal stenosis (LTS) has been the customizable laryngotracheal stent, made by dividing a T‐tube in half (“L stent”). These L stents can be placed into the subglottis as well as the posterior glottis to prevent rapid re‐stenosis following surgery, and they are easily removed in the office. We sought to review our experience with these stents and analyze patterns of success and failure.Retrospective chart review was performed of all tracheostomy‐dependent patients who underwent L stent placement from January 2019 through February 2024. Clinical and demographic data were reviewed, with decannulation as the primary endpoint. Patients were assessed as having comorbid conditions (diabetes, coronary artery disease, morbid obesity, prior radiation) or not.A total of 16 patients underwent stent placement. Six patients had posterior glottic stenosis (PGS), six had subglottic stenosis (SGS), and four had multilevel stenosis. Of these 16 patients, 9 were ultimately decannulated (56.2%). Three of the successes were PGS (33.3%), four were SGS (44.4%), and two had both SGS and PGS (22.2%). Patients who were decannulated were statistically less likely to have comorbid conditions than patients who failed decannulation (p = 0.0350).For tracheostomy‐dependent patients who have failed first‐line therapy, endoscopic surgery paired with L stent placement offers a reasonable alternative to open airway reconstruction or more destructive arytenoidectomy or cordotomy procedures. As with most airway surgeries, patient selection is important, as the presence of multilevel stenosis and/or comorbid conditions can predict a higher failure rate.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"42 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141928571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Accurate staging of cervical lymph nodes is crucial in the management of head and neck cancers (HNCs). Sentinel lymph node biopsy (SLNB) offers a minimally invasive alternative to neck dissection for identifying occult metastases. This review aims to assess the feasibility and effectiveness of indocyanine green (ICG) fluorescence‐guided SLNB for HNCs.Systematic searches of the PubMed, Embase, and Scopus databases were conducted to identify all clinical articles on ICG‐guided SLNB in HNC from database inception through May 1, 2022. Numerous variables were extracted across papers, including patient and study characteristics, imaging parameters, and SLN detection rates. Risk of bias was evaluated via the Methodological Index for Non‐Randomized Studies (MINORS) criteria.A final six studies met inclusion criteria, encompassing 86 distinct head and neck tumors. The mean number of SLNs identified was 2.46 for fluorescence imaging and 2.83 for gamma tracing. Fluorescence imaging exhibited a higher pooled SLN detection rate (98.0%) compared to gamma tracing (87.6%). Pooled sensitivity for fluorescence imaging (71.0%) was also determined to be higher than that for gamma tracing (66.7%). Pooled specificity was 100% across both modalities. Studies were assessed to be of moderate quality by the MINORS criteria, with an average score of 11.25 for noncomparative studies and 20.5 for comparative studies.ICG‐guided SLNB procedures are feasible and effective in the context of HNCs. The technique offers potentially higher SLN detection rates and shows promise in enhancing clinical and oncologic outcomes when compared to standard lymphoscintigraphy. Further studies with standardized metrics are, however, needed to validate these findings and identify optimal imaging techniques and parameters.
