Pub Date : 2019-12-06DOI: 10.1177/0003489419892292
A. Adler, Mary F. Musso, Deepak K. Mehta, A. Chandrakantan
Objective: To describe a minimalist approach to sedating children for DISE procedures. Methods: We searched existing literature and derived and tested our algorithm on patients using evidence-based studies. Results: We were able to successfully sedate, without airway intervention, 15 highly complex children with a variety of comorbidities for DISE procedures. Conclusion: We describe a minimalistic sedation approach for DISE procedures in highly complex children. Further studies are required to compare this regimen to natural sleep states.
{"title":"Pediatric Drug Induced Sleep Endoscopy: A Simple Sedation Recipe","authors":"A. Adler, Mary F. Musso, Deepak K. Mehta, A. Chandrakantan","doi":"10.1177/0003489419892292","DOIUrl":"https://doi.org/10.1177/0003489419892292","url":null,"abstract":"Objective: To describe a minimalist approach to sedating children for DISE procedures. Methods: We searched existing literature and derived and tested our algorithm on patients using evidence-based studies. Results: We were able to successfully sedate, without airway intervention, 15 highly complex children with a variety of comorbidities for DISE procedures. Conclusion: We describe a minimalistic sedation approach for DISE procedures in highly complex children. Further studies are required to compare this regimen to natural sleep states.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"84 1","pages":"428 - 433"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73896550","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 : 2019-12-06DOI: 10.1177/0003489419892285
M. Jalali, H. Gerami, A. Saberi, Siavash Razaghi
Objectives: The aim of this study was to compare the effects of betahistine with dimenhydrinate on the resolution of residual dizziness (RD) of patients with benign paroxysmal positional vertigo (BPPV) after successful Epley maneuver. Methods: In this double-blind, randomized clinical trial, patients with posterior semicircular canal type of BPPV were included. After execution of the Epley maneuver, patients were assigned randomly to one group for 1 week: betahistine, dimenhydrinate or placebo. The primary outcomes were scores of the Dizziness Handicap Inventory (DHI) and the modified Berg balance scale (mBBS). All patients were asked to describe the characteristics of their subjective residual symptoms. Binary logistic regression analysis was performed to examine the predictors of improved RD. All analyses were conducted using SPSS 19.0. Results: In total, 117 patients (age range: 20-65 years) participated in this study. After the Epley maneuver, 88 participants had RD. After the intervention, 38 patients exhibited an improved RD. Less than 50% of participants in the three groups showed mild to moderate dizziness handicap. However, there was no significant difference between mBBS scores of groups before or after the intervention. Logistic regression was shown that patients with receiving betahistine were 3.18 times more likely to have no RD than the placebo group. Increasing age was associated with a decreased likelihood of improving RD (P = .05). Conclusion: The analysis of data showed that the use of betahistine had more effect on improving RD symptoms. We recommended future studies using objective indicators of residual dizziness.
{"title":"The Impact of Betahistine versus Dimenhydrinate in the Resolution of Residual Dizziness in Patients with Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial","authors":"M. Jalali, H. Gerami, A. Saberi, Siavash Razaghi","doi":"10.1177/0003489419892285","DOIUrl":"https://doi.org/10.1177/0003489419892285","url":null,"abstract":"Objectives: The aim of this study was to compare the effects of betahistine with dimenhydrinate on the resolution of residual dizziness (RD) of patients with benign paroxysmal positional vertigo (BPPV) after successful Epley maneuver. Methods: In this double-blind, randomized clinical trial, patients with posterior semicircular canal type of BPPV were included. After execution of the Epley maneuver, patients were assigned randomly to one group for 1 week: betahistine, dimenhydrinate or placebo. The primary outcomes were scores of the Dizziness Handicap Inventory (DHI) and the modified Berg balance scale (mBBS). All patients were asked to describe the characteristics of their subjective residual symptoms. Binary logistic regression analysis was performed to examine the predictors of improved RD. All analyses were conducted using SPSS 19.0. Results: In total, 117 patients (age range: 20-65 years) participated in this study. After the Epley maneuver, 88 participants had RD. After the intervention, 38 patients exhibited an improved RD. Less than 50% of participants in the three groups showed mild to moderate dizziness handicap. However, there was no significant difference between mBBS scores of groups before or after the intervention. Logistic regression was shown that patients with receiving betahistine were 3.18 times more likely to have no RD than the placebo group. Increasing age was associated with a decreased likelihood of improving RD (P = .05). Conclusion: The analysis of data showed that the use of betahistine had more effect on improving RD symptoms. We recommended future studies using objective indicators of residual dizziness.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"37 1","pages":"434 - 440"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75819976","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 : 2019-12-01DOI: 10.1177/0003489419892287
