Τρίτη, 7 Μαΐου 2019

🇬 🇬 🇬 Otolaryngologic Clinics

Movement Disorders and Voice
The primary movement disorders affecting the voice are laryngeal dystonia (including spasmodic dysphonia), essential voice tremor, and Parkinson disease. Diagnosis of these conditions is clinical and based on a detailed history, voice evaluation, and physical and laryngoscopic examination. Laryngeal dystonia and essential voice tremor are hyperfunctional disorders and are treated most commonly with botulinum toxin injections. Parkinson disease is a hypofunctional disorder that may affect the voice and most commonly is treated with Lee Silverman Voice Treatment.

Medications and Vocal Function
Medications can have innumerable direct and indirect effects on laryngeal hydration, vocal fold mucosal integrity, laryngeal muscle function, and laryngeal sensation. Effects, therefore, can be subtle and slowly progressive over time. This article delineates the general classes of medications that are known to cause alterations of vocal function, highlights medical history symptoms that may help raise suspicion for medication-related vocal changes, and presents recommendations for approaches to treatment of these issues.

Unilateral Vocal Fold Immobility in Children
Unilateral vocal fold paralysis (UVFP) in children may cause dysfunction in voice, swallowing, and breathing, thus influencing all components of laryngeal function. UVFP in children is usually the result of iatrogenic injury. The approach to patients with suspected UVFP should involve a detailed patient history, a focused physical examination with flexible nasopharyngoscopy, and relevant imaging if the cause of UVFP is uncertain. Management aims to strengthen voice, decrease aspiration, and improve quality of life. Laryngeal reinnervation is becoming more common, potentially offering permanent improvement in vocal and swallowing function through increasing bulk and tone to the paralyzed vocal fold.

Presbyphonia and Minimal Glottic Insufficiency
Presbyphonia is defined as aging of the voice, and its growing attention as a medical concern parallels the continuing increase of the geriatric population worldwide. It results from physiologic changes to several laryngeal structures, including the musculature, surrounding cartilage, and lamina propria of the vocal folds. Characterized by glottic insufficiency, dysphonia in the elderly typically presents as a deterioration of voice quality, altered pitch and fundamental frequency, vocal fatigue, and strain. Fortunately, there are multiple treatment options that have proven successful in improving quality of life and restoring vocal stability for these patients.

Components of Voice Evaluation
This article provides a concise review of contemporary options for evaluating voice disorders. Focus is given to patient history and patient-derived voice handicap and quality of life assessments, clinician-derived perceptual analysis of voice, and finally flexible and rigid, high-definition laryngoscopy with videostroboscopy to fully evaluate laryngeal function and biomechanics.

Office-based Procedures in Otolaryngology
Contemporary otolaryngology clinical practice entails a wide array of office-based surgical procedures. Recent advances in anesthesia, medical technology, and surgical technique have resulted in a shift of procedures from the operating room to the office. Today, 70% of all operations are performed outside the hospital operating room. In fact, it is estimated that up to 15% of procedural interventions occur in an office-based setting.1

Coding for Otolaryngology Office Procedures
This review article provides a summary of current correct coding for in-office surgical procedures. The relevant Current Procedural Terminology codes are covered and tips and guidance provided for their correct use. Also, where applicable, facility versus nonfacility reimbursement policy and the associated implications for physicians practicing in hospital-based clinics are discussed.

Minimally Invasive Facial Cosmetic Procedures
Minimally invasive procedures including neurotoxins, dermal fillers, deoxycholic acid, lasers, peels, and microneedling offer powerful, less permanent adjuncts to surgery that are highly effective in select patients. Injectables and skin resurfacing techniques target facial irregularities including wrinkles and fine lines, decrease in volume and contour, and unwanted fat. Determining the best approach for a given patient involves careful consideration of the patient's health conditions, unique anatomic characteristics, tissue quality, and desired results. A detailed understanding of facial anatomy, aesthetics, and techniques is necessary to master these approaches. This article addresses the spectrum of nonsurgical cosmetic procedures to rejuvenate and optimize the face.

In-Office Ultrasonographic Evaluation of Neck Masses/Thyroid Nodules
Office-based ultrasonography is increasingly becoming an integral part of an otolaryngology-head and neck surgery practice. A thorough knowledge of the ultrasonic appearance of normal and abnormal pathology are key for performing/interpreting office-based head and neck ultrasonography. A focused but systematic approach allows for efficient and effective office-based head and neck ultrasonography. Office-based ultrasonography also allows for imaging procedures expanding the otolaryngologist's armamentarium. Ultrasound-guided fine needle aspiration (USgFNA) is an integral part of clinician-performed ultrasonography because it allows cytologic diagnosis of suspicious lesions. Understanding the successful techniques and pitfalls in this procedure are critical for the otolaryngologist performing USgFNA.

Surgical Cosmetic Procedures of the Face
Surgical techniques for cosmetic facial rejuvenation, antiaging concerns, and the optimization of facial beauty can be nuanced and complex. Generally speaking, surgical interventions, including facelift, necklift, blepharoplasty, and rhinoplasty, are the gold standard approaches for the enhancement of facial features. A detailed understanding of facial anatomy, aesthetics, and techniques is necessary to master these approaches.

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