Pub Date : 2020-01-01DOI: 10.1177/0003489419876291
Changxing Liu, Liyang Tang, P. Goel, Tamara Chambers, N. Kokot, U. Sinha, D. Maceri
Objective: Prediction and early intervention for hypocalcemia following parathyroidectomy and total thyroidectomy can decrease hospital cost and prevent severe hypocalcemia-related complications. This study aims to predict the severity of hypocalcemia after parathyroidectomy or thyroidectomy and to stratify patients into groups with different levels of risk for developing severe hypocalcemia, so that higher risk patients may be monitored more closely and receive earlier interventions. Methods: This was a retrospective cohort study of 100 patients with primary hyperparathyroidism who underwent parathyroidectomy as the primary treatment modality at a tertiary care hospital. Clinical information, including demographic information, perioperative PTH and calcium levels, vitamin D levels, weight of the pathologic glands removed, gland pathology, and re-admission rates, were retrieved. Statistical analysis was performed to analyze the association between collected variables and percentage of calcium drop following parathyroidectomy with statistical significant set at P-values <0.05. Results: Age, sex, and vitamin D level provided very minimal information to quantify risks of postoperative hypocalcemia. The percentage of decrease from preoperative PTH level to the lowest PTH level after the removal of the abnormal gland(s) is the most significant predicting factor for the severity of postoperative hypocalcemia. There is a mathematic regressional correlation between them. A formula was generated to quantify this linear relationship between them, and the nadir calcium can be calculated as Ca nadir = Ca preop * [ 1 − 0 . 35 * ( PTH preop − PTH intraop ) 2 PTH preop 2 ] , where Canadir = the lowest postoperative calcium level, and PTHintraop = PTH level 15 minutes after removal of the abnormal gland, with the value of R2 > 0.7. The formula has been tested primarily in our patient population with good reliability. Conclusions: The highest preoperative, lowest postoperative, and change in PTH level can help us reliably calculate the trend of postoperative calcium level. Decision to pursue early interventions can be made based on the calculated result from the formula we obtained.
{"title":"A Practical Mathematic Method to Predict and Manage Hypocalcemia After Parathyroidectomy and Thyroidectomy","authors":"Changxing Liu, Liyang Tang, P. Goel, Tamara Chambers, N. Kokot, U. Sinha, D. Maceri","doi":"10.1177/0003489419876291","DOIUrl":"https://doi.org/10.1177/0003489419876291","url":null,"abstract":"Objective: Prediction and early intervention for hypocalcemia following parathyroidectomy and total thyroidectomy can decrease hospital cost and prevent severe hypocalcemia-related complications. This study aims to predict the severity of hypocalcemia after parathyroidectomy or thyroidectomy and to stratify patients into groups with different levels of risk for developing severe hypocalcemia, so that higher risk patients may be monitored more closely and receive earlier interventions. Methods: This was a retrospective cohort study of 100 patients with primary hyperparathyroidism who underwent parathyroidectomy as the primary treatment modality at a tertiary care hospital. Clinical information, including demographic information, perioperative PTH and calcium levels, vitamin D levels, weight of the pathologic glands removed, gland pathology, and re-admission rates, were retrieved. Statistical analysis was performed to analyze the association between collected variables and percentage of calcium drop following parathyroidectomy with statistical significant set at P-values <0.05. Results: Age, sex, and vitamin D level provided very minimal information to quantify risks of postoperative hypocalcemia. The percentage of decrease from preoperative PTH level to the lowest PTH level after the removal of the abnormal gland(s) is the most significant predicting factor for the severity of postoperative hypocalcemia. There is a mathematic regressional correlation between them. A formula was generated to quantify this linear relationship between them, and the nadir calcium can be calculated as Ca nadir = Ca preop * [ 1 − 0 . 35 * ( PTH preop − PTH intraop ) 2 PTH preop 2 ] , where Canadir = the lowest postoperative calcium level, and PTHintraop = PTH level 15 minutes after removal of the abnormal gland, with the value of R2 > 0.7. The formula has been tested primarily in our patient population with good reliability. Conclusions: The highest preoperative, lowest postoperative, and change in PTH level can help us reliably calculate the trend of postoperative calcium level. Decision to pursue early interventions can be made based on the calculated result from the formula we obtained.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"17 1","pages":"70 - 77"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83214319","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419867976
Amit Ritter, U. Alkan, D. Yahav, E. Soudry, E. Reifen
Objectives: Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Methods: Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Results: Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Conclusions: Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.
