Τετάρτη 10 Φεβρουαρίου 2021

Are sinonasal dissection courses a valid instrument for endoscopic sinus surgeons? A report on 7-years of experience.

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Are sinonasal dissection courses a valid instrument for endoscopic sinus surgeons? A report on 7-years of experience.

Acta Otorhinolaryngol Ital. 2020 Dec;40(6):415-420

Authors: Pagella F, Emanuelli E, Benazzo M, Pusateri A, Ugolini S, Melegatti M, Ciorba A, Pelucchi S

PMID: 33558769 [PubMed - in process]

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Effectiveness of superior eyelid endoscopic-assisted approach in the management of selected orbital abscess: considerations on 4 cases.

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Effectiveness of superior eyelid endoscopic-assisted approach in the management of selected orbital abscess: considerations on 4 cases.

Acta Otorhinolaryngol Ital. 2020 Dec;40(6):421-425

Authors: Dallan I, Cristofani-Mencacci L, Cambi C, Scarano M, Casani AP, Seccia V

PMID: 33558770 [PubMed - in process]

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Structural changes in the extracellular matrix after cross-linking of nasal polyp tissue.

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Structural changes in the extracellular matrix after cross-linking of nasal polyp tissue.

Acta Otorhinolaryngol Ital. 2020 Dec;40(6):426-434

Authors: Coronel N, Pezato R, do Amaral JB, Ticlia L, Pinto Bezerra TF, Gomes LF, Dreyfuss J, Chamon W, Gregório LC

PMID: 33558771 [PubMed - in process]

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Effects of biological therapies on chronic rhinosinusitis in severe asthmatic patients.

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Effects of biological therapies on chronic rhinosinusitis in severe asthmatic patients.

Acta Otorhinolaryngol Ital. 2020 Dec;40(6):435-443

Authors: Bandi F, Gallo S, Preti A, Mozzanica F, Visca D, Marelli M, Maddalone E, Gambarini C, Vaghi A, Spanevello A, Castelnuovo P

Abstract
Objective: The introduction of monoclonal antibody (mAb) therapies represents a promising treatment for refractory chronic rhinosinusitis (CRS). We assessed the effects of selected mAbs (omalizumab, mepolizumab, benralizumab) on CRS in severe asthmatic patients in a real-life setting.
Methods: A prospective observational study on severe asthmatic patients, treated with 3 different mAb (omalizumab, mepolizumab, benralizumab), and comorbid CRS was conducted. All patients were followed for 52 weeks. The degree of nasal control, SinoNasal Outcome Test (SNOT) 22, Nasal Polyp Score (NPS), Lund Kennedy Score (LKS) were collected at baseline and at 52-week.
Results: 40 patients (33 with nasal polyps) were studied. 33 patients (82.5%) had uncontrolled nasal disease at baseline, and 15 (37.5%) were uncontrolled after 52 weeks. Significant improvement was observed for SNOT 22 (P < 0.001), SNOT 1-12 (P < 0.001) and degree of nasal control (P < 0.001). Differences in NPS (P = 0.130) and LKS (P = 0.124) were not significant. Net change in the above-mentioned parameters among the three treatment groups was not significantly different.
Conclusions: The study shows an improvement of nasal symptoms after 52 weeks of mAb treatment, which was not associated with significant improvement of endoscopic findings. Larger studies are needed to assess the real-life efficacy of mAbs in CRS.

PMID: 33558772 [PubMed - in process]

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Evaluation of a large cohort of adult patients with Meniere's disease: bedside and clinical history.

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Evaluation of a large cohort of adult patients with Ménière's disease: bedside and clinical history.

Acta Otorhinolaryngol Ital. 2020 Dec;40(6):444-449

Authors: Teggi R, Battista RA, Di Berardino F, Familiari M, Cangiano I, Gatti O, Bussi M

Abstract
Objective: The purpose of this study was to assess vestibular findings and clinical history in a large cohort of patients affected by Ménière's disease.
Methods: We retrospectively analysed 511 adult patients fulfilling criteria for definite unilateral Ménière's disease according to Barany Society. Thorough clinical history, audiometric exam, central nervous system MRI, quantification of serum autoantibodies and complete vestibular function test were performed.
Results: Mean age at clinical record was 55.4 years, while age at onset of the first vertigo attack was 47.4 ± 14.3 years. Ménière's disease overlapped with migraine in 43.4% of patients. In 31.7% of cases, positivity was found for at least one autoantibody. Forty-nine patients (9.6%) had family history for Ménière's disease. Bedside examination resulted in 14.7% positivity for video head impulse test, 58.9% for skull vibration-induced nystagmus, 38.7% for the positional test and 23.1% for the post head shaking test. Complete negative examination was reported in 115 cases.
Conclusions: Ménière's disease was seen to present a characteristic phenotypic pattern in our cohort, confirming the crucial role of thorough anamnesis and bedside examination in diagnosis.

