Otolaryngology Consult Protocols in the Setting of COVID-19: The University of Pittsburgh Approach

xlomafota13 shared this article with you from Inoreader Otolaryngology Consult Protocols in the Setting of COVID-19: The University of Pittsburgh Approach Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Mar 29:34894211005937. doi: 10.1177/00034894211005937. Online ahead of print. ABSTRACT OBJECTIVE: To analyze trends in otolaryngology consultations and provide algorithms to guide management during the COVID-19 pandemic. METHODS: A retrospective cohort study at a single institution tertiary care hospital. A total of 95 otolaryngology consultations were performed from March 1, 2020 to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019 to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data collected included patient demographics, COVID-19 status, reason for consult, location of consult, type of consult, procedures performed, need for surgical intervention, length of hospital stay and recommended follow up. RESULTS: Patient populations in the pre-COVID-era and COVID-era were similar in terms of their distribution of demographics and chief complaints. Craniofacial trauma was the most common reason for consultation in both periods, followed by vocal fold and airway-related consults. We saw a 21.5% decrease in the rate of consults seen per month during the COVID-era compared to the 6 months prior. Review of trends in the consult workflow allowed for development of several algorithms to safely approach otolaryngology consults during the COVID-19 pandemic. CONCLUSIONS: Otolaryngology consultations provide valuable services to inpatients and patients in the emergency departmen t ranging from evaluation of routine symptoms to critical airways. Systematic otolaryngology consult service modifications are required in order to reduce risk of exposure to healthcare providers while providing comprehensive patient care. PMID:33779296 | DOI:10.1177/00034894211005937 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diagnosis of Retrolingual Obstruction during Drug-Induced Sleep Endoscopy versus Polysomnography with Nasopharyngeal Tube in Patients with Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Diagnosis of Retrolingual Obstruction during Drug-Induced Sleep Endoscopy versus Polysomnography with Nasopharyngeal Tube in Patients with Obstructive Sleep Apnea Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Mar 29:34894211005944. doi: 10.1177/00034894211005944. Online ahead of print. ABSTRACT OBJECTIVE: To compare the retrolingual obstruction during drug-induced sleep endoscopy (DISE) with the retrolingual obstruction during polysomnography with nasopharyngeal tube (NPT-PSG). METHODS: A cross-sectional study of 77 consecutive patients with moderate and severe obstructive sleep apnea (OSA) was conducted. After 15 patients were excluded from t he study for not completing DISE or NPT-PSG successfully, 62 patients were included in this study. Retrolingual sites of obstruction grade 2 determined by DISE according to the VOTE (velum, oropharynx lateral wall, tongue base, and epiglottis) classification were considered as retrolingual obstruction, while apnea-hypopnea index (AHI) ≥ 15 events/hour determined by NPT-PSG was considered as retrolingual obstruction. The extent of agreement between DISE and NPT-PSG findings was evaluated using unweighted Cohen's kappa test. RESULTS: The 62 study participants (11 moderate OSA, 51 severe OSA) had a mean (SD) age of 39.8 (9.9) years, and 58 (94%) were men. No statistically significant differences between included and excluded patients were observed in patient characteristics. The extent of agreement in retrolingual obstruction between DISE and NPT-PSG was 80.6% (Cohen k = 0.612; 95% CI, 0.415-0.807). CONCLUSION: Retrolingual obstruction requiring treatment showed go od agreement between DISE and NPT-PSG, suggesting that NPT-PSG may also be a reliable method to assess the retrolingual obstruction. PMID:33779299 | DOI:10.1177/00034894211005944 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of Conductive Hearing Loss with the Structural Changes in the Organ of Corti