{"title":"Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology","authors":"Amit Ritter, U. Alkan, D. Yahav, E. Soudry, E. Reifen","doi":"10.1177/0003489419867976","DOIUrl":"https://doi.org/10.1177/0003489419867976","url":null,"abstract":"Objectives: Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Methods: Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Results: Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Conclusions: Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"106 1","pages":"11 - 5"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76225720","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419875160
Hermann Raunig, G. Hamilton
Background: In this paper, the author describes a novel step-by-step setback procedure for correcting protruding lobules; the success of correcting protruding lobules depends on the nature and severity of the auricular lobule deformity. Although the auricular lobules occupy small areas on either side of the head, protruding or misshapen lobules exert a significant and sometimes exaggerated disfiguring influence on the otherwise aesthetically pleasing appearance of the ears. Because the lobule is a soft structure without a cartilage skeleton, the correction of a protruding ear and lobule is always a challenge. Methods: Protruding lobule abnormalities stem from deformities of the cauda helicis (cartilaginous helical tail) of the auricular lobule, soft tissue, and/or a shortage of anterior skin; however, the abnormalities are usually a combination of all of the above. Therefore, surgical procedures should address all of the causes of lobule deformity and preserve as much tissue and blood supply as possible. Achieving a successful intervention depends on reducing the tension that affects the entire lobule. Results: This is a retrospective analysis of 660 patients who had otoplasty performed by the first author between January 2010 and December 2017. Correction of the ear lobule was needed in 398 (60.3%) patients. Of these, 44.6% patients were male, 55.4% female and the average age was 9 years (range 4-18 years). In this patient cohort, 356 (89.4%) required bilateral and 42 (10.5%) unilateral ear lobule correction. Standardized pre- and postoperative images were recorded for each patient. Conclusion: The goal of a setback procedure is a natural and harmonious auricular lobule appearance that is achieved through simple, optimal surgery that addresses all of the features of the auricular anatomy.
{"title":"Repair of the Protruding Lobule","authors":"Hermann Raunig, G. Hamilton","doi":"10.1177/0003489419875160","DOIUrl":"https://doi.org/10.1177/0003489419875160","url":null,"abstract":"Background: In this paper, the author describes a novel step-by-step setback procedure for correcting protruding lobules; the success of correcting protruding lobules depends on the nature and severity of the auricular lobule deformity. Although the auricular lobules occupy small areas on either side of the head, protruding or misshapen lobules exert a significant and sometimes exaggerated disfiguring influence on the otherwise aesthetically pleasing appearance of the ears. Because the lobule is a soft structure without a cartilage skeleton, the correction of a protruding ear and lobule is always a challenge. Methods: Protruding lobule abnormalities stem from deformities of the cauda helicis (cartilaginous helical tail) of the auricular lobule, soft tissue, and/or a shortage of anterior skin; however, the abnormalities are usually a combination of all of the above. Therefore, surgical procedures should address all of the causes of lobule deformity and preserve as much tissue and blood supply as possible. Achieving a successful intervention depends on reducing the tension that affects the entire lobule. Results: This is a retrospective analysis of 660 patients who had otoplasty performed by the first author between January 2010 and December 2017. Correction of the ear lobule was needed in 398 (60.3%) patients. Of these, 44.6% patients were male, 55.4% female and the average age was 9 years (range 4-18 years). In this patient cohort, 356 (89.4%) required bilateral and 42 (10.5%) unilateral ear lobule correction. Standardized pre- and postoperative images were recorded for each patient. Conclusion: The goal of a setback procedure is a natural and harmonious auricular lobule appearance that is achieved through simple, optimal surgery that addresses all of the features of the auricular anatomy.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"38 1","pages":"63 - 69"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86991272","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419867969
Lyndon Chan, Leon Kitpornchai, S. MacKay