{"title":"Indocyanine green fluorescence‐guided sentinel lymph node biopsy: A systematic review","authors":"Sanjena Venkatesh, Emma De Ravin, K. Rajasekaran","doi":"10.1002/wjo2.197","DOIUrl":"https://doi.org/10.1002/wjo2.197","url":null,"abstract":"Accurate staging of cervical lymph nodes is crucial in the management of head and neck cancers (HNCs). Sentinel lymph node biopsy (SLNB) offers a minimally invasive alternative to neck dissection for identifying occult metastases. This review aims to assess the feasibility and effectiveness of indocyanine green (ICG) fluorescence‐guided SLNB for HNCs.Systematic searches of the PubMed, Embase, and Scopus databases were conducted to identify all clinical articles on ICG‐guided SLNB in HNC from database inception through May 1, 2022. Numerous variables were extracted across papers, including patient and study characteristics, imaging parameters, and SLN detection rates. Risk of bias was evaluated via the Methodological Index for Non‐Randomized Studies (MINORS) criteria.A final six studies met inclusion criteria, encompassing 86 distinct head and neck tumors. The mean number of SLNs identified was 2.46 for fluorescence imaging and 2.83 for gamma tracing. Fluorescence imaging exhibited a higher pooled SLN detection rate (98.0%) compared to gamma tracing (87.6%). Pooled sensitivity for fluorescence imaging (71.0%) was also determined to be higher than that for gamma tracing (66.7%). Pooled specificity was 100% across both modalities. Studies were assessed to be of moderate quality by the MINORS criteria, with an average score of 11.25 for noncomparative studies and 20.5 for comparative studies.ICG‐guided SLNB procedures are feasible and effective in the context of HNCs. The technique offers potentially higher SLN detection rates and shows promise in enhancing clinical and oncologic outcomes when compared to standard lymphoscintigraphy. Further studies with standardized metrics are, however, needed to validate these findings and identify optimal imaging techniques and parameters.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141828303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the diagnostic value of the fasting hypopharyngeal salivary pepsin concentration test for laryngopharyngeal reflux disease (LPRD).Volunteers were grouped by reflux symptom index scale, reflux finding score scale, and 24‐h hypopharyngeal‐esophageal multichannel intraluminal impedance with pH monitoring results. The study comprised 56, 27, and 20 individuals in the LPRD, asymptomatic laryngopharyngeal reflux (LPR), and asymptomatic non‐LPR groups, respectively. All underwent a fasting hypopharyngeal saliva pepsin testing via enzyme‐linked immunosorbent assay. Statistical analysis determined the optimal diagnostic cutoff value, sensitivity, and specificity of hypopharyngeal salivary pepsin for LPRD. Correlation analysis was performed with reflux scale scores and LPR parameters.Fasting hypopharyngeal salivary pepsin concentration in the LPRD group was significantly higher than in the asymptomatic control group (Z = −4.724, p < 0.05). The area under the receiver operating characteristic curve (AUC) analysis identified an optimal cutoff value of 29.62 ng/mL for salivary pepsin concentration (AUC, 0.767; sensitivity, 51.8%; and specificity, 93.6%). There was no statistically significant difference in salivary pepsin concentration between the asymptomatic LPR and non‐LPR groups. The concentration was higher in the LPRD group than in the asymptomatic LPR and non‐LPR groups (p < 0.05). Fasting hypopharyngeal salivary pepsin concentration exhibited a weakly positive correlation with vocal cord edema, intralaryngeal mucus adherence, excess throat mucus or postnasal drip, coughing during meals/lying down, troublesome or annoying cough, and liquid and weakly acidic reflux episodes.The fasting hypopharyngeal salivary pepsin concentration test is a highly specific, simple, and noninvasive method with significant clinical diagnostic value for LPRD.
{"title":"Diagnostic value of fasting hypopharyngeal salivary pepsin concentration test for laryngopharyngeal reflux disease","authors":"Chaofeng Liu, Chenjie Hou, Ting Chen, Liuqing Chen, Jingyi Zheng, Yu‐Jin Zheng, Xiaowei Zheng","doi":"10.1002/wjo2.200","DOIUrl":"https://doi.org/10.1002/wjo2.200","url":null,"abstract":"To investigate the diagnostic value of the fasting hypopharyngeal salivary pepsin concentration test for laryngopharyngeal reflux disease (LPRD).Volunteers were grouped by reflux symptom index scale, reflux finding score scale, and 24‐h hypopharyngeal‐esophageal multichannel intraluminal impedance with pH monitoring results. The study comprised 56, 27, and 20 individuals in the LPRD, asymptomatic laryngopharyngeal reflux (LPR), and asymptomatic non‐LPR groups, respectively. All underwent a fasting hypopharyngeal saliva pepsin testing via enzyme‐linked immunosorbent assay. Statistical analysis determined the optimal diagnostic cutoff value, sensitivity, and specificity of hypopharyngeal salivary pepsin for LPRD. Correlation analysis was performed with reflux scale scores and LPR parameters.Fasting hypopharyngeal salivary pepsin concentration in the LPRD group was significantly higher than in the asymptomatic control group (Z = −4.724, p < 0.05). The area under the receiver operating characteristic curve (AUC) analysis identified an optimal cutoff value of 29.62 ng/mL for salivary pepsin concentration (AUC, 0.767; sensitivity, 51.8%; and specificity, 93.6%). There was no statistically significant difference in salivary pepsin concentration between the asymptomatic LPR and non‐LPR groups. The concentration was higher in the LPRD group than in the asymptomatic LPR and non‐LPR groups (p < 0.05). Fasting hypopharyngeal salivary pepsin concentration exhibited a weakly positive correlation with vocal cord edema, intralaryngeal mucus adherence, excess throat mucus or postnasal drip, coughing during meals/lying down, troublesome or annoying cough, and liquid and weakly acidic reflux episodes.The fasting hypopharyngeal salivary pepsin concentration test is a highly specific, simple, and noninvasive method with significant clinical diagnostic value for LPRD.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141829648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Douglas, Mandy K. Salmon, Rijul S. Kshirsagar, J. Eide, Caitlin A. White, Julia Kharlip, Christina Jackson, John Y.K. Lee, Daniel Yoshor, Michael A. Kohanski, James N. Palmer, N. Adappa
Pituitary apoplexy (PA) is a rare condition caused by hemorrhage or infarction of the pituitary gland with associated risk of cranial neuropathies, endocrinopathies, and even death. Human immunodeficiency virus (HIV) has been shown to have some association with pituitary apoplexy, however, large‐scale studies have not been performed.A retrospective cohort study of subjects greater than 18 years of age was performed using the national TriNetX database. The general population was first compared with those undergoing treatment for PA to compare general demographics and incidence of HIV. The PA cohort was then substratified by HIV status and propensity matched by age and sex to evaluate differences in visual outcomes and endocrine metrics. Using the diagnosis of pituitary apoplexy as an index event, the rate of HIV diagnosis at the time of presentation or in the three months following treatment was calculated. Two‐tailed, unpaired t‐tests were performed.A total 2066 patients were identified (902 HIV, 1158 controls). Those with HIV showed an increased rate of pituitary apoplexy (odds ratio [OR]: 19.8) versus healthy adults and were more likely to be younger and male. Among patients treated for pituitary apoplexy, patients with HIV were more likely to have increased thyroid stimulating hormone, reduced T4, and increased prolactin compared with healthy controls. There were no significant differences in visual outcomes between HIV positive and control patients. Importantly, 74% of patients did not carry a diagnosis of HIV on presentation but were diagnosed at the time of or in the three months following treatment for pituitary apoplexy.Diagnosis and treatment of pituitary apoplexy shows a high rate of concurrent or subsequent diagnosis of HIV. Screening for HIV should be considered in patients undergoing treatment for pituitary apoplexy.
垂体性脑瘫（PA）是由垂体出血或梗塞引起的一种罕见疾病，具有颅神经病变、内分泌病变甚至死亡的相关风险。人类免疫缺陷病毒（HIV）已被证明与垂体性脑瘫有一定的关联，但尚未进行过大规模的研究。首先将普通人群与接受 PA 治疗的人群进行比较，以比较一般人口统计学特征和艾滋病发病率。然后，按 HIV 感染状况对 PA 组群进行分层，并按年龄和性别进行倾向匹配，以评估视觉结果和内分泌指标的差异。以垂体性脑瘫的诊断为指标事件，计算发病时或治疗后三个月内的艾滋病诊断率。共确定了 2066 名患者（902 名艾滋病毒感染者，1158 名对照组）。与健康成人相比，HIV 感染者患垂体性脑瘫的比例更高（几率比 [OR]：19.8），而且更可能是年轻人和男性。在接受垂体性脑瘫治疗的患者中，与健康对照组相比，HIV 感染者更容易出现促甲状腺激素升高、T4 降低和催乳素升高的情况。艾滋病毒阳性患者和对照组患者的视觉结果没有明显差异。重要的是，74%的患者在就诊时未被诊断出感染艾滋病毒，但在垂体性脑瘫治疗时或治疗后三个月内被诊断出感染艾滋病毒。垂体性脑瘫患者在接受治疗时应考虑进行 HIV 筛查。
