Τρίτη 30 Μαρτίου 2021

New Visionary in Upper Airway Surgeries–THRIVE, a Tubeless Ventilation

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Abstract

THRIVE stands for Transnasal Humidified Rapid Insufflation Ventilatory Exchange. Usage of THRIVE technique is common in emergency settings and of late its usage in upper airway surgeries is gaining popularity. (1) To determine the operative time, total anaesthesia time, safety and efficacy of THRIVE in patients undergoing upper airway surgeries for varied pathologies. (2) To assess the surgeon's satisfaction and patients post-operative comfort. An observational study was from May 2019 to Oct 2020. Study was conducted through a detailed proforma which consists of patient demographic details, physical status, co-morbidities and various domains to assess the safety and efficacy of THRIVE. A total of 32 patients were divided into four groups depending on the type of surgery. We had 18 patients in microlaryngeal excision, six in direct laryngoscopy and biopsy, four in tracheostomy and four in balloon dilatation for subglottic stenosis groups. The mean operation time was 16 ± 2 min in the first three groups and 29 ± 0.8 in the fourth group. All the patients underwent successful surgeries without any episodes of desaturation, without complications and with good surgical satisfaction. THRIVE with appropriate safety precautions can be tried in patients undergoing various upper airway surgeries of short duration. All the patients in our study maintained stable vital parameters throughout the surgery. Initial results with the use of THRIVE as per our study and other studies are definitely encouraging to use THRIVE in upper airway surgeries with varied pathologies.

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Is Working Memory Compromised in Individuals with Sensorineural Hearing Loss with Auditory Neural Origin?

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Abstract

The study aimed to investigate the working memory and speech recognition in noise from individuals with Sensori Neural Hearing Loss (SNHL) with and without auditory neuropathy spectrum disorder (ANSD). The purpose of assessing working memory recommends for a potential intervention program to perceive speech. Twenty participants in the age range of 16–44 years, diagnosed as having mild to moderate SNHL were recruited for the study. The participants were divided into two groups based on the presence and absence of ANSD (10 in each group). The visual working memory was assessed in all the participants using the Operation Span Test, Reading Span Test and Visual Backward Test. Speech perception ability was assessed using the SNR 50 test. There was no significant difference between the scores of Operation Span, Reading Span, and Visual Backward Span for individuals with SNHL with and without ANSD. There was a significant difference between the scores of SNR 50 f or individuals with SNHL with and without ANSD. The visual working memory in individuals with and without ANSD is similar. Speech perception in noise is significantly affected in ANSD than SNHL without ANSD. Thus, it is recommended to use speech reading, which utilizes visual working memory to interpret the message, as previous studies have reported that individuals with ANSD show limited benefit in auditory mode of rehabilitation alone.

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Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes

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Introduction: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. Methods: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matc hed 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. Results: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p #x3e; 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p #x3e; 0.05). Conclusion: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery perfor med. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.
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Sentinel lymph node biopsy versus elective neck dissection: long-term oncologic outcomes in clinically node-negative tongue cancer

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Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2020.02411. Online ahead of print.

ABSTRACT

OBJECTIVES.: To compare the long-term oncologic outcomes of sentinel lymph node biopsy (SLNB) versus elective neck dissection (END) in clinically node-negative (cN0) tongue cancer.

METHODS.: This is a retrospective cohort study of patients with cN0 tongue cancer from a single institution, including 91 patients in the SLNB group and 120 patients in the END group.

RESULTS.: Overall recurrence rate was no significant difference in the recurrence rate between the two groups. The regional control rate was also comparable between the two groups (p = 0.49). The 5-year RFS was slightly better in the SLNB group (p = 0.427). The 5-year OS was 89.9% in the SLNB group vs. 91.9% in the END group (p = 0.737). In propensity-matched subgroup analysis, the type of neck management did not affect RFS nor OS.

CONCLUSION.: . SLNB showed n on-inferior oncologic outcomes compared to END in patients with cN0 tongue squamous cell carcinoma.