Introduction: Transpalatal advancement (TPA) is a procedure that is used when modern variants of uvulopharyn-gopalatoplasty are unable to provide enough anterior traction. Although successful in reduction of obstructive sleep apnea (OSA) parameters, it also comes with procedure-specific risks. Formation of an oro-nasal fistula (ONF) is a complication that results in significant morbidity and a protracted treatment course. Methods: After approval from the University of Wollongong Health Research Ethics Committee, a retrospective chart review of all cases undergoing TPA performed by a single surgeon over a 10-year period from 2008 to 2018 was performed. Patients underwent pre- and postoperative level 1 or 2 polysomnography. Factors potentially contributing to palatal complications, as well as pre- and postoperative polysomnographic parameters, subjective sleep questionnaires, and body mass index (BMI) were statistically analyzed where a P value <.05 was considered a significant result. Results: A total of 59 patients were included. Overall palatal complication rate was 25.4% (15/59), with the most common being transient velo-palatal insufficiency (VPI) (8/59, 13.6%). ONF developed in 4/59 (6.8%) of patients. None of the analyzed contributing factors for palatal complications were statistically significant, except the presence of a high-arched palate and development of ONF. All analyzed sleep parameters, as well as BMI, were significantly different when comparing pre- to postoperative results. Conclusion: This study suggests that TPA has a role in current sleep surgery paradigms and can significantly improve both objective and subjective outcome measures of OSA. Surgeons contemplating TPA on patients with high-arched hard palates should do so with caution.
{"title":"Causative Factors for Complications in Transpalatal Advancement","authors":"Lyndon Chan, Leon Kitpornchai, S. MacKay","doi":"10.1177/0003489419867969","DOIUrl":"https://doi.org/10.1177/0003489419867969","url":null,"abstract":"Introduction: Transpalatal advancement (TPA) is a procedure that is used when modern variants of uvulopharyn-gopalatoplasty are unable to provide enough anterior traction. Although successful in reduction of obstructive sleep apnea (OSA) parameters, it also comes with procedure-specific risks. Formation of an oro-nasal fistula (ONF) is a complication that results in significant morbidity and a protracted treatment course. Methods: After approval from the University of Wollongong Health Research Ethics Committee, a retrospective chart review of all cases undergoing TPA performed by a single surgeon over a 10-year period from 2008 to 2018 was performed. Patients underwent pre- and postoperative level 1 or 2 polysomnography. Factors potentially contributing to palatal complications, as well as pre- and postoperative polysomnographic parameters, subjective sleep questionnaires, and body mass index (BMI) were statistically analyzed where a P value <.05 was considered a significant result. Results: A total of 59 patients were included. Overall palatal complication rate was 25.4% (15/59), with the most common being transient velo-palatal insufficiency (VPI) (8/59, 13.6%). ONF developed in 4/59 (6.8%) of patients. None of the analyzed contributing factors for palatal complications were statistically significant, except the presence of a high-arched palate and development of ONF. All analyzed sleep parameters, as well as BMI, were significantly different when comparing pre- to postoperative results. Conclusion: This study suggests that TPA has a role in current sleep surgery paradigms and can significantly improve both objective and subjective outcome measures of OSA. Surgeons contemplating TPA on patients with high-arched hard palates should do so with caution.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"12 1","pages":"18 - 22"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81687718","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419870820
S. Okhovat, T. Milner, W. Clement, D. Wynne, T. Kunanandam
Objectives: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). Methods: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. Results: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. Conclusion: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. Level of Evidence: 3b
{"title":"Validation of Animal Models for Simulation Training in Pediatric Laryngotracheal Reconstruction","authors":"S. Okhovat, T. Milner, W. Clement, D. Wynne, T. Kunanandam","doi":"10.1177/0003489419870820","DOIUrl":"https://doi.org/10.1177/0003489419870820","url":null,"abstract":"Objectives: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). Methods: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. Results: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. Conclusion: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. Level of Evidence: 3b","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"21 1","pages":"46 - 54"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76494256","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419875755
K. Yan, J. Taxy, A. Paintal, A. Friedman