{"title":"Pituitary apoplexy is associated with concurrent or subsequent diagnosis of human immunodeficiency virus","authors":"J. Douglas, Mandy K. Salmon, Rijul S. Kshirsagar, J. Eide, Caitlin A. White, Julia Kharlip, Christina Jackson, John Y.K. Lee, Daniel Yoshor, Michael A. Kohanski, James N. Palmer, N. Adappa","doi":"10.1002/wjo2.201","DOIUrl":"https://doi.org/10.1002/wjo2.201","url":null,"abstract":"Pituitary apoplexy (PA) is a rare condition caused by hemorrhage or infarction of the pituitary gland with associated risk of cranial neuropathies, endocrinopathies, and even death. Human immunodeficiency virus (HIV) has been shown to have some association with pituitary apoplexy, however, large‐scale studies have not been performed.A retrospective cohort study of subjects greater than 18 years of age was performed using the national TriNetX database. The general population was first compared with those undergoing treatment for PA to compare general demographics and incidence of HIV. The PA cohort was then substratified by HIV status and propensity matched by age and sex to evaluate differences in visual outcomes and endocrine metrics. Using the diagnosis of pituitary apoplexy as an index event, the rate of HIV diagnosis at the time of presentation or in the three months following treatment was calculated. Two‐tailed, unpaired t‐tests were performed.A total 2066 patients were identified (902 HIV, 1158 controls). Those with HIV showed an increased rate of pituitary apoplexy (odds ratio [OR]: 19.8) versus healthy adults and were more likely to be younger and male. Among patients treated for pituitary apoplexy, patients with HIV were more likely to have increased thyroid stimulating hormone, reduced T4, and increased prolactin compared with healthy controls. There were no significant differences in visual outcomes between HIV positive and control patients. Importantly, 74% of patients did not carry a diagnosis of HIV on presentation but were diagnosed at the time of or in the three months following treatment for pituitary apoplexy.Diagnosis and treatment of pituitary apoplexy shows a high rate of concurrent or subsequent diagnosis of HIV. Screening for HIV should be considered in patients undergoing treatment for pituitary apoplexy.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141831755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aims to develop a sulcus vocalis model in the excised canine larynx and to investigate the validity of the model.Type II sulcus vocalis was created by continuous intradermal suture in six excised canine larynges. We investigated the validity of the model based on phonatory (aerodynamic and acoustic) measures, laryngeal videostroboscopy (LVS), and histological examination. The aeroacoustic parameters included phonation threshold pressure (PTP), fundamental frequency (Fo), jitter %, shimmer %, and harmonics‐to‐noise ratio (HNR).In all the experimental specimens, there were significant increases in the PTP ([6.61 ± 1.66] cm H2O, p < 0.01), the Fo ([106.48 ± 49.59] Hz, p = 0.003), the jitter ([0.76 ± 0.42]%, p = 0.007), the shimmer ([6.87 ± 2.99%, p = 0.002]), while the HNR decreased ([5.71 ± 4.68] dB, p = 0.031), compared to that of the untreated canine larynges. The estabilished model simulated the histology with type Ⅱ sulcus.Type Ⅱ sulcus vocalis was successfully created in excised canine larynx. The aeroacoustic and LVS analysis of this model resembled the characteristics of patients with sulcus vocalis. The model could be helpful to elucidate the pathology of the phonation, and evaluate and compare the treatments for sulcus vocalis.
{"title":"Development and validity of type II sulcus vocalis in excised canine larynx","authors":"Ting Gong, Peng‐Cheng Yu, Chao Xue, An‐Rong Sun, Yi Zhang, Rui Fang, Bing‐Hua Zhu","doi":"10.1002/wjo2.193","DOIUrl":"https://doi.org/10.1002/wjo2.193","url":null,"abstract":"This study aims to develop a sulcus vocalis model in the excised canine larynx and to investigate the validity of the model.Type II sulcus vocalis was created by continuous intradermal suture in six excised canine larynges. We investigated the validity of the model based on phonatory (aerodynamic and acoustic) measures, laryngeal videostroboscopy (LVS), and histological examination. The aeroacoustic parameters included phonation threshold pressure (PTP), fundamental frequency (Fo), jitter %, shimmer %, and harmonics‐to‐noise ratio (HNR).In all the experimental specimens, there were significant increases in the PTP ([6.61 ± 1.66] cm H2O, p < 0.01), the Fo ([106.48 ± 49.59] Hz, p = 0.003), the jitter ([0.76 ± 0.42]%, p = 0.007), the shimmer ([6.87 ± 2.99%, p = 0.002]), while the HNR decreased ([5.71 ± 4.68] dB, p = 0.031), compared to that of the untreated canine larynges. The estabilished model simulated the histology with type Ⅱ sulcus.Type Ⅱ sulcus vocalis was successfully created in excised canine larynx. The aeroacoustic and LVS analysis of this model resembled the characteristics of patients with sulcus vocalis. The model could be helpful to elucidate the pathology of the phonation, and evaluate and compare the treatments for sulcus vocalis.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141367983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uzair Chilwan, Smita Caren Mathias, Asif Maitheen, Al Shifa Khan, R. Balasubramanium