PMID:33781056 | DOI:10.21053/ceo.2020.02411

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Modified transoral endoscopic thyroidectomy technique using trapdoor suspension sutures

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Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2021.00101. Online ahead of print.

NO ABSTRACT

PMID:33781057 | DOI:10.21053/ceo.2021.00101

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Hearing impairment increases economic inequality

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Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2021.00325. Online ahead of print.

ABSTRACT

OBJECTIVE: We evaluated the change in income level in a hearing-impaired population.

METHODS: The study subjects were selected from the Korean National Health Insurance Service-Health Screening Cohort data from 2002-2015 of Koreans ≥ 40 years old. In all, 5,857 hearing-impaired subjects were matched with 23,428 comparison participants. The difference in the initial income level and the income level at 1, 2, 3, 4, and 5 years post-enrollment were compared between the hearing-impaired and comparison groups. The interaction of time*hearing impairment/comparison was estimated.

RESULTS: Both the hearing-impaired group and the comparison group showed increased income levels over time. In the hearing-impaired group, the income levels at 4 and 5 years post-enrollment were higher than the initial income level (each p < 0.001). In the comparison group, the income levels of all the participants after 1-5 years were higher than the initial income level (each p < 0.001). The interaction of time*hearing impairment was statistically significant (p = 0.021).

CONCLUSION: The increase in income over time was relatively lower in the hearing-impaired adult population; therefore, the gap in income level widened between this population and the normal-hearing population.

PMID:33781058 | DOI:10.21053/ceo.2021.00325

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Development of HIGH-INTENSITY FOCUSED ULTRASOUND(HIFU) Therapy in Inferior Turbinate Hypertrophy

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Clin Exp Otorhinolaryngol. 2021 Mar 30. doi: 10.21053/ceo.2020.02383. Online ahead of print.

ABSTRACT

OBJECTIVES: Inferior turbinate (IT) hypertrophy is the main cause of chronic nasal obstruction. We developed a high-intensity focused ultrasound (HIFU) ablation device to treat patients with IT hypertrophy.

METHODS: First, computed tomography (CT) images of patients without any evidence of sinonasal disease were evaluated to measure and compared the IT, medial mucosal thickness (MT), and space between the nasal septum and IT according to clinical characteristics such as septal deviation. A HIFU prototype was developed based on human anatomical studies. The experimental study was performed in five pigs; the cross-sectional areas of the nasal cavity airway and histological changes at 1 and 4 weeks postoperatively were evaluated to compare the efficacy of HIFU turbinoplasty with that of radiofrequency turbinoplasty and control.

< p>RESULTS: The mean medial MT of the anterior, middle, and posterior portions of the IT were 4.66±1.14, 4.23±0.97, and 6.17±1.29 mm, respectively. The mean medial IT spaces was 2.65±0.79 mm. The diameter and focal depth of the prototype were 4 mm and 3 mm. HIFU showed no postoperative complications including bleeding or scar formation. After HIFU treatment, the cross-sectional area of the nasal airway increased by 196.62(7.8%) mm3 and 193.74(8.3%) mm3 at 1 week and 4 weeks, compared with the increase of 87.20(3.1%) mm3 and 213.81(9.0%) mm3, respectively, after radiofrequency therapy. Qualitative histologic analysis after radiofrequency turbinoplasty showed epithelial layer disruption at 1 week and increased fibrosis along with decreased glandular structure at 4 weeks. The HIFU group had an intact epithelial layer at 1 week postoperatively. However, significant differences were observed at 4 weeks, including increased fibrosis, and decreased glandular structure.

CONCLUSION: The efficacy and safety of HIFU turbinoplasty had been observed in an animal study. Our results warrant the need for further human clinical trials.

PMID:33781059 | DOI:10.21053/ceo.2020.02383

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Extraction of Aural Foreign Bodies in a Rural Setting: 10-Year Review and a Novel Method to Remove Magnetic Stones

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Ear Nose Throat J. 2021 Mar 30:1455613211006007. doi: 10.1177/01455613211006007. Online ahead of print.