Objective: The identification of rare sources of laryngeal infection in immunocompetent patients. Recovered organisms were Mycobacterium tuberculosis (laryngeal tuberculosis [LTB]), Mycobacterium fortuitum (laryngeal Mycobacterium fortuitum [LMF]), and Blastomyces dermatiditis (laryngeal blastomycosis [LB]). Method: Single institution retrospective case series of three patients over a 2.5-year period and review of the literature on laryngeal infections by three atypical organisms. Results: Three patients presented with hoarseness and cough; one additionally had throat pain (LTB). Indirect laryngoscopy demonstrated diffuse laryngeal ulceration (LTB, LMF) and an exophytic, contiguous glottic mass (LB). Direct microlaryngoscopic biopsies and cultures established the diagnoses, including a frozen section in one case (LB), which prevented a simultaneously planned surgical resection. Appropriate antimicrobial therapy yielded dramatic laryngeal and corresponding vocal improvement, for which we provide unique photo and audio documentation. In the last 10 years, fewer than 500 cases of LTB have been reported in the English language medical literature, principally outside the United States. To date, there have been reports of only 34 LB and no cases of LMF. Conclusion: Atypical infections of the larynx may be localized and mimic laryngeal cancer on endoscopy. Tissue examination as well as microbiologic samples are diagnostic and complementary.
{"title":"Atypical Laryngeal Infections: Localized Lesions from Unusual Organisms May Simulate Malignancy","authors":"K. Yan, J. Taxy, A. Paintal, A. Friedman","doi":"10.1177/0003489419875755","DOIUrl":"https://doi.org/10.1177/0003489419875755","url":null,"abstract":"Objective: The identification of rare sources of laryngeal infection in immunocompetent patients. Recovered organisms were Mycobacterium tuberculosis (laryngeal tuberculosis [LTB]), Mycobacterium fortuitum (laryngeal Mycobacterium fortuitum [LMF]), and Blastomyces dermatiditis (laryngeal blastomycosis [LB]). Method: Single institution retrospective case series of three patients over a 2.5-year period and review of the literature on laryngeal infections by three atypical organisms. Results: Three patients presented with hoarseness and cough; one additionally had throat pain (LTB). Indirect laryngoscopy demonstrated diffuse laryngeal ulceration (LTB, LMF) and an exophytic, contiguous glottic mass (LB). Direct microlaryngoscopic biopsies and cultures established the diagnoses, including a frozen section in one case (LB), which prevented a simultaneously planned surgical resection. Appropriate antimicrobial therapy yielded dramatic laryngeal and corresponding vocal improvement, for which we provide unique photo and audio documentation. In the last 10 years, fewer than 500 cases of LTB have been reported in the English language medical literature, principally outside the United States. To date, there have been reports of only 34 LB and no cases of LMF. Conclusion: Atypical infections of the larynx may be localized and mimic laryngeal cancer on endoscopy. Tissue examination as well as microbiologic samples are diagnostic and complementary.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"118 1","pages":"82 - 86"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82843067","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419870829
Melissa R Chao, K. A. Howe, J. Pierce, Amanda Stark, Marshall E. Smith, M. Christensen
Objectives: Injury to the recurrent laryngeal nerve (RLN), if severe enough, can result in vocal fold paralysis. Reinnervation surgery can improve patient outcomes, but previous studies have reported a negative correlation between time since onset of paralysis and surgical outcomes. The ability of the paralyzed nerve to serve as a conduit for donor nerve fibers may be a factor in the success of reinnervation; however, changes in RLN composition after paralysis have not been well studied. Therefore, we investigated the morphometric composition of explanted RLN sections from patients who had experienced vocal fold paralysis for varying length of times. Methods: Nine nerve sections from unilateral vocal fold paralysis (UVP) patients and seven control nerve sections were analyzed for morphometric parameters including fascicular area, fiber count, fiber density, fiber packing, mean g-ratio, and fiber diameter distribution. Nerves from UVP patients were also compared as a function of time since UVP onset. Results: In comparison to control nerves, paralyzed nerves were found to have significantly lower fiber densities and fiber packing, higher mean g-ratio values, and a shift in diameter distributions toward smaller diameter fibers. With respect to paralysis duration, no significant differences were observed except in fiber diameter distributions, where those with paralysis for >2 years had distributions that were significantly shifted toward smaller diameter fibers. Conclusions: The morphometric data presented here suggest that correlations between the time since onset of vocal fold paralysis and reinnervation outcomes may be due to fiber size changes in the paralyzed nerve over time.