C. Honey, M. Krüger, M. Morrison, B. S. Dhaliwal, A. Hu
Objectives: A patient is presented with neurogenic cough due to a unilateral vascular compression of a vagus nerve rootlet at the brainstem with complete resolution of cough following microvascular decompression of that nerve. This etiology of a neurogenic cough has not been previously reported to our knowledge. The proportion of patients with neurogenic cough refractory to all current therapies and suffering with this treatable condition remains to be defined. We introduce the concept of Vagus Associated Neurogenic Cough Occurring due to Unilateral Vascular Encroachment of its Root (VANCOUVER syndrome) and present the salient features of this condition. Methods: A case review is presented with details of the patient’s history, examination, imaging, laryngoscopy, intraoperative findings, and long-term clinical outcome. Results: A 60-year-old man presented with a 15-year history of non-productive cough refractory to antibiotics, and anti-reflux medications. Investigations by an allergist, a cardiologist, a gastroenterologist, two pulmonologists, and an otolaryngologist were negative. MRI demonstrated a vascular compression of his left vagus nerve and microvascular decompression of that nerve resolved his symptoms. There were no surgical complications and the patient remains asymptomatic at 1 year. Conclusions: Neurogenic cough has been likened to a vagus nerve neuropathy in a similar way that trigeminal neuralgia is a trigeminal nerve neuropathy. Both cause intermittent sensory phenomena in their distribution and can be ameliorated with neuropathic medications. We demonstrate that neurogenic cough, like trigeminal neuralgia, may be caused by a vascular compression of its nerve root. A proposed mechanism of this type of neurogenic cough is presented along with a potential diagnostic paradigm for these patients.
{"title":"Vagus Associated Neurogenic Cough Occurring Due to Unilateral Vascular Encroachment of Its Root: A Case Report and Proof of Concept of VANCOUVER Syndrome","authors":"C. Honey, M. Krüger, M. Morrison, B. S. Dhaliwal, A. Hu","doi":"10.1177/0003489419892287","DOIUrl":"https://doi.org/10.1177/0003489419892287","url":null,"abstract":"Objectives: A patient is presented with neurogenic cough due to a unilateral vascular compression of a vagus nerve rootlet at the brainstem with complete resolution of cough following microvascular decompression of that nerve. This etiology of a neurogenic cough has not been previously reported to our knowledge. The proportion of patients with neurogenic cough refractory to all current therapies and suffering with this treatable condition remains to be defined. We introduce the concept of Vagus Associated Neurogenic Cough Occurring due to Unilateral Vascular Encroachment of its Root (VANCOUVER syndrome) and present the salient features of this condition. Methods: A case review is presented with details of the patient’s history, examination, imaging, laryngoscopy, intraoperative findings, and long-term clinical outcome. Results: A 60-year-old man presented with a 15-year history of non-productive cough refractory to antibiotics, and anti-reflux medications. Investigations by an allergist, a cardiologist, a gastroenterologist, two pulmonologists, and an otolaryngologist were negative. MRI demonstrated a vascular compression of his left vagus nerve and microvascular decompression of that nerve resolved his symptoms. There were no surgical complications and the patient remains asymptomatic at 1 year. Conclusions: Neurogenic cough has been likened to a vagus nerve neuropathy in a similar way that trigeminal neuralgia is a trigeminal nerve neuropathy. Both cause intermittent sensory phenomena in their distribution and can be ameliorated with neuropathic medications. We demonstrate that neurogenic cough, like trigeminal neuralgia, may be caused by a vascular compression of its nerve root. A proposed mechanism of this type of neurogenic cough is presented along with a potential diagnostic paradigm for these patients.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"1 1","pages":"523 - 527"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85032807","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 : 2019-12-01DOI: 10.1177/0003489419892997
M. Abouzari, Donald Tan, B. Sarna, Y. Ghavami, K. Goshtasbi, Erica M Parker, Harrison W. Lin, H. Djalilian
Objectives: To evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis. Methods: In a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications. Pre- and post-treatment average loudness discomfort level (LDL), hyperacusis discomfort level measured by a visual analogue scale (VAS), and scores on the modified Khalfa questionnaire for severity of hyperacusis were compared. Results: Twenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB (P < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment (P < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7, P < .001). Conclusions: The majority of patients with hyperacusis demonstrated symptomatic improvement from migraine prophylaxis therapy, as indicated by self-reported and audiometric measures. Our findings indicate that, for some patients, hyperacusis may share a pathophysiologic basis with migraine disorder and may be successfully managed with multimodal migraine prophylaxis therapy.