ABSTRACT

BACKGROUND: The external auditory canal's unique anatomical characteristics made the presence of foreign bodies (FBs) a clinical challenge, particularly in rural settings without ready access to tertiary care and specialist intervention.

AIMS: Our study surveys the experience in aural FBs surgical management in a rural Australian tertiary center. It proposes a safe, easy, and affordable technique to remove stones from the ear canal.

METHODS: We have completed a 10-year retrospective surgical chart review, including 474 patients (52 adults and 428 children) requiring surgical management to remove aural FBs at the Royal Darwin Hospital, Northern Territory, Australia. We surveyed for patient demographics, foreign-body description, complications, location, and removal attempts. We identified what factors determine the need for surgical management and propose a technique for a safe, uncomplicated, and affordable removal of stones from the ear canal after applying this method in a small subgroup.

RESULTS: The most common FBs requiring surgery in children were stones. A predominance in the Aboriginal population from remote communities was found, leading to a nasal bridle magnet technique to remove stones in rural settings. This method reduces the number of extraction attempts of the most frequent FB found in children's ears, aimin g to minimize complications, negative experiences, and health cost.

CONCLUSION: Contrary to international literature, stones were found to be the most common FB in remote aboriginal populations. The proposed technique reduces the number of extraction attempts of the most frequent FB found in children's ears, aiming to minimize complications, negative experiences, and health cost.

PMID:33781128 | DOI:10.1177/01455613211006007

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Chronic Invasive Fungal Sinusitis With Negative Histopathology: A Diagnostic Challenge

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Ear Nose Throat J. 2021 Mar 30:145561320973773. doi: 10.1177/0145561320973773. Online ahead of print.

ABSTRACT

Although the diagnosis of chronic invasive fungal sinusitis relies chiefly on identification of invasive fungi on histology, the insidious nature of the disease can preclude detection of fungal organisms. Here, we present a case of chronic invasive fungal sinusitis with negative histopathologic findings and a definitive diagnosis made through fungal DNA detection. C linicians should consider polymerase chain reaction an important complement to histology and culture in the diagnosis of chronic invasive fungal sinusitis.

PMID:33781123 | DOI:10.1177/0145561320973773

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Giant Fibrovascular Polyp as an Unusual Cause of Globus Pharyngeus

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Ear Nose Throat J. 2021 Mar 30:1455613211003989. doi: 10.1177/01455613211003989. Online ahead of print.

ABSTRACT

Differential diagnosis of globus sensation in an otherwise asymptomatic patient should include hypopharyngeal fibrovascular polyp to avoid potentially fatal complications like airway compromise following regurgitation. We present a case of a 74-year-old man with a 13-cm long hypopharyngeal fibrovascular polyp with 9 months history of globus sensation. A narrow stal k of the giant polyp allowed endoscopic removal and complete resection with the CO2 laser. Histopathological examination was conclusive for the fibrovascular polyp.

PMID:33781124 | DOI:10.1177/01455613211003989

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COVID19 and acute lymphoblastic leukemias of children and adolescents: Updated recommendations (Version 2) of the Leukemia Committee of the French Society for the fight against Cancers and leukemias in children and adolescents (SFCE)

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Bull Cancer. 2021 Mar 11:S0007-4551(21)00082-5. doi: 10.1016/j.bulcan.2021.02.004. Online ahead of print.

ABSTRACT

Since the emergence of the SARS-CoV-2 infection, many recommendations have been made. However, the very specific nature of acute lymphoblastic leukemias and their treatment in children and adolescents led the Leukemia Committee of the French Society for the fight against Cancers and leukemias in children and adolescents (SFCE) to propose more specific recommendations. Here is the second version of these recommendations updated according to the evolution of knowledge on COVID19.

PMID:33781551 | DOI:10.1016/j.bulcan.2021.02.004

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