{"title":"Morphometric Differences in the Recurrent Laryngeal Nerve in Patients with Vocal Fold Paralysis","authors":"Melissa R Chao, K. A. Howe, J. Pierce, Amanda Stark, Marshall E. Smith, M. Christensen","doi":"10.1177/0003489419870829","DOIUrl":"https://doi.org/10.1177/0003489419870829","url":null,"abstract":"Objectives: Injury to the recurrent laryngeal nerve (RLN), if severe enough, can result in vocal fold paralysis. Reinnervation surgery can improve patient outcomes, but previous studies have reported a negative correlation between time since onset of paralysis and surgical outcomes. The ability of the paralyzed nerve to serve as a conduit for donor nerve fibers may be a factor in the success of reinnervation; however, changes in RLN composition after paralysis have not been well studied. Therefore, we investigated the morphometric composition of explanted RLN sections from patients who had experienced vocal fold paralysis for varying length of times. Methods: Nine nerve sections from unilateral vocal fold paralysis (UVP) patients and seven control nerve sections were analyzed for morphometric parameters including fascicular area, fiber count, fiber density, fiber packing, mean g-ratio, and fiber diameter distribution. Nerves from UVP patients were also compared as a function of time since UVP onset. Results: In comparison to control nerves, paralyzed nerves were found to have significantly lower fiber densities and fiber packing, higher mean g-ratio values, and a shift in diameter distributions toward smaller diameter fibers. With respect to paralysis duration, no significant differences were observed except in fiber diameter distributions, where those with paralysis for >2 years had distributions that were significantly shifted toward smaller diameter fibers. Conclusions: The morphometric data presented here suggest that correlations between the time since onset of vocal fold paralysis and reinnervation outcomes may be due to fiber size changes in the paralyzed nerve over time.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"6 1","pages":"32 - 38"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74566844","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419870833
Jennifer A. Villwock, Jennifer Li, C. Moore, A. Chiu, Kevin J. Sykes
Background: Olfactory dysfunction is an important facet of numerous disease states ranging from sinonasal disease to neurocognitive disorders. Due to expense and/or logistical barriers, objective olfactory testing is not common. We describe the creation of a novel, essential oil-based smell test, Affordable Rapid Olfaction Measurement Array (AROMA), composed at 14 scents at different concentrations and demonstrate correlation of AROMA with the University of Pennsylvania Smell Identification Test (UPSIT), patient age, Sinonasal Outcomes Test (SNOT-22), and perceived loss of smell. Methods: AROMA was developed for point-of-care olfactory testing and compared to the UPSIT, as well as subjective outcome measures as noted above. About 37 healthy controls were prospectively recruited to assess the reliability of AROMA using a test–retest protocol. An additional cohort of 38 participants with sinonasal disease were prospectively recruited to complete the AROMA and UPSIT, and were compared with a cohort of 30 healthy controls. Spearman correlation correlated AROMA and UPSIT results, patient age, SNOT-22, and perceived loss of smell. Results: AROMA demonstrated good test–retest reliability (r = 0.85, P < .001). Spearman’s rho correlation of AROMA to UPSIT was statistically significant at ρ = 0.75 (P < .001). SNOT-22, age, and perceived sense of smell were all significantly correlated with both AROMA (ρ = −0.548, −0.557, −0.642, respectively) and UPSIT (ρ = −0.367, −0.460, −0.552, respectively). Conclusion: AROMA has a strong correlation with UPSIT and may be more strongly correlated with sinonasal outcomes. Additionally, AROMA is reusable; level of odorant is not static; and AROMA can test both odor detection and identification. Level of evidence: 2b