PMID: 33558773 [PubMed - in process]

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Subtotal petrosectomy and cochlear implantation.

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Subtotal petrosectomy and cochlear implantation.

Acta Otorhinolaryngol Ital. 2020 Dec;40(6):450-456

Authors: D'Angelo G, Donati G, Bacciu A, Guida M, Falcioni M

Abstract
Objective: The objective of this study is to analyse surgical outcomes in a series of patients who underwent subtotal petrosectomy in combination with cochlear implantation.
Methods: Retrospective chart review. Thirty patients (32 ears) underwent subtotal petrosectomy and cochlear implantation in one stage. Indications for subtotal petrosectomy included the following: cholesteatoma, chronic otitis media, previous canal wall-down, osteoradionecrosis, revision surgery for clinical reasons, inner ear malformations, middle ear anatomical variations and severe cochlear ossification.
Results: Follow-up ranged from 2 to 54 months. Only 2 complications related to the subtotal petrosectomy (1 subcutaneous abdominal haematoma and 1 subcutaneous abdominal seroma) occurred in this series. Complete electrode insertion was achieved in all but 4 cases.
Conclusions: Subtotal petrosectomy is a safe procedure and can offer technical advantages in some cases of complex cochlear implantation.

PMID: 33558774 [PubMed - in process]

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The effect of N-acetyl cysteine on biofilm layers in an experimental model of chronic otitis media.

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The effect of N-acetyl cysteine on biofilm layers in an experimental model of chronic otitis media.

Acta Otorhinolaryngol Ital. 2020 Dec;40(6):457-462

Authors: Ersoy ÃallıoÄlu E, Berçin S, BaÅdemir G, KiriÅ M, Tatar Ä°, Tuzuner A, OÄuzhan T, Müderris T, Sargon MF, Korkmaz MH

Abstract
Objectıve: The aim of this study was to investigate the efficacy of N-acetylcysteine (NAC) on biofilm layers and on the course of disease in chronic otitis media.
Methods: Twenty-five rats that were induced with chronic otitis media (COM) were separated into three groups. In Group 1 (N = 18), 0.2% ciprofloxacin + 0.1% dexamethasone sodium phosphate + 0.5 mg/ml NAC solution was locally injected to the right ear of the rats; in Group 2, (N=18) 0.2% ciprofloxacin + 0.1% dexamethasone sodium phosphate was locally injected to the left ear of the rats. No treatment was applied to either ear of rats in Group 3 (N = 5). Histopathological and scanning electron microscope (SEM) evaluations were performed in all groups.
Results: SEM revealed biofilm formation in all COM induced groups. No significant difference was seen between groups 1 and 2 in terms of suppuration levels, fibrosis, inner ear involvement, infection staging and biofilm formation (p > 0.05).
Conclusıons: In this study, while histopathological and SEM evaluation revealed no effect of 0.5 mg/ml NAC on the biofilm layer in COM-induced rats, further studies with NAC at different concentrations are still needed on different types of experimental animals.

PMID: 33558775 [PubMed - in process]

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The Effects of Using Bioglue in Nasal Septal Surgery.

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The Effects of Using Bioglue in Nasal Septal Surgery.

Ear Nose Throat J. 2021 Feb 09;:145561321991349

Authors: Subasi B, Guclu E

Abstract
OBJECTIVES: Nasal septal surgery is one of the most common surgical procedure performed by otolaryngologists. Nasal packs are used for bleeding control, prevention of septal hematoma, replacement of mucoperichondrial flaps, and stabilization of the septum after nasal septal surgery. The aim of this study was to investigate the effects of albumin-glutaraldehyde-based tissue adhesive (Bioglue), which can be used as an alternative to nasal pack on the nasal septum after experimental nasal septum surgery.
METHODS: A total of 16 female Wistar albino rats were randomly separated into the study group (n = 10) and the control group (n = 6). After raising the mucoperichondrial flap on one side of the septum, Bioglue was used to fix the mucoperichondrial flap over the septal cartilage ın the study group and nasal packs (Merocel) were used for fixation in the control group. The rats were sacrificed at 2 and 4 weeks after septoplasty. All the tissue samples were evaluated under light microscope by the same pathologist in respect of foreign-body reaction, degree of inflammation, granulation tissue, fibrosis, cartilage damage, and cilia and goblet cell damage. In the control group, the Merocel packs were removed after 2 days and the groups were compared in terms of hematoma.
RESULTS: No hematoma was observed in any group. Septal perforation was determined in all the study group participants and loss of cilia and goblet cells and foreign-body reaction were found in 8 samples of the study group participants and in none of the control group.
CONCLUSIONS: The results of this study show that Bioglue caused segmental cartilage injury; therefore, it may not suitable for use following septal surgery.