目的:评价多模式偏头痛预防治疗对听觉亢进患者的疗效。方法:在一项前瞻性队列研究中，使用多模式循序渐进的偏头痛预防方案(去甲替林、维拉帕米、托吡酯或其组合)以及改变生活方式和饮食习惯来治疗耳聋患者。比较治疗前和治疗后的平均响度不适水平(LDL)、视觉模拟量表(VAS)测量的听觉亢进不适水平和改进的Khalfa听力亢进严重程度问卷得分。结果:25例患者中有22例(88%)在治疗后主观症状得到缓解。治疗后的听音图显示，平均LDL从81.3±3.2 dB显著改善到86.4±2.6 dB (P < 0.001)，表明声音耐受性增加。VAS不适感评分也由治疗前平均7.7±1.1分显著改善至治疗后平均3.7±1.6分(P < 0.001)。改良Khalfa问卷的平均总分(32.2±3.6 vs 22.0±5.7,P < 0.001)也有显著改善。结论:正如自我报告和听力测量所表明的那样，大多数偏头痛预防治疗的患者表现出症状改善。我们的研究结果表明，对于一些患者来说，耳鸣可能与偏头痛有共同的病理生理基础，可以通过多模式偏头痛预防治疗成功地控制。
{"title":"Efficacy of Multi-Modal Migraine Prophylaxis Therapy on Hyperacusis Patients","authors":"M. Abouzari, Donald Tan, B. Sarna, Y. Ghavami, K. Goshtasbi, Erica M Parker, Harrison W. Lin, H. Djalilian","doi":"10.1177/0003489419892997","DOIUrl":"https://doi.org/10.1177/0003489419892997","url":null,"abstract":"Objectives: To evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis. Methods: In a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications. Pre- and post-treatment average loudness discomfort level (LDL), hyperacusis discomfort level measured by a visual analogue scale (VAS), and scores on the modified Khalfa questionnaire for severity of hyperacusis were compared. Results: Twenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB (P < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment (P < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7, P < .001). Conclusions: The majority of patients with hyperacusis demonstrated symptomatic improvement from migraine prophylaxis therapy, as indicated by self-reported and audiometric measures. Our findings indicate that, for some patients, hyperacusis may share a pathophysiologic basis with migraine disorder and may be successfully managed with multimodal migraine prophylaxis therapy.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"23 1","pages":"421 - 427"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86345457","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 : 2019-11-28DOI: 10.1177/0003489419889371
J. Choi, Jae Yeup Jung, J. Moon, S. Hwang
Objectives: Respiratory mechanics instability (RMI) based on paradoxical movement is correlated with respiratory disturbance such as apnea-hypopnea index (AHI) and reflects the severity of obstructive sleep apnea (OSA). The purpose of this study was to identify RMI as a method for assessing the effectiveness of continuous positive airway pressure (CPAP) in the management for OSA. Methods: A total of 71 consecutive OSA patients with CPAP titration were included in this study. We compared sleep (sleep efficiency, arousal index, and sleep stages), respiratory (AHI, oxygen desaturation index ≥3% [ODI3], and lowest oxygen saturation), and RMI parameters (events, index, duration, and % of stage duration) between diagnostic polysomnography and CPAP titration data. Results: All RMI parameters (events [157.5 ± 80.9 vs 80.0 ± 47.1; P < .001], index [25.3 ± 12.4 vs 12.7 ± 7.0; P < .001], duration [182.6 ± 96.2 vs 79.8 ± 88.9; P < .001], and % of stage duration [49.0 ± 24.4 vs 20.5 ± 21.3; P < .001]) were significantly improved by the alleviation of obstructive respiratory disturbance parameters (AHI [45.1 ± 23.0 vs 4.2 ± 4.3; P < .001], ODI3 [44.9 ± 22.6 vs 4.8 ± 4.6; P < .001], and lowest oxygen saturation [77.7 ± 7.3 vs 89.3 ± 3.8; P < .001]) compared to diagnostic polysomnography and CPAP titration data. Conclusion: RMI may be a useful method for evaluating the effect of CPAP in OSA patients.