Speech language pathologists (SLPs) play a crucial role while dealing with tracheostomized patients, particularly in addressing communication impairments and dysphagia. However, in India, there is a lack of standardized guidelines for SLPs in the treatment of tracheostomy patients, resulting in variations in clinical practices and patient care.An online survey was conducted among 106 experienced SLPs in India. The survey included questions pertaining to various aspects of assessment and treatment in tracheostomized patients. Survey data were analyzed to identify the level of consensus among SLPs in these areas.The survey results revealed varying levels of consensus among SLPs in most of the domains. Most responses fell within the moderate to low consensus range, indicating a lack of standardized practices.The study highlights the lack of standardized guidelines among SLPs in India when it comes to tracheostomy patient care. Hence, the study recommends collaboration among relevant organizations to enhance knowledge sharing and standardize clinical guidelines to improve the overall quality of care for tracheostomy patients in India.
{"title":"Assessment and management approaches for dysphagia in tracheostomized patients: Practices of speech‐language pathologists in India","authors":"Uzair Chilwan, Smita Caren Mathias, Asif Maitheen, Al Shifa Khan, R. Balasubramanium","doi":"10.1002/wjo2.184","DOIUrl":"https://doi.org/10.1002/wjo2.184","url":null,"abstract":"Speech language pathologists (SLPs) play a crucial role while dealing with tracheostomized patients, particularly in addressing communication impairments and dysphagia. However, in India, there is a lack of standardized guidelines for SLPs in the treatment of tracheostomy patients, resulting in variations in clinical practices and patient care.An online survey was conducted among 106 experienced SLPs in India. The survey included questions pertaining to various aspects of assessment and treatment in tracheostomized patients. Survey data were analyzed to identify the level of consensus among SLPs in these areas.The survey results revealed varying levels of consensus among SLPs in most of the domains. Most responses fell within the moderate to low consensus range, indicating a lack of standardized practices.The study highlights the lack of standardized guidelines among SLPs in India when it comes to tracheostomy patient care. Hence, the study recommends collaboration among relevant organizations to enhance knowledge sharing and standardize clinical guidelines to improve the overall quality of care for tracheostomy patients in India.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"136 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shayan Khalid Ghaloo, Syed Shabbir Afzal, S. A. Abbas, Shayan Ansari, Mriganka De, H. Iftikhar
Tracheomalacia is defined as the weakening of the tracheal rings secondary to long‐standing compression or inherent structural weakness, leading to stridor and airway compromise. The common etiological factor of tracheomalacia includes compression of the tracheal framework due to a large multinodular goiter. There are various management techniques described in the literature to manage a patient with tracheomalacia including tracheostomy, tracheal stenting, and tracheopexy. However, the evidence of tracheomalacia in the literature is conflicting. Therefore, a systematic review was conducted to estimate the incidence of tracheomalacia after thyroidectomy.The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A literature search was performed on PubMed, Web of Science, Cochrane library, and Elton B. Stephens Co. cumulative index to nursing and allied health literature plus to determine the incidence of tracheomalacia among patients undergoing thyroidectomy up till October 2021. The eligibility was assessed by two independent authors. A quality assessment of individual studies was performed using the National Institute of Health quality assessment tool. Outcomes were double data extracted and were analyzed using OpenMeta.The online search retrieved 214 papers, out of which 17 studies were included that fulfilled the eligibility criteria. The number of patients included in the systematic review who underwent thyroidectomy was 1108. The mean age was 55.8 ± 7.7 years, ranging from 48 to 75 years. Tracheomalacia was reported in 146 patients (1.4%). Sternotomy was performed in 102 patients to approach the goiters with retrosternal extension. The most common intervention to manage tracheomalacia was tracheostomy or prolonged intubation.Tracheomalacia is a rare complication. In cases where tracheomalacia is encountered, common methods of management include tracheostomy or prolonged endotracheal intubation. Prospective, long‐term studies are required to accurately assess its true incidence and associated factors.