{"title":"Affordable Rapid Olfaction Measurement Array: A Novel, Essential Oil-Based Test Strongly Correlated with UPSIT and Subjective Outcome Measures","authors":"Jennifer A. Villwock, Jennifer Li, C. Moore, A. Chiu, Kevin J. Sykes","doi":"10.1177/0003489419870833","DOIUrl":"https://doi.org/10.1177/0003489419870833","url":null,"abstract":"Background: Olfactory dysfunction is an important facet of numerous disease states ranging from sinonasal disease to neurocognitive disorders. Due to expense and/or logistical barriers, objective olfactory testing is not common. We describe the creation of a novel, essential oil-based smell test, Affordable Rapid Olfaction Measurement Array (AROMA), composed at 14 scents at different concentrations and demonstrate correlation of AROMA with the University of Pennsylvania Smell Identification Test (UPSIT), patient age, Sinonasal Outcomes Test (SNOT-22), and perceived loss of smell. Methods: AROMA was developed for point-of-care olfactory testing and compared to the UPSIT, as well as subjective outcome measures as noted above. About 37 healthy controls were prospectively recruited to assess the reliability of AROMA using a test–retest protocol. An additional cohort of 38 participants with sinonasal disease were prospectively recruited to complete the AROMA and UPSIT, and were compared with a cohort of 30 healthy controls. Spearman correlation correlated AROMA and UPSIT results, patient age, SNOT-22, and perceived loss of smell. Results: AROMA demonstrated good test–retest reliability (r = 0.85, P < .001). Spearman’s rho correlation of AROMA to UPSIT was statistically significant at ρ = 0.75 (P < .001). SNOT-22, age, and perceived sense of smell were all significantly correlated with both AROMA (ρ = −0.548, −0.557, −0.642, respectively) and UPSIT (ρ = −0.367, −0.460, −0.552, respectively). Conclusion: AROMA has a strong correlation with UPSIT and may be more strongly correlated with sinonasal outcomes. Additionally, AROMA is reusable; level of odorant is not static; and AROMA can test both odor detection and identification. Level of evidence: 2b","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"EM-22 1","pages":"39 - 45"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84525857","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419873353
D. Cazzador, D. Borsetto, E. Alexandre, F. Chiumenti, A. Pusateri, F. Pagella, E. Emanuelli
To the Editor: We read with interest the article by Rotsides et al entitled “Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery” highlighting the functional outcome after nasolacrimal duct (NLD) transection performed during sinus and skull base surgery where a multi-institutional series of 29 patients was analyzed. The authors compared two groups of patients undergoing endoscopic medial maxillectomy and NLD simple transection or NLD marsupialization, respectively. Only 1 patient submitted to simple NLD transection and postoperative radiotherapy due to malignant sinonasal squamous cell carcinoma developed postoperative epiphora. The failure rate calculated in the simple NLD transection subgroup was 7.7%. Although no patients in the marsupialization group suffered from postoperative epiphora, the data were insufficient to statistically determine the better efficacy of one surgical technique over the other. The authors concluded that endoscopic NLD simple transection or with flap marsupialization during endoscopic sinus and skull base surgery carries a low risk of postoperative epiphora. We would praise the authors for having proposed marsupialization of the transected NLD for the management of the lacrimal pathway during medial maxillectomy as a valid alternative for the surgeons in addition to concurrent dacryocystorhinostomy (DCR) or lacrimal preserving approaches to the maxillary