目的:基于矛盾运动的呼吸力学不稳定性(RMI)与呼吸障碍如呼吸暂停低通气指数(AHI)相关，反映阻塞性睡眠呼吸暂停(OSA)的严重程度。本研究的目的是确定RMI作为评估持续气道正压通气(CPAP)在OSA治疗中的有效性的方法。方法:本研究共纳入71例连续接受CPAP滴定治疗的OSA患者。我们比较了诊断性多导睡眠图和CPAP滴定数据之间的睡眠(睡眠效率、觉醒指数和睡眠阶段)、呼吸(AHI、氧去饱和指数≥3% [ODI3]和最低氧饱和度)和RMI参数(事件、指数、持续时间和阶段持续时间的百分比)。结果:所有RMI参数(事件[157.5±80.9 vs 80.0±47.1;p <。001]，指数[25.3±12.4 vs 12.7±7.0;p <。[001]，持续时间[182.6±96.2 vs 79.8±88.9;p <。001]，期持续时间的%[49.0±24.4 vs 20.5±21.3;P < .001])均因缓解阻塞性呼吸障碍参数而显著改善(AHI[45.1±23.0 vs 4.2±4.3;p <。001]， ODI3[44.9±22.6 vs 4.8±4.6;p <。最低血氧饱和度[77.7±7.3 vs 89.3±3.8];P < .001])与诊断性多导睡眠图和CPAP滴定数据相比。结论:RMI可作为评价阻塞性睡眠呼吸暂停患者CPAP治疗效果的有效方法。
{"title":"The Usefulness of Respiratory Mechanic Instability in Evaluating the Effect of Continuous Positive Airway Pressure for Obstructive Sleep Apnea","authors":"J. Choi, Jae Yeup Jung, J. Moon, S. Hwang","doi":"10.1177/0003489419889371","DOIUrl":"https://doi.org/10.1177/0003489419889371","url":null,"abstract":"Objectives: Respiratory mechanics instability (RMI) based on paradoxical movement is correlated with respiratory disturbance such as apnea-hypopnea index (AHI) and reflects the severity of obstructive sleep apnea (OSA). The purpose of this study was to identify RMI as a method for assessing the effectiveness of continuous positive airway pressure (CPAP) in the management for OSA. Methods: A total of 71 consecutive OSA patients with CPAP titration were included in this study. We compared sleep (sleep efficiency, arousal index, and sleep stages), respiratory (AHI, oxygen desaturation index ≥3% [ODI3], and lowest oxygen saturation), and RMI parameters (events, index, duration, and % of stage duration) between diagnostic polysomnography and CPAP titration data. Results: All RMI parameters (events [157.5 ± 80.9 vs 80.0 ± 47.1; P < .001], index [25.3 ± 12.4 vs 12.7 ± 7.0; P < .001], duration [182.6 ± 96.2 vs 79.8 ± 88.9; P < .001], and % of stage duration [49.0 ± 24.4 vs 20.5 ± 21.3; P < .001]) were significantly improved by the alleviation of obstructive respiratory disturbance parameters (AHI [45.1 ± 23.0 vs 4.2 ± 4.3; P < .001], ODI3 [44.9 ± 22.6 vs 4.8 ± 4.6; P < .001], and lowest oxygen saturation [77.7 ± 7.3 vs 89.3 ± 3.8; P < .001]) compared to diagnostic polysomnography and CPAP titration data. Conclusion: RMI may be a useful method for evaluating the effect of CPAP in OSA patients.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"30 1","pages":"388 - 393"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87088167","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 : 2019-11-26DOI: 10.1177/0003489419891451
A. Bezdjian, R. Smith, N. Gabra, Luhe Yang, M. Bianchi, S. Daniel
Purpose: To compare intra- and postoperative outcomes between the standard linear incision with tissue preservation and the Minimally Invasive Ponto Surgery (MIPS). Study Design: A non-randomized retrospective cohort series. Methods: Medical files were reviewed of adult and pediatric bone anchored hearing implant recipients. Extracted outcomes included patient characteristics, implant survival, operative time, anesthesia use, intra and postoperative complications, soft tissue tolerability assessed by the Holger’s classification, and implant stability assessed by the Resonance Frequency Analysis (RFA). Outcomes were compared between two surgeries. Results: A total of 59 implants were placed (21 MIPS; 38 linear). Conductive hearing loss was the most common etiology for implantation. Surgery was conducted under local anesthesia in 67% of MIPS patients and 16% of linear patients. No intraoperative complications were reported for both surgical approaches and no implants were lost. Patients undergoing implantation via the MIPS approach displayed less skin reaction postoperatively, however this was not significant (P = .2848). The most common Holgers score for both groups was grade 1. The median and mean surgical duration for the MIPS group was statistically lower than the linear group (P = .0001). Implant stability measured by the RFA implant stability quotient was greater in the MIPS cohort. Conclusion: The MIPS approach seems either similar or superior to the linear approach in all perioperative outcomes evaluated. Outcomes such as surgical duration, anesthesia choice and implant stability measurements support implantation through the MIPS approach for patients meeting eligibility criteria.