气管畸形是指气管环因长期受压或固有结构薄弱而变弱，导致呼吸困难和气道受损。气管瘘的常见病因包括大型多结节性甲状腺肿压迫气管框架。文献中描述了多种治疗气管空洞患者的方法，包括气管造口术、气管支架植入术和气管切开术。然而，文献中关于气管空洞的证据并不一致。因此，我们进行了一项系统性综述，以估计甲状腺切除术后气管瘘的发生率。该系统性综述是根据系统性综述和荟萃分析首选报告项目（PRISMA）指南进行的。在PubMed、Web of Science、Cochrane图书馆和Elton B. Stephens Co.护理与联合健康文献累积索引上进行了文献检索，以确定截至2021年10月接受甲状腺切除术的患者中气管瘘的发生率。研究资格由两位独立作者进行评估。采用美国国立卫生研究院质量评估工具对各项研究进行了质量评估。结果采用双重数据提取，并使用 OpenMeta 进行分析。在线检索检索到 214 篇论文，其中有 17 项研究符合资格标准。纳入系统综述的甲状腺切除术患者人数为1108人。平均年龄为 55.8 ± 7.7 岁，从 48 岁到 75 岁不等。146例患者（1.4%）出现气管瘘。102例患者接受了胸骨后延伸的甲状腺肿切除术。处理气管瘘最常见的干预措施是气管造口术或长期插管。在出现气管瘘的病例中，常见的处理方法包括气管造口术或长时间气管插管。要准确评估气管瘘的真实发生率和相关因素，需要进行前瞻性的长期研究。
{"title":"Tracheomalacia in patients undergoing thyroid surgery—What is the true estimate: A systematic review and meta‐analysis","authors":"Shayan Khalid Ghaloo, Syed Shabbir Afzal, S. A. Abbas, Shayan Ansari, Mriganka De, H. Iftikhar","doi":"10.1002/wjo2.182","DOIUrl":"https://doi.org/10.1002/wjo2.182","url":null,"abstract":"Tracheomalacia is defined as the weakening of the tracheal rings secondary to long‐standing compression or inherent structural weakness, leading to stridor and airway compromise. The common etiological factor of tracheomalacia includes compression of the tracheal framework due to a large multinodular goiter. There are various management techniques described in the literature to manage a patient with tracheomalacia including tracheostomy, tracheal stenting, and tracheopexy. However, the evidence of tracheomalacia in the literature is conflicting. Therefore, a systematic review was conducted to estimate the incidence of tracheomalacia after thyroidectomy.The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A literature search was performed on PubMed, Web of Science, Cochrane library, and Elton B. Stephens Co. cumulative index to nursing and allied health literature plus to determine the incidence of tracheomalacia among patients undergoing thyroidectomy up till October 2021. The eligibility was assessed by two independent authors. A quality assessment of individual studies was performed using the National Institute of Health quality assessment tool. Outcomes were double data extracted and were analyzed using OpenMeta.The online search retrieved 214 papers, out of which 17 studies were included that fulfilled the eligibility criteria. The number of patients included in the systematic review who underwent thyroidectomy was 1108. The mean age was 55.8 ± 7.7 years, ranging from 48 to 75 years. Tracheomalacia was reported in 146 patients (1.4%). Sternotomy was performed in 102 patients to approach the goiters with retrosternal extension. The most common intervention to manage tracheomalacia was tracheostomy or prolonged intubation.Tracheomalacia is a rare complication. In cases where tracheomalacia is encountered, common methods of management include tracheostomy or prolonged endotracheal intubation. Prospective, long‐term studies are required to accurately assess its true incidence and associated factors.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"55 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. A. Fornazieri, B. M. Cunha, S. P. Nicacio, L. K. Anzolin, José L. B. da Silva, Aristides Fernandes Neto, Deusdedit Brandão Neto, R. Voegels, F. Pinna
The aim of this study was to assess the relative efficacy of medications used following severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection on self‐reported alterations in taste and/or smell function.Seven hundred and fourteen persons with self‐reported postcoronavirus disease 2019 (post‐COVID‐19) chemosensory disorders were personally interviewed regarding specific medications they were administered following the acute phase of the disease. The dependent measure—self‐reported total recovery of chemosensory symptoms—was subjected to stepwise logistic regression. Independent predictors included demographic and clinical variables, in addition to specific medications used to mitigate disease symptoms (i.e., systemic corticosteroids, oseltamivir, vitamin C, ibuprofen, hydroxychloroquine, azithromycin, ivermectin, nitazoxanide, anticoagulants, and zinc).The median time between COVID‐19 symptom onset and the interviews was 81 days (interquartile range: 60–104). Of the 714 subjects, 249 (34.9%) reported total recovery of their chemosensory function; 437 (61.2%) had at least one treatment since the beginning of the disease. Women and those with more comorbidities had undergone more treatments. The recovery rates of the treated and nontreated groups did not differ significantly. Nonetheless, respondents who had used nitazoxanide tended to have a higher rate of self‐reported taste or smell recovery. Those who took oral zinc were less likely to improve.No medication employed during the first months after SARS‐CoV‐2 infection had a clear positive effect on returning self‐reported smell or taste function to normal, although nitrazoxide trended in a positive direction. Oral zinc had a negative effect on the reported recovery of these senses.