xlomafota13 shared this article with you from Inoreader Association of Conductive Hearing Loss with the Structural Changes in the Organ of Corti Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Objective: The aim of the study was to evaluate the association of conductive hearing loss (CHL) with the structural changes in the organ of Corti. Methods: Twenty ears of 10 healthy adult Wistar albino rats were included in the study. The right ears (n = 10) of the animals served as controls (group 1), and no surgical intervention was performed in these ears. A tympanic membrane perforation without annulus removal was performed under operative microscope on the left ears (n = 5) in 5 of 10 animals (group 2). A tympanic membrane perforation with annulus removal was performed under operative microscope on the left ears (n = 5) of the remaining 5 animals (group 3). Auditory brainstem response testing was performed in the animals before the interventions. After 3 months, the animals were sacrificed, their temporal bones were removed, and inner ears were investigated using scanning electron microscopy (SEM). The organ of Corti was evaluated from the cochlear base to apex in the modiolar axis, and the parameters were scored semiquantitatively. Results: In group 1, the pre- and post-intervention hearing thresholds were similar (p #x3e; 0.05). In group 2, a hearing decrease of at least 5 dB was encountered in all test frequencies (p #x3e; 0.05). In group 3, at the frequency range of 2–32 kHz, there was a significant hearing loss after 3 months (p #x3c; 0.01). After 3 months, the hearing thresh olds in group 2 and 3 were higher than group 1 (p #x3c; 0.01). The hearing threshold in group 3 was higher than group 2 (p #x3c; 0.01). On SEM evaluation, the general cell morphology and stereocilia of the outer hair cells were preserved in all segments of the cochlea in group 1 with a mean SEM score of 0.2. There was segmental degeneration in the general cell morphology and outer hair cells in group 2 with a mean SEM score of 2.2. There was widespread degeneration in the general cell morphology and outer hair cells in group 3 with a mean SEM score of 3.2. The SEM scores of group 2 and 3 were significantly higher than group 1 (p #x3c; 0.05). The SEM scores of group 3 were significantly higher than group 2 (p #x3c; 0.05). Conclusion: CHL may be associated with an inner ear damage. The severity of damage appears to be associated with severity and duration of CHL. Early correction of CHL is advocated in order to reverse or prevent progression o f the inner ear damage, which will enhance the success rates of hearing restoration surgeries. Subjective differences and compliance of the hearing aid users may be due to the impact of CHL on inner ear structures. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Langerhans Cell Histiocytosis in Paediatric Zygoma Swelling

xlomafota13 shared this article with you from Inoreader Langerhans Cell Histiocytosis in Paediatric Zygoma Swelling Via Otolaryngology Indian Abstract Langerhans cell histiocytosis (LCH) is a rare neoplasm characterized by accumulation of histiocytes in various tissues. It has a wide clinical spectrum and its presentation may mimic clinical features of common diseases. High level of suspicion is required for early diagnosis. Here is a rare case of a rapidly aggressive LCH which first presented with right zygomatic swelling. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Augmented Reality with HoloLens® in Parotid Tumor Surgery: A Prospective Feasibility Study

xlomafota13 shared this article with you from Inoreader Augmented Reality with HoloLens® in Parotid Tumor Surgery: A Prospective Feasibility Study Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Introduction: Augmented reality can improve planning and execution of surgical procedures. Head-mounted devices such as the HoloLens® (Microsoft, Redmond, WA, USA) are particularly suitable to achieve these aims because they are controlled by hand gestures and enable contactless handling in a sterile environment. Objectives: So far, these systems have not yet found their way into the operating room for surgery of the parotid gland. This study explored the feasibility and accuracy of augmented reality-assisted parotid surgery. Methods: 2D MRI holographic images were created, and 3D holograms were reconstructed from MRI DICOM files and made visible via the HoloLens. 2D MRI slices were scrolled through, 3D images were rotated, and 3D structures were shown and hidden only using hand gestures. The 3D model and the patient were aligned manually. Results: The use of augmented reality with the HoloLens in parotic surgery was feasible. Gestures were recognized correctly. Mean accuracy of superimposition of the holographic model and patient's anatomy was 1.3 cm. Highly significant differences were seen in position error of registration between central and peripheral structures (p = 0.0059), with a least deviation of 10.9 mm (centrally) and highest deviation for the peripheral parts (19.6-mm deviation). Conclusion: This pilot study offers a first proof of concept of the clinical feasibility of the HoloLens for parotid tumor surgery. Workflow is not affected, but addition al information is provided. The surgical performance could become safer through the navigation-like application of reality-fused 3D holograms, and it improves ergonomics without compromising sterility. Superimposition of the 3D holograms with the surgical field was possible, but further invention is necessary to improve the accuracy. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Contemporary management of the neck in nasopharyngeal carcinoma

