Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update

xlomafota13 shared this article with you from Inoreader Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update Via The Laryngoscope Objectives/Hypothesis To provide the ADHERE registry Upper Airway Stimulation (UAS) outcomes update, including analyses grouped by body mass index (BMI) and therapy discomfort. Study Design Prospective observational study. Methods ADHERE captures UAS outcomes including apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), therapy usage, patient satisfaction, clinician assessment, and safety over a 1-year period. BMI ≤32 kg/m2 (BMI32) and 32 < BMI ≤35 kg/m2 (BMI35) group outcomes were examined. Results One thousand eight hundred forty-nine patients enrolled in ADHERE, 1,019 reached final visit, 843 completed the visit. Significant changes in AHI (−20.9, P < .0001) and ESS (− 4.4, P < .0001) were demonstrated. Mean therapy usage was 5.6 ± 2.2 hr/day. Significant therapy use difference was present in patients with reported discomfort versus no discomfort (4.9 ± 2.5 vs. 5.7 ± 2.1 hr/day, P = .01). Patients with discomfort had higher final visit mean AHI versus without discomfort (18.9 ± 18.5 vs. 13.5 ± 13.7 events/hr, P = .01). Changes in AHI and ESS were not significantly different. Serious adverse events reported in 2.3% of patients. Device revision rate was 1.9%. Surgical success was less likely in BMI35 versus BMI32 patients (59.8% vs. 72.2%, P = .02). There was a significant therapy use difference: 5.8 ± 2.0 hr/day in BMI32 v ersus 5.2 ± 2.2 hr/day in BMI35 (P = .028). Conclusions Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI32 and BMI35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Correlations between olfactory psychophysical scores and SARS‐CoV‐2 viral load in COVID‐19 patients.

xlomafota13 shared this article with you from Inoreader Correlations between olfactory psychophysical scores and SARS‐CoV‐2 viral load in COVID‐19 patients. Via The Laryngoscope Abstract Objective The aim of this study was to evaluate the correlations between the severity and duration of olfactory dysfunctions (OD), assessed with psychophysical tests, and the viral load on the rhino-pharyngeal swab determined with a direct method, in patients affected by coronavirus disease 2019 (COVID-19). Methods Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and determination of the normalized viral load on nasopharyngeal swab within 10 days of the clinical onset of COVID-19. Results Sixty COVID-19 patients were included in this study. On psychophysical testing 12 patients (20% of the cohort) presented with anosmia, 11 (18.3%) severe hyposmia, 13 (18.3%) moderate hyposmia and 10 (16.7%) mild hyposmia with an overall prevalence of OD of 76.7%. The overall median olfactory score was 50 (IQR 30–72.5) with no significant differences between clinical severity subgroups. The median normalized viral load detected in the series was 2.56E+06 viral copies/106 copies of human beta-2microglobulin mRNA present in the sample (IQR 3.17E+04–1.58E+07) without any significant correlations with COVID-19 severity. The correlation between viral load and olfactory scores at baseline (R2 = 0.0007; p = 0.844) and 60-day follow-up (R2 = 0.0077; p = 0.519) was weak and not significant. Conclusions the presence of OD does not seem to be useful in identifying subjects at risk for being super-spreaders nor who is at risk of developing long-term OD. Similarly, the pathogenesis of OD is probably related to individual factors rather than to viral load and activity. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of severe tongue edema with prone positioning in patients intubated for COVID‐19

xlomafota13 shared this article with you from Inoreader Association of severe tongue edema with prone positioning in patients intubated for COVID‐19 Via The Laryngoscope ABSTRACT Objective Prone positioning is frequently used in patients intubated for COVID-19 related lung injury to improve oxygenation. At our institution, we observed severe tongue edema develop in some of these patients. Hence, we sought to determine the incidence of tongue edema in this cohort and whether prone positioning was a risk factor associated with this complication. Methods A single-system retrospective cohort study of patients intubated for respiratory failure secondary to COVID-19 who subsequently developed clinically notable tongue edema from March 13 to July 5, 2020. Results 260 patients were intubated for COVID-19 related respiratory failure during the study period. 158 patients (60.8%) underwent at least one episode of proning. 12 patients in total (4.6%) developed clinically significant tongue edema. 11 of the 12 patients (91.7%) who developed tongue edema underwent proning prior to the development of edema. Prone positioning was associated with an increased incidence of tongue edema (odds ratio [OR] 7.56, 95% confidence interval [CI] 0.96–59.46, p = 0.027). In all proned patients who developed edema, this complication was noted during proning or shortly after supination (range 0–4 days). Tongue edema was primarily managed with conservative measures; one patient required tracheostomy for definitive management. Conclusion Tongue edema appears to develop in a subset of patients with COVID-19 who are intubated. It appears to be associated with prone positioning but is likely multifactorial in nature. Further investigation into its incidence and pathophysiology is warranted. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Aesthesiometer‐Based Testing for Laryngopharyngeal Hyposensitivity