{"title":"Effect of drug therapies on self‐reported chemosensory outcomes after COVID‐19","authors":"M. A. Fornazieri, B. M. Cunha, S. P. Nicacio, L. K. Anzolin, José L. B. da Silva, Aristides Fernandes Neto, Deusdedit Brandão Neto, R. Voegels, F. Pinna","doi":"10.1002/wjo2.183","DOIUrl":"https://doi.org/10.1002/wjo2.183","url":null,"abstract":"The aim of this study was to assess the relative efficacy of medications used following severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection on self‐reported alterations in taste and/or smell function.Seven hundred and fourteen persons with self‐reported postcoronavirus disease 2019 (post‐COVID‐19) chemosensory disorders were personally interviewed regarding specific medications they were administered following the acute phase of the disease. The dependent measure—self‐reported total recovery of chemosensory symptoms—was subjected to stepwise logistic regression. Independent predictors included demographic and clinical variables, in addition to specific medications used to mitigate disease symptoms (i.e., systemic corticosteroids, oseltamivir, vitamin C, ibuprofen, hydroxychloroquine, azithromycin, ivermectin, nitazoxanide, anticoagulants, and zinc).The median time between COVID‐19 symptom onset and the interviews was 81 days (interquartile range: 60–104). Of the 714 subjects, 249 (34.9%) reported total recovery of their chemosensory function; 437 (61.2%) had at least one treatment since the beginning of the disease. Women and those with more comorbidities had undergone more treatments. The recovery rates of the treated and nontreated groups did not differ significantly. Nonetheless, respondents who had used nitazoxanide tended to have a higher rate of self‐reported taste or smell recovery. Those who took oral zinc were less likely to improve.No medication employed during the first months after SARS‐CoV‐2 infection had a clear positive effect on returning self‐reported smell or taste function to normal, although nitrazoxide trended in a positive direction. Oral zinc had a negative effect on the reported recovery of these senses.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"86 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140983058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jing‐Lin Su, Jing Kang, Qin‐Yi Ren, Zhi‐Xian Zhu, Si‐Yi Zhang, Ping‐Jiang Ge
Medical masks have been shown to significantly influence speech communication in healthy people. The effect of mask‐wearing on phonatory capability and daily communication exchanges in patients with voice disorders remains unclear. To evaluate the effect of the medical mask on acoustic parameters in patients with a voice disorder, we measured the voice frequency, quality, and intensity.Thirty‐three healthy and 44 voice disorder patients were involved in this study, including 27 patients with vocal‐fold lesions and 17 with primary functional dysphonia. Perceptual evaluation and acoustic parameters, including F0 (fundamental frequency), jitter, shimmer, and maximum vocal intensity, were analyzed without and with medical masks.With medical mask‐wearing, the maximum vocal intensity significantly decreased in all patients with voice disorders (p < 0.05), especially in patients with lesions of vocal folds (p < 0.05) and functional dysphonia (p < 0.05). The perceptual evaluation roughness scales also increased in patients with lesions of vocal folds (p < 0.05) and functional dysphonia (p < 0.05) with mask‐wearing. There were no significant effects of mask‐wearing on acoustic parameters for healthy participants.The intensity was influenced when wearing medical masks in patients with disordered voices. The voice perceptual roughness scales also significantly increased compared to those without medical masks.