xlomafota13 shared this article with you from Inoreader Contemporary management of the neck in nasopharyngeal carcinoma Via Head & Neck Abstract Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Establishment and validation of a novel nomogram to predict overall survival in nasopharyngeal carcinoma with lymph node metastasis

xlomafota13 shared this article with you from Inoreader Establishment and validation of a novel nomogram to predict overall survival in nasopharyngeal carcinoma with lymph node metastasis Via Head & Neck Abstract Background The aim of the present study was to establish and validate a nomogram to predict the overall survival (OS) in nasopharyngeal carcinoma (NPC) patients with lymph node metastasis (LNM). Methods A novel nomogram was constructed using 863 patients with LNM‐positive NPC from the Surveillance, Epidemiology, and End Results (SEER) database. Significant prognostic factors in the nomograms were determined using multivariate Cox risk analysis. The predictive capability was evaluated using calibration curves and decision curve analysis (DCA). Results Multivariate analysis identified seven factors that could be used to construct the nomogram: age, pathological type, T stage, M stage, surgery of primary site, radiotherapy, and chemotherapy. The calibration curves and DCA demonstrated optimal agreement. Based on the nomogram, all patients could be stratified into three risk groups: low, middle, and high. Conclusions The novel nomogram demonstrated its potential as an individualized tool to predict OS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Survival outcomes for head and neck patients with Medicaid: A health insurance paradox

xlomafota13 shared this article with you from Inoreader Survival outcomes for head and neck patients with Medicaid: A health insurance paradox Via Head & Neck Abstract Purpose Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid. Methods A cohort of 18–64‐year‐old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007–2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC‐specific mortality. Results Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non‐Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured. Conclusion Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Determination of posterolateral oropharyngeal wall thickness and the potential implications for transoral surgical margins in tonsil cancer

xlomafota13 shared this article with you from Inoreader Determination of posterolateral oropharyngeal wall thickness and the potential implications for transoral surgical margins in tonsil cancer Via Head & Neck Abstract Background Margins in transoral surgery for tonsil cancer can be limited by oropharyngeal wall thickness (OWT), but the normal range is not well established. Methods In 240 noncancer subjects, OWT was measured bilaterally in the vicinity of the tonsils with MRI. Statistical analysis was performed to assess for interaction of age, sex, location, and obesity. Results Mean(SD) OWT measured 3.4(0.6) mm posteriorly, 3.7(2.0) mm between the styloglossus and stylopharyngeus, and 5.3(0.8) mm laterally. OWT was greater in men, correlated with obesity, decreased posteriorly and laterally in the 60–80 versus 40–59 year age groups, and increased when styloglossus/stylopharyngeus were closer. OWT was <5 mm in 36.7%–97.9% of locations, with the largest percentage below this threshold located posteriorly. Conclusions OWT is frequently <5 mm, particularly in the posterior and intermuscular areas, suggesting that a smaller surgical margin may need to be accepted in transoral tonsil cancer surgery for anatomic reasons. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females?

xlomafota13 shared this article with you from Inoreader Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females? Via Folia Phoniatrica et Logopaedica Background: The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers. Methods: The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pat hology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a:]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with t tests. Results: On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, p = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = –0.35, p = 0.000) and harmonics-to-noise ratio (HNR; ρ = –0.30, p = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, p = 0.000) and Tilt (ρ = –0.40, p = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak. Conclusion: The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers. Folia Phoniatr Logop View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

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

xlomafota13 shared this article with you from Inoreader New Visionary in Upper Airway Surgeries–THRIVE, a Tubeless Ventilation Via Otolaryngology Indian 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. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.