Safety of different surgical modalities for recurrent respiratory papillomatosis resection: A systematic review and meta‐analysis

AlexandrosSfakianakis shared this article with you from Inoreader Safety of different surgical modalities for recurrent respiratory papillomatosis resection: A systematic review and meta‐analysis via Wiley: Clinical Otolaryngology: Table of Contents Abstract Background Currently, the most common surgical modalities used for recurrent respiratory papillomatosis (RRP) resection are microdebrider, carbon dioxide (CO2) laser and potassium-titanyl-phosphate (KTP) laser. However, complication rates vary among different surgical modalities and have been controversial in different studies. Objective of Review This study systematically reviews the available studies which reported intra-operative and post-operative complications, aiming to compare the safety of microdebrider, CO2 laser and KTP laser. Type of Review Meta-analysis. Search Strategy Seven electronic databases (PubMed/MEDLINE, EMBASE[Ovid], Scopus, Cochrane Library and Web of Science) were searched from inception through 28 April 2022. Randomised controlled, prospective or retrospective observational studies that recorded the complications of three different surgical modalities for RRP resection were included in the meta-analysis. Evaluation Method Outcomes of interest were intra-operative and post-operative complications, and complication rate was calculated to evaluate the safety of surgical methods. Results Twenty different studies were included in quantitative synthesis. Only one study compared outcomes of those three kinds of treatment modalities simultaneously, two studies compared microdebrider and CO2 laser, and the remaining studies focussed on only one of three treatments. The weighted average complication rate for microdebrider was 0.03 (95% confidence interval [CI] 0.00–0.21), n = 6, for CO2 laser treatment was 0.16 (95% CI 0.09–0.25), n = 14 and for KTP laser treatment was 0.04 (95% CI 0.00–0.14), n = 4. Conclusion The limited evidence demonstrated that CO2 lasers in the surgical treatment of RRP may lead to more surgical complications, and microdebrider and KTP lasers may be safer. However, the heterogeneous data limit any strong comparison of outcomes of different treatment of laryngeal papillomas. Future randomised controlled trials that directly compare the safety of different surgical modalities are needed. View on Web

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Automated detection of glottic laryngeal carcinoma in laryngoscopic images from a multicentre database using a convolutional neural network

AlexandrosSfakianakis shared this article with you from Inoreader Automated detection of glottic laryngeal carcinoma in laryngoscopic images from a multicentre database using a convolutional neural network via Wiley: Clinical Otolaryngology: Table of Contents Abstract Objective Little is known about the efficacy of using artificial intelligence (AI) to identify laryngeal carcinoma from images of vocal lesions taken in different hospitals with multiple laryngoscope systems. This multicentre study aimed to establish an AI system and provide a reliable auxiliary tool to screen for laryngeal carcinoma. Study design Multicentre case–control study. Setting Six tertiary care centres. Participants Laryngoscopy images were collected from 2179 patients with vocal fold lesions. Outcome measures An automatic detection system of laryngeal carcinoma was established and used to distinguish malignant and benign vocal lesions in 2179 laryngoscopy images acquired from 6 hospitals with 5 types of laryngoscopy systems. Pathological examination was the gold standard for identifying malignant and benign vocal lesions. Results Out of 89 cases in the malignant group, the classifier was able to correctly identify laryngeal carcinoma in 66 patients (74.16%, sensitivity). Out of 640 cases in the benign group, the classifier was able to accurately assess the laryngeal lesion in 503 cases (78.59%, specificity). Furthermore, the region-based convolutional neural network (R-CNN) classifier achieved an overall accuracy of 78.05%, with a 95.63% negative predictive value and a 32.51% positive predictive value for the testing data set. Conclusion This automatic diagnostic system has the potential to assist clinical laryngeal carcinoma diagnosis which may improve and standardise the diagnostic capacity of laryngologists using different laryngoscopes. View on Web

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Spontaneous recovery rate of idiopathic sudden sensorineural hearing loss: A systematic review and meta‐analysis

AlexandrosSfakianakis shared this article with you from Inoreader Spontaneous recovery rate of idiopathic sudden sensorineural hearing loss: A systematic review and meta‐analysis via Wiley: Clinical Otolaryngology: Table of Contents Abstract Purpose Steroids comprise the mainstay of treatment for idiopathic sudden sensorineural hearing loss (ISSNHL). Since steroidal treatment was integrated to clinical practice guidelines, newly published no-treatment or placebo arms in clinical trials are scarce. To evaluate the effectiveness of steroidal treatment ± hyperbaric oxygen therapy, the data should be compared to spontaneous recovery. The aim of this paper is to find the most accurate spontaneous recovery rate, in the light of which, other treatment modalities should be judged. Materials and Methods Eligible studies published until July 2021 were identified through systematic searches of 'PubMed', 'Web of Science' and 'Google Scholar'. Retrospective studies and randomised/non-randomised control trials involving only adult participants (≥18 years) with ISSNHL, and placebo/no treatment were included. Only articles that used the American Academy of Otolaryngology–Head and Neck Surgery's diagnostic criteria for ISSNHL were included. Results 942 records initially identified, 166 duplicates and 753 articles were excluded based on article subject, title, and abstract. The full texts of 13 articles were reviewed. Seven studies were included for qualitative synthesis, five papers included in quantitative synthesis. 180 ears were included in pooled statistics. The pooled spontaneous recovery was 60.28% (95% confidence interval [CI] = 38.88%–79.94%) with a heterogeneity of 86.0% (95% CI = 69.4%–93.6%). Conclusions Spontaneous recovery of ISSNHL should not be over-looked, as it may be close to 60%. This may have both clinical and research implications. View on Web

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Efficacy of carbon dioxide laser and caustic agent cauterisation for the focal granular myringitis: A randomised trial

AlexandrosSfakianakis shared this article with you from Inoreader Efficacy of carbon dioxide laser and caustic agent cauterisation for the focal granular myringitis: A randomised trial via Wiley: Clinical Otolaryngology: Table of Contents Abstract Objectives Granular myringitis (GM) is a troublesome disease with a high incidence of recurrence and relapse. CO2 laser vaporisation and trichloroacetic acid (TAA) have been applied in treating several otological diseases, both with favourable therapeutic efficacy. However, long-term therapeutic efficacy of both CO2 laser vaporisation and TAA cauterisation against GM has not yet been evaluated. We aimed to investigate the therapeutic potential of CO2 laser vaporisation and TAA cauterisation in GM management. Study Design Prospective and randomised study. Participants A total of 88 GM patients who failed therapy with boric acid, alcohol and glycerin ear drop otic solution between July 2009 and January 2018 were included. Participants were randomly assigned to receive CO2 laser vaporisation (n = 39) or TAA cauterisation (n = 49). Main Outcome Measures Main outcomes were treatment success, complications after 4 months of treatment, and recurrence within