sinus. However, we would highlight that more than one variable could have biased the results, starting from the inclusion criteria of the study. Patients treated for sinonasal diseases of different histopathological nature (inflammatory or neoplastic) were analyzed together, as well as patients who received postoperative radiotherapy. Acute on chronic inflammation, chronic sinusitis and epithelial cysts represent different entities requiring functional endoscopic sinus surgery, where the NLD is preferably preserved. Probably, radiation therapy of the midface determines an increased risk of epiphora due to lacrimal canaliculi and nasal mucosal scarring, which increases when it follows maxillectomy for sinonasal cancers, with recently reported rates of 29%. Not least, it is our feeling that the rate of NLD stenosis in the postoperative period might have been underestimated, given the short follow-up time between NLD transection and the last clinical examination reported in the paper (mean 10.5 months, range 1-33 months). In this context, we would like to share our experience reporting on the rate of epiphora after NLD simple transection in a homogenous and continuous cohort of patients endoscopically treated for sinonasal inverted papilloma by the same senior surgeon between 2002 and 2017 (see Table 1). Over a series of 116 patients, 30 (25.8%) were submitted to transnasal endoscopic partial maxillectomy type 3A and 3B (TurriZanoni, Battaglia and Karligkiotis, 2017) with NLD simple transection to obtain adequate surgical control within the maxilla
致编辑:我们饶有兴趣地阅读了Rotsides等人发表的题为“鼻泪管在鼻内镜和颅底手术中的管理”的文章，该文章强调了在鼻内镜和颅底手术中进行鼻泪管(NLD)横断后的功能结果，该研究分析了多机构系列的29例患者。作者比较了两组分别接受内窥镜下上颌骨内侧切除术和NLD单纯横切或NLD有袋化手术的患者。仅有1例患者因恶性鼻窦鳞状细胞癌行单纯NLD横断及术后放疗后出现术后显色。单纯NLD横断亚组的失败率为7.7%。尽管有袋化组中没有患者出现术后外溢，但数据不足以统计确定一种手术技术优于另一种手术技术的疗效。作者得出结论，在内镜下鼻窦和颅底手术中，内窥镜下NLD简单断面或皮瓣有袋化具有较低的术后上睑下垂风险。我们要赞扬作者提出的有袋化横切的NLD作为在内侧上颌切除术中泪道管理的有效选择，除了并发泪囊鼻腔造口术(DCR)或保留泪道的上颌窦入路。然而，我们要强调的是，从研究的纳入标准开始，不止一个变量可能会对结果产生偏倚。同时分析不同组织病理性质(炎症性或肿瘤性)的鼻窦炎患者，以及术后接受放疗的患者。急性慢性炎症、慢性鼻窦炎和上皮囊肿代表不同的实体，需要功能性内窥镜鼻窦手术，其中NLD最好得到保存。可能，中面部的放射治疗决定了泪小管和鼻粘膜瘢痕造成的泪显的风险增加，当鼻窦癌患者进行上颌切除术后，这一风险增加，最近报道的比例为29%。尤其值得注意的是，鉴于本文报道的NLD截断到最后一次临床检查的随访时间较短(平均10.5个月，范围1-33个月)，我们认为术后NLD狭窄的发生率可能被低估了。在此背景下，我们想分享我们在2002年至2017年期间由同一名资深外科医生进行鼻内窥镜治疗的鼻腔内翻性乳头状瘤的同质连续队列患者中NLD简单横切后表观率的报告经验(见表1)。在116例患者中，30例(25.8%)被提交经鼻内窥镜部分上颌切除3A和3B型(TurriZanoni, Battaglia和Karligkiotis，2017)与NLD简单横断以获得上颌窦内足够的手术控制。未放置泪道支架。中位随访64个月(IQR 37-91)， 3例(10%)患者分别在术后3、32、84个月出现术后上显。因此，他们在内镜下进行了DCR手术，平均48个月的随访记录了症状的完全解决。这些数据可能会在病例系列的总体数量较少中找到理由，这无疑会增加不同结果的风险。Rotsides等人对内窥镜手术期间NLD的处理进行了简要的文献回顾。当仅分析报道内窥镜下上颌骨内侧切除术合并NLD横切术去除IP的患者时，总体上显率在0%至12%之间，平均随访47个月。873353 AORXXX10.1177/0003489419873353Annals of耳鼻喉科学年鉴，cazzador et al letters 2019
{"title":"Comments on “Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery”","authors":"D. Cazzador, D. Borsetto, E. Alexandre, F. Chiumenti, A. Pusateri, F. Pagella, E. Emanuelli","doi":"10.1177/0003489419873353","DOIUrl":"https://doi.org/10.1177/0003489419873353","url":null,"abstract":"To the Editor: We read with interest the article by Rotsides et al entitled “Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery” highlighting the functional outcome after nasolacrimal duct (NLD) transection performed during sinus and skull base surgery where a multi-institutional series of 29 patients was analyzed. The authors compared two groups of patients undergoing endoscopic medial maxillectomy and NLD simple transection or NLD marsupialization, respectively. Only 1 patient submitted to simple NLD transection and postoperative radiotherapy due to malignant sinonasal squamous cell carcinoma developed postoperative epiphora. The failure rate calculated in the simple NLD transection subgroup was 7.7%. Although no patients in the marsupialization group suffered from postoperative epiphora, the data were insufficient to statistically determine the better efficacy of one surgical technique over the other. The