PMID: 33559491 [PubMed - as supplied by publisher]

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Inferior Surface Leukoplakia of Vocal Folds: Risk of Recurrence: A Preliminary Study.

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Inferior Surface Leukoplakia of Vocal Folds: Risk of Recurrence: A Preliminary Study.

Ear Nose Throat J. 2021 Feb 09;:145561321989437

Authors: Hasegawa H, Matsuzaki H, Makiyama K, Oshima T

Abstract
OBJECTIVES: This study aimed to identify vocal fold leukoplakia (VFL) lesions on the inferior surface as a risk factor for recurrence.
METHODS: This was a retrospective study with data collected from 2001 to 2018. The study comprised 37 patients with VFL, divided into the nonrecurrent and recurrent groups. We examined the clinicopathological characteristics and the surgical procedures performed in each patient.
RESULTS: Among the 37 patients, 15 (40.5%) had residual (3) or recurrent (12) VFL. Of those patients with and without recurrence, 8 of 12 (66.7%) and 6 of 22 (27.3%), respectively, had inferior surface lesions of the vocal fold at the initial operation (P = .036). Recurrences were significantly higher in patients with inferior surface lesions. Other evaluated factors did not show significance for recurrence.
CONCLUSION: The presence of VFL lesions on the inferior surface is a significant risk factor for recurrence.

PMID: 33559492 [PubMed - as supplied by publisher]

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How Can We Manage Penetrating Neck Injury with Blunt Carotid Injury and Spinal Injury: Case Report and Review of Literature

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Abstract

The Neck is a cylindrical structure containing vital neurovascular and visceral structures tightly packed in a relatively small volume. Mortality rate increases when there is an injury to vascular structures especially the carotid artery, surrounded by other vital neurovascular structures; injuring the neck leads to devastating morbidity when compared to other injuries. With increased awareness of screening techniques and improved detection rates, there is an urge in opting for selective neck exploration and initial aggressive antithrombotic therapy for blunt carotid artery injuries. Here we report a case of a 20-year-old male, with a lacerated injury of the right side of the neck causing transection of the right internal jugular vein, grade 4 (Denver classification) blunt carotid injury, along with cervical vertebral fractures without neurological deficits. The patient underwent emergency surgical neck wound exploration, flush ligation of transacted Right Intern al Jugular Vein, and conservative management for blunt carotid artery injury using anti platelets (Aspirin and Clopidogrel) avoiding any immediate neurological deficits. Whenever lacerated neck wounds are evaluated, the chance of blunt injury to the carotid is to be borne in mind and such an injury can be managed with double antiplatelet therapy, if there are no demonstrable neurological deficits.

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(1) The Cole formula for uncuffed tubes: ID (intenal diameter) in mm= (age in years)/4 + 4 (2) The Motoyama formula for cuffed ETTs in children aged 2 yr or older: ID in mm = (age in years)/4 + 3.5 (3) The Khine formula for cuffed ETTs in children younger than 2 yr: ID in mm = (age in years)/4 + 3.0

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https://resus.me/kids-tracheal-tubes-formulas-galore/

An ultrasound study of paediatric airways showed sonographic measurement to be a better predictor of tracheal tube size (using a formula – derived and then validated – to estimate external tube diameter) than traditional formulae for selecting the internal tube diameter based on age. Since the measurements, taken at the lower edge of the cricoid cartilage, were made after patients were paralyzed, and were performed without ventilation or positive end-expiratory pressure to minimize fluctuation in tracheal diameter, taking about 30 seconds, this is not something I anticipate applying in critical care practice. However, the paper does provide a good opportunity to revise some of the existing formulae. They used:
(1) The Cole formula for uncuffed tubes: ID (intenal diameter) in mm= (age in years)/4 + 4
(2) The Motoyama formula for cuffed ETTs in children aged 2 yr or older: ID in mm = (age in years)/4 + 3.5
(3) The Khine formula for cuffed ETTs in children younger than 2 yr: ID in mm = (age in years)/4 + 3.0
The formula established in the study was:

cuffed ETT outer diameter (OD) = 0.46 x (subglottic diameter) + 1.56
uncuffed ETT OD = 0.55 x (subglottic diameter) + 1.16
Age in months also correlated with optimal ETT size in mm, although the correlation was weaker than for subglottic diameter:

cuffed ETT OD = 0.027 x (age) + 5.2
uncuffed ETT OD = 0.030 x (age) + 5.4
BACKGROUND: Formulas based on age and height often fail to reliably predict the proper endotracheal tube (ETT) size in pediatric patients. We, thus, tested the hypothesis that subglottic diameter, as determined by ultrasonography, better predicts optimal ETT size than existing methods.
METHODS: A total of 192 patients, aged 1 month to 6 yr, who were scheduled for surgery and undergoing general anesthesia were enrolled and divided into development and validation phases. In the development group, the optimal ETT size was selected according to standard age-based formulas for cuffed and uncuffed tubes. Tubes were replaced as necessary until a good clinical fit was obtained. Via ultrasonography, the subglottic upper airway diameter was determined before tracheal intubation. We constructed a regression equation between the subglottic upper airway diameter and the outer diameter of the ETT finally selected. In the validation group, ETT size was selected after ultrasonography using this regression equation. The primary outcome was the fraction of initial cuffed and uncuffed tube sizes, as selected through the regression formula, that proved clinically optimal.
RESULTS: Subglottic upper airway diameter was highly correlated with outer ETT diameter deemed optimal on clinical grounds. The rate of agreement between the predicted ETT size based on ultrasonic measurement and the final ETT size selected clinically was 98% for cuffed ETTs and 96% for uncuffed ETTs.
CONCLUSIONS: Measuring subglottic airway diameter with ultrasonography facilitates the selection of appropriately sized ETTs in pediatric patients. This selection method better predicted optimal outer ETT diameter than standard age- and height-based formulas.

Prediction of Pediatric Endotracheal Tube Size by Ultrasonography
Anesthesiology. 2010 Oct;113(4):819-24

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3 THOUGHTS ON "KIDS TRACHEAL TUBES – FORMULAS GALORE"
Christopher
MARCH 30, 2011 AT 9:32 AM
I think the question we have in the field is not tube size but rather cuff inflation volume! Easy for adults, 10 mL until the pilot balloon feels solid. For kids do we start with 5 mL? Less? Tube size based?
All we have is a Broselow tape and cuffed tubes, no manometers to get the 20 cmH2O or less required to seal the airway.
Are there any formulas for this?

REPLY
Cliff
MARCH 30, 2011 AT 11:33 AM
Good question! I think less – in fact less even for adults check out this table http://www.ncbi.nlm.nih.gov/pmc/articles/PMC535565/table/T3/ which comes from the article 'Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure' at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC535565/.
I think for kids especially a manometer is a good idea
Cliff

REPLY
Christopher
MARCH 31, 2011 AT 10:35 AM
Uh oh, field experience shows we fill the cuff with a full syringe! Likely we need to adjust our thinking and probably grab some more studies to get our protocols in order. Thank you for the link.

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Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy.

Ear Nose Throat J. 2021 Feb 09;:145561320980511

Authors: Tareerath M, Mangmeesri P

Abstract
OBJECTIVES: To retrospectively investigate the reliability of the age-based formula, year/4 + 3.5 mm in predicting size and year/2 + 12 cm in predicting insertion depth of preformed endotracheal tubes in children and correlate these data with the body mass index.
PATIENTS AND METHODS: Patients were classified into 4 groups according to their nutritional status: thinness, normal weight, overweight, and obesity; we then retrospectively compared the actual size of endotracheal tube and insertion depth to the predicting age-based formula and to the respective bend-to-tip distance of the used preformed tubes.
RESULTS: Altogether, 300 patients were included. The actual endotracheal tube size corresponded with the Motoyama formula (64.7%, 90% CI: 60.0-69.1), except for thin patients, where the calculated size was too large (0.5 mm). The insertion depth could be predicted within the range of the bend-to-tip distance and age-based formula in 85.0% (90% CI: 81.3-88.0) of patients.
CONCLUSION: Prediction of the size of cuffed preformed endotracheal tubes using the formula of Motoyama was accurate in most patients, except in thin patients (body mass index < -2 SD). The insertion depth of the tubes was mostly in the range of the age-based-formula to the bend-to-tip distance.

PMID: 33559493 [PubMed - as supplied by publisher]

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