{"title":"Experience with Minimally Invasive Ponto Surgery and Linear Incision Approach for Pediatric and Adult Bone Anchored Hearing Implants","authors":"A. Bezdjian, R. Smith, N. Gabra, Luhe Yang, M. Bianchi, S. Daniel","doi":"10.1177/0003489419891451","DOIUrl":"https://doi.org/10.1177/0003489419891451","url":null,"abstract":"Purpose: To compare intra- and postoperative outcomes between the standard linear incision with tissue preservation and the Minimally Invasive Ponto Surgery (MIPS). Study Design: A non-randomized retrospective cohort series. Methods: Medical files were reviewed of adult and pediatric bone anchored hearing implant recipients. Extracted outcomes included patient characteristics, implant survival, operative time, anesthesia use, intra and postoperative complications, soft tissue tolerability assessed by the Holger’s classification, and implant stability assessed by the Resonance Frequency Analysis (RFA). Outcomes were compared between two surgeries. Results: A total of 59 implants were placed (21 MIPS; 38 linear). Conductive hearing loss was the most common etiology for implantation. Surgery was conducted under local anesthesia in 67% of MIPS patients and 16% of linear patients. No intraoperative complications were reported for both surgical approaches and no implants were lost. Patients undergoing implantation via the MIPS approach displayed less skin reaction postoperatively, however this was not significant (P = .2848). The most common Holgers score for both groups was grade 1. The median and mean surgical duration for the MIPS group was statistically lower than the linear group (P = .0001). Implant stability measured by the RFA implant stability quotient was greater in the MIPS cohort. Conclusion: The MIPS approach seems either similar or superior to the linear approach in all perioperative outcomes evaluated. Outcomes such as surgical duration, anesthesia choice and implant stability measurements support implantation through the MIPS approach for patients meeting eligibility criteria.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"71 1","pages":"380 - 387"},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81828283","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 : 2019-11-24DOI: 10.1177/0003489419890349
J. Tansey, J. Hamblin, Madhu Mamidala, Jerome W. Thompson, Jennifer Mclevy, J. Wood, A. Sheyn
Objectives: Assess the outcome of Intravenous (IV) dexamethasone in the treatment of pediatric deep neck space infections (DNSI) in combination with IV antibiotics. Methods: Retrospective chart review of pediatric patients admitted for a DNSI from March 2014 to June 2016. Patient characteristics including demographics, abscess type, antibiotic, dexamethasone, surgery, culture, and length of stay (LOS) were obtained. Patients treated with antibiotics alone versus antibiotics and dexamethasone were compared. Primary outcome measures were rate of surgical drainage and LOS. Results: Overall 153 patients with DNSI were identified, including 62 lateral neck, 18 parapharyngeal, 40 peritonsillar, 32 retropharyngeal, and 1 submandibular. All patients received antibiotics. Dexamethasone was used in 35% of patients. The rate of surgical drainage in the dexamethasone and non-dexamethasone group was 36% and 53% respectively (P = .043). LOS was shorter for the dexamethasone group (2.9 days) compared to the non-dexamethasone group (3.8 days) but was non-significant, P-value-.09. The most common microorganisms cultured were MRSA (25), MSSA (11), and Streptococcus pyogenes (10). Conclusion: Dexamethasone use was associated with a decreased rate of surgical drainage in pediatric patients with DNSI. Further prospective study is needed to determine the role of dexamethasone in treatment.