authors concluded that endoscopic NLD simple transection or with flap marsupialization during endoscopic sinus and skull base surgery carries a low risk of postoperative epiphora. We would praise the authors for having proposed marsupialization of the transected NLD for the management of the lacrimal pathway during medial maxillectomy as a valid alternative for the surgeons in addition to concurrent dacryocystorhinostomy (DCR) or lacrimal preserving approaches to the maxillary sinus. However, we would highlight that more than one variable could have biased the results, starting from the inclusion criteria of the study. Patients treated for sinonasal diseases of different histopathological nature (inflammatory or neoplastic) were analyzed together, as well as patients who received postoperative radiotherapy. Acute on chronic inflammation, chronic sinusitis and epithelial cysts represent different entities requiring functional endoscopic sinus surgery, where the NLD is preferably preserved. Probably, radiation therapy of the midface determines an increased risk of epiphora due to lacrimal canaliculi and nasal mucosal scarring, which increases when it follows maxillectomy for sinonasal cancers, with recently reported rates of 29%. Not least, it is our feeling that the rate of NLD stenosis in the postoperative period might have been underestimated, given the short follow-up time between NLD transection and the last clinical examination reported in the paper (mean 10.5 months, range 1-33 months). In this context, we would like to share our experience reporting on the rate of epiphora after NLD simple transection in a homogenous and continuous cohort of patients endoscopically treated for sinonasal inverted papilloma by the same senior surgeon between 2002 and 2017 (see Table 1). Over a series of 116 patients, 30 (25.8%) were submitted to transnasal endoscopic partial maxillectomy type 3A and 3B (TurriZanoni, Battaglia and Karligkiotis, 2017) with NLD simple transection to obtain adequate surgical control within the maxilla","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"332 1","pages":"93 - 94"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75477421","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}
Pub Date : 2020-01-01DOI: 10.1177/0003489419870832
Eve Tranchito, Nipun Chhabra
Objectives: To highlight a severe case of rhinotillexomania (compulsive nasal picking) and its potential to manifest as empty nose syndrome (ENS). Methods: A single case report with the presentation and management of a patient with severe rhinotillexomania who presented with chronic obstructive symptoms. We review the current literature on rhinotillexomania and ENS. Results: This patient’s manifestations mimic the obstructive symptoms of ENS, despite widely patent nasal passages. Conclusion: This is the first report of rhinotillexomania manifesting with features of ENS.
{"title":"Rhinotillexomania Manifesting as Empty Nose Syndrome","authors":"Eve Tranchito, Nipun Chhabra","doi":"10.1177/0003489419870832","DOIUrl":"https://doi.org/10.1177/0003489419870832","url":null,"abstract":"Objectives: To highlight a severe case of rhinotillexomania (compulsive nasal picking) and its potential to manifest as empty nose syndrome (ENS). Methods: A single case report with the presentation and management of a patient with severe rhinotillexomania who presented with chronic obstructive symptoms. We review the current literature on rhinotillexomania and ENS. Results: This patient’s manifestations mimic the obstructive symptoms of ENS, despite widely patent nasal passages. Conclusion: This is the first report of rhinotillexomania manifesting with features of ENS.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"21 1","pages":"87 - 90"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79299288","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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