xlomafota13 shared this article with you from Inoreader Aesthesiometer‐Based Testing for Laryngopharyngeal Hyposensitivity Via The Laryngoscope Objectives/Hypothesis To develop a method for threshold estimation of the laryngeal adductor reflex (LAR) response using Cheung-Bearelly monofilaments. Study Design Cross-sectional. Methods Twenty-two healthy adults (12 men, 10 women) were tested for LAR response outcome using 30 mm 5–0 and 4–0 nylon monofilaments. Tactile stimuli were delivered to the aryepiglottic (AE) fold and medial pyriform sinus (MPS). Dichotomous classifier features and performance (area under the curve (AUC)), the LAR response outcome agreement and disagreement matrix, and test–retest reliability were examined. From those data, a test protocol that would minimize patient burden to estimate the LAR triggering threshold was formulated. Results Classifier performance of 5–0 monofilament stimulation of the AE fold (sensitivity = 0.63, specificity = 0.63, PPV = 0.74, NPV = 0.25) and MPS (sensitivity = 0.45, specificity = 0.77, PPV = 0.74, NPV = 0.23,) was slightly below that of 4–0 monofilament stimulation of the AE fold (sensitivity = 0.82, specificity = 0.50, PPV = 0.82, NPV = 0.50) and MPS (sensitivity = 0.84, specificity = 0.64, PPV = 0.90, NPV = 0.56), based on AUC. LAR response outcome agreement for 5–0 and 4–0 stimulations was high (93%) for 5–0 positive response, but low (29%) for 5–0 negative response. Aesthesiometer test–retest reliability for LAR response outcome was excellent (Cronbach's alpha = 0.97). Conclusions Threshold estimation of the LAR response may be operationalized by adopting a decision tree protocol. For negative LAR response to initial 5–0 monofilament stimulation and positive response to subsequent 4–0 monofilament stimulation, the higher threshold is confirmed. Positive LAR response to 5–0 or 4–0 monofilament stimulation is expected in over 90% of asymptomatic adults. Negative LAR response to 4–0 monofilament stimulation identifies patients at risk for laryngopharyngeal hyposensitivity. Level of Evidence 3b Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Temporal Bone Osteoradionecrosis: An 18‐year, Single‐Institution Experience

xlomafota13 shared this article with you from Inoreader Temporal Bone Osteoradionecrosis: An 18‐year, Single‐Institution Experience Via The Laryngoscope Objectives/Hypothesis To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes. Study Design Retrospective chart review. Methods Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease. Results TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful. Conclusions TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management. Level of Evidence IV Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Slide Tracheoplasty for Congenital Tracheal Stenosis Repair: A Systematic Review and Meta‐Analysis

xlomafota13 shared this article with you from Inoreader Slide Tracheoplasty for Congenital Tracheal Stenosis Repair: A Systematic Review and Meta‐Analysis Via The Laryngoscope Objectives Congenital tracheal stenosis (CTS) is a rare but life-threatening condition in children. At present, slide tracheoplasty has been advocated as the preferred technique for most cases of CTS. However, the morbidity and mortality subsequent to slide tracheoplasty need further elaboration. Therefore, a meta-analysis was performed on the outcomes of slide tracheoplasty in children with CTS. Study Design Systematic review and meta-analysis. Methods Electronic databases, including PubMed, Embase, and Cochrane Library CENTRAL, were systematically searched for the period from January 1990 to March 2021 for literature that reported clinical outcomes of slide tracheoplasty for children with CTS. Meta-regression and subgroup analyses were performed to determine the risk factors for in-hospital mortality and airway reinterventions. Results A total of 25 studies involving 577 patients were included. For children with CTS, in-hospital and overall mortality after slide tracheoplasty was 6.1% (95% CI = 4.2%–8.0%) and 9.7% (95% CI = 7.3%–12.1%), respectively. The incidence of airway reinterventions was 23.0% (95% CI = 15.6%–30.5%). The length of postoperative ventilation and hospital stay was 6.8 days (95% CI = 5.1–8.4 days) and 19.2 days (95% CI = 15.8–22.7 days), respectively. Postoperative complications occurred in 46.6% (95% CI = 35.8%–57.4%) of all patients. Meta-regression analysis showed that a higher proportion of the recently published studies reported significantly better in-hospital survival (coefficient −0.011, P = .021). Conclusions In conclusion, in-hospital mortality after slide tracheoplasty is 6.1%, and the incidence of airway reinterventions is 23.0%. In-hospital mortality after slide tracheoplasty has decreased chronologically. Level of Evidence NA Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Thyroid collision tumor containing oncocytic carcinoma, classical and hobnail variants of papillary carcinoma and areas of poorly differentiated carcinoma

xlomafota13 shared this article with you from Inoreader Thyroid collision tumor containing oncocytic carcinoma, classical and hobnail variants of papillary carcinoma and areas of poorly differentiated carcinoma Via radioactive iodine Arch Endocrinol Metab. 2021 Jul 16:2359-3997000000389. doi: 10.20945/2359-3997000000389. Online ahead of print. ABSTRACT Collision tumors are rare and may comprise components with different behavior, treatments, and prognosis. We report an unprecedented case of aggressive thyroid collision tumor containing widely invasive oncocytic carcinoma (OC), classical and hobnail (HPTC) variants of papillary carcinoma, and poorly differentiated carcinoma (PDTC). The patient underwent total th yroidectomy, radioactive iodine therapy, and within months progressed with local recurrence, and pulmonary metastases requiring neck dissection, external radiotherapy and systemic treatment with sorafenib. The rapid progression, dedifferentiated metastatic lesions, and failure to treatments resulted in the patient's death. The great variety of histological types and the evolution of this case were a challenge for the management of metastatic disease. Widely invasive OC, HPTC and PDTC are considered to have a worse prognosis. HPTC has never been reported as a component of a collision tumor. HPTC and PDTC should call attention to a possible higher-grade transformation. PMID:34283905 | DOI:10.20945/2359-3997000000389 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.