{"title":"Effect of medical mask on voice in patients with dysphonia","authors":"Jing‐Lin Su, Jing Kang, Qin‐Yi Ren, Zhi‐Xian Zhu, Si‐Yi Zhang, Ping‐Jiang Ge","doi":"10.1002/wjo2.181","DOIUrl":"https://doi.org/10.1002/wjo2.181","url":null,"abstract":"Medical masks have been shown to significantly influence speech communication in healthy people. The effect of mask‐wearing on phonatory capability and daily communication exchanges in patients with voice disorders remains unclear. To evaluate the effect of the medical mask on acoustic parameters in patients with a voice disorder, we measured the voice frequency, quality, and intensity.Thirty‐three healthy and 44 voice disorder patients were involved in this study, including 27 patients with vocal‐fold lesions and 17 with primary functional dysphonia. Perceptual evaluation and acoustic parameters, including F0 (fundamental frequency), jitter, shimmer, and maximum vocal intensity, were analyzed without and with medical masks.With medical mask‐wearing, the maximum vocal intensity significantly decreased in all patients with voice disorders (p < 0.05), especially in patients with lesions of vocal folds (p < 0.05) and functional dysphonia (p < 0.05). The perceptual evaluation roughness scales also increased in patients with lesions of vocal folds (p < 0.05) and functional dysphonia (p < 0.05) with mask‐wearing. There were no significant effects of mask‐wearing on acoustic parameters for healthy participants.The intensity was influenced when wearing medical masks in patients with disordered voices. The voice perceptual roughness scales also significantly increased compared to those without medical masks.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"122 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140986376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Efficient methods are available to diagnose pyriform sinus fistula (PSF). This study aimed to assess the value of high‐definition laryngoscopy (HDL) in the diagnosis of PSF.From January 2017 to December 2019, patients with PSF were enrolled into this study. HDL was performed without general anesthesia. Laryngoscopy characteristics were analyzed. An inner orifice in the pyriform fossa indicated the presence of PSF. The diagnostic accuracy of HDL was compared to that of barium swallow.A total of 56 patients (33 males and 23 females, ages 2–57 years) were included. The positive predictive value of HDL was 96.4%, and that of barium swallow was 89.2%. Compared to pronouncing the English letter “e,” anterior cervical skin traction plus Valsalva maneuver could offer a clearer view of the inner orifice in the pyriform fossa (χ2 = 11.187, p < 0.05). Nevertheless, compared to barium swallow, HDL showed no statistically significant difference in diagnosing PSF (χ2 = 2.598, p > 0.05).Both HDL and barium swallow have their advantages and are complementary in diagnosing PSF. Their combination may achieve a higher diagnostic accuracy for PFS.
{"title":"Value of high‐definition laryngoscopy in the diagnosis of pyriform sinus fistula","authors":"Pei‐Jun Zhang, Xiu‐Fen Tian","doi":"10.1002/wjo2.180","DOIUrl":"https://doi.org/10.1002/wjo2.180","url":null,"abstract":"Efficient methods are available to diagnose pyriform sinus fistula (PSF). This study aimed to assess the value of high‐definition laryngoscopy (HDL) in the diagnosis of PSF.From January 2017 to December 2019, patients with PSF were enrolled into this study. HDL was performed without general anesthesia. Laryngoscopy characteristics were analyzed. An inner orifice in the pyriform fossa indicated the presence of PSF. The diagnostic accuracy of HDL was compared to that of barium swallow.A total of 56 patients (33 males and 23 females, ages 2–57 years) were included. The positive predictive value of HDL was 96.4%, and that of barium swallow was 89.2%. Compared to pronouncing the English letter “e,” anterior cervical skin traction plus Valsalva maneuver could offer a clearer view of the inner orifice in the pyriform fossa (χ2 = 11.187, p < 0.05). Nevertheless, compared to barium swallow, HDL showed no statistically significant difference in diagnosing PSF (χ2 = 2.598, p > 0.05).Both HDL and barium swallow have their advantages and are complementary in diagnosing PSF. Their combination may achieve a higher diagnostic accuracy for PFS.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"109 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140986903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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