{"title":"Dexamethasone Use in the Treatment of Pediatric Deep Neck Space Infections","authors":"J. Tansey, J. Hamblin, Madhu Mamidala, Jerome W. Thompson, Jennifer Mclevy, J. Wood, A. Sheyn","doi":"10.1177/0003489419890349","DOIUrl":"https://doi.org/10.1177/0003489419890349","url":null,"abstract":"Objectives: Assess the outcome of Intravenous (IV) dexamethasone in the treatment of pediatric deep neck space infections (DNSI) in combination with IV antibiotics. Methods: Retrospective chart review of pediatric patients admitted for a DNSI from March 2014 to June 2016. Patient characteristics including demographics, abscess type, antibiotic, dexamethasone, surgery, culture, and length of stay (LOS) were obtained. Patients treated with antibiotics alone versus antibiotics and dexamethasone were compared. Primary outcome measures were rate of surgical drainage and LOS. Results: Overall 153 patients with DNSI were identified, including 62 lateral neck, 18 parapharyngeal, 40 peritonsillar, 32 retropharyngeal, and 1 submandibular. All patients received antibiotics. Dexamethasone was used in 35% of patients. The rate of surgical drainage in the dexamethasone and non-dexamethasone group was 36% and 53% respectively (P = .043). LOS was shorter for the dexamethasone group (2.9 days) compared to the non-dexamethasone group (3.8 days) but was non-significant, P-value-.09. The most common microorganisms cultured were MRSA (25), MSSA (11), and Streptococcus pyogenes (10). Conclusion: Dexamethasone use was associated with a decreased rate of surgical drainage in pediatric patients with DNSI. Further prospective study is needed to determine the role of dexamethasone in treatment.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"92 1","pages":"376 - 379"},"PeriodicalIF":0.0,"publicationDate":"2019-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80928622","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 : 2019-11-24DOI: 10.1177/0003489419891450
Amishav Y Bresler, Roman Povolotskiy, Brandon K. Nguyen, G. Zuliani, J. Eloy, B. Paskhover, Peter Svider
Objective: The safety and efficacy of extracorporeal septoplasty (ECS) has long been debated. Our objective was to determine this technique’s functional and aesthetic outcomes and complications through a systematic review of the literature. Data Sources: PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases were evaluated for studies detailing functional or aesthetic outcomes of ECS. Review Methods: Bias was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-randomized Studies (MINORS) score. Aesthetic and functional outcomes in addition to complications were evaluated using subjective and objective measures. Meta-analyses were performed when appropriate. Results: Seventeen studies encompassing 1418 patients were included. The average MINORS score for observational studies was 9.2. Overall there was a significant improvement in subjective nasal function with a preoperative average Nasal Obstruction Symptom Evaluation (NOSE) score of 75 (±16) decreasing to 19.5 (±16.5) postoperatively for a mean difference (MD) of −55 (95% confidence interval (CI): –60 to −49.5). In terms of objective nasal function, at 6 months postoperatively, there was an improvement of nasal flow measured by rhinometry ranging from 70 to 71% across studies. Anthropometric measurements were utilized for objective aesthetic outcomes. There was a significant improvement in I-shaped deviations (MD: –2.7°, 95% CI: –5.6 to −0.16) and C-shaped deviations improved by 11.9° (95% CI +2.8-+21.2). Complication rates ranged from 0 to 18%. Conclusion: ECS can achieve significant improvements in the subjective and objective function of the nose. The associated complication rate is low but variable between surgeons.
