Otolaryngologic Clinics of North America最新文献

Dysphonia is a common symptom of laryngopharyngeal reflux disease (LPRD) and requires multimodal, patient-centered care to address. Challenges in diagnosing LPRD can also complicate treatment of nonspecific dysphonia symptoms. Careful history taking with sensitivity to cultural lifestyle components in each patient is critical to management. Surgical management of acid reflux is not always indicated for dysphonia and the risk to the vagus nerve during fundoplication can worsen dysphonia. There are low-risk nutraceutical therapies that have demonstrated clinical benefit in the literature, and these should be considered for patients with polypharmacy or can be used concurrently with acid suppressive medication.

Laryngopharyngeal reflux disease (LPRD) presents as a constellation of nonspecific upper aerodigestive tract symptoms and signs. Among many objective tools available on the market, hypopharyngeal-esophageal multichannel intraluminal impedance and pH monitoring (HEMII-pH) is considered to date the gold standard technique for diagnosing LPRD, as well as tailoring treatment according to the different LPR profiles. More studies are needed to further validate and standardize diagnostic criteria and evaluate long-term outcomes of patients diagnosed and treated for LPRD using HEMII-pH.

Nasal obstruction is often a multifactorial problem, attributable to physiologic and anatomic processes. Nasal valve compromise may be static or dynamic in nature. Successful diagnostic evaluation rests on a comprehensive history and physical examination.

The number of non-Caucasian patients with nasal valve compromise seeking functional rhinoplasty is projected to increase in tandem with an increasingly diverse population in the United States. Gaining a deeper appreciation for the variances in nasal morphology amongst different ethnicities will help rhinoplasty surgeons perform accurate preoperative evaluations, optimize functional and esthetic outcomes, and maintain ethnic congruence with surgery.

The saddle nose deformity is associated with dorsal collapse and can have both function and cosmetic problems. The saddle nose can cause nasal obstruction by narrowing the nasal cavities, eliciting dynamic internal and external nasal valve narrowing, and abnormally widening the internal and external nasal valves altering airflow dynamics, sinonasal passageways, and olfaction. The saddle nose is challenging to treat due to skin contracture, lack of donor tissue, and difficulties in esthetic integration. A focus on balancing the functional and esthetic concerns during treatment is paramount.

The internal nasal valve, the narrowest portion of the nasal airway, is prone to collapse and is often targeted for improvement in nasal reconstruction and rhinoplasty. Endonasal techniques can reduce surrounding trauma and reduce operative times compared to traditional open methods. Options include the use of spreader, butterfly and alar batten grafts, suspension and flaring sutures, and Z-plasty for scarring. These techniques offer structural support and improved airflow with less risk of external changes, but also the challenges of limited visibility and the need for precise graft placement.

Airway obstruction is a possible sequela following reconstruction of the nose after Mohs excision of skin cancers. While the principles and goals of tissue replacement after Mohs micrographic surgery are well-established, less attention has been paid to the evaluation of the nasal airway after reconstruction. Reconstructive planning begins with understanding the risk factors associated with the development of nasal valve compromise. Several approaches to prevent and correct nasal valve narrowing will be reviewed as part of a unified reconstructive plan for patients after skin cancer excision in high risk areas.

The external nasal valve is the anatomic structure formed by the caudal septum, alar rim, medial crura of the lower lateral cartilage, and nasal sill at the level of the nasal vestibule. Evaluation of external nasal valve dysfunction is dependent upon a thorough history and physical examination. Symptoms and quality of life impact are the main drivers for patients to seek out clinical evaluation. It is paramount that surgeons are familiar with available nonsurgical and surgical options for the management of external nasal valve dysfunction.