目的:体外鼻中隔成形术(ECS)的安全性和有效性一直存在争议。我们的目的是通过对文献的系统回顾来确定该技术的功能和美学结果以及并发症。数据来源:PubMed/MEDLINE、Embase、Cochrane图书馆和Web of Science数据库被评估为详细描述ECS功能或美学结果的研究。评价方法:采用Cochrane偏倚风险工具和非随机研究方法学指数(minor)评分评价偏倚。采用主观和客观的方法评估美学和功能结果以及并发症。适当时进行meta分析。结果:17项研究共纳入1418例患者。观察性研究的平均未成年人得分为9.2分。总体而言，主观鼻功能有显著改善，术前鼻塞症状评估(NOSE)平均评分为75(±16)分，术后降至19.5(±16.5)分，平均差值(MD)为- 55(95%可信区间(CI): -60至- 49.5)。在客观鼻功能方面，术后6个月，研究中鼻测量术测量的鼻流量改善幅度为70%至71%。人体测量测量用于客观美学结果。i型偏差显著改善(MD: - 2.7°，95% CI: - 5.6至- 0.16)，c型偏差改善11.9°(95% CI +2.8-+21.2)。并发症发生率从0到18%不等。结论:ECS能显著改善鼻的主客观功能。相关并发症发生率较低，但因外科医生而异。
{"title":"Functional and Aesthetic Outcomes of Extracorporeal Septoplasty: A Systematic Review and Meta-Analyses","authors":"Amishav Y Bresler, Roman Povolotskiy, Brandon K. Nguyen, G. Zuliani, J. Eloy, B. Paskhover, Peter Svider","doi":"10.1177/0003489419891450","DOIUrl":"https://doi.org/10.1177/0003489419891450","url":null,"abstract":"Objective: The safety and efficacy of extracorporeal septoplasty (ECS) has long been debated. Our objective was to determine this technique’s functional and aesthetic outcomes and complications through a systematic review of the literature. Data Sources: PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases were evaluated for studies detailing functional or aesthetic outcomes of ECS. Review Methods: Bias was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-randomized Studies (MINORS) score. Aesthetic and functional outcomes in addition to complications were evaluated using subjective and objective measures. Meta-analyses were performed when appropriate. Results: Seventeen studies encompassing 1418 patients were included. The average MINORS score for observational studies was 9.2. Overall there was a significant improvement in subjective nasal function with a preoperative average Nasal Obstruction Symptom Evaluation (NOSE) score of 75 (±16) decreasing to 19.5 (±16.5) postoperatively for a mean difference (MD) of −55 (95% confidence interval (CI): –60 to −49.5). In terms of objective nasal function, at 6 months postoperatively, there was an improvement of nasal flow measured by rhinometry ranging from 70 to 71% across studies. Anthropometric measurements were utilized for objective aesthetic outcomes. There was a significant improvement in I-shaped deviations (MD: –2.7°, 95% CI: –5.6 to −0.16) and C-shaped deviations improved by 11.9° (95% CI +2.8-+21.2). Complication rates ranged from 0 to 18%. Conclusion: ECS can achieve significant improvements in the subjective and objective function of the nose. The associated complication rate is low but variable between surgeons.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"12 1","pages":"401 - 410"},"PeriodicalIF":0.0,"publicationDate":"2019-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77038516","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 : 2019-11-21DOI: 10.1177/0003489419887990
Caitlin Bertelsen, Janet S. Choi, Anna Jackanich, Marshall Ge, Gordon H. Sun, Tamara Chambers
Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c
{"title":"Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center","authors":"Caitlin Bertelsen, Janet S. Choi, Anna Jackanich, Marshall Ge, Gordon H. Sun, Tamara Chambers","doi":"10.1177/0003489419887990","DOIUrl":"https://doi.org/10.1177/0003489419887990","url":null,"abstract":"Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"30 1","pages":"369 - 375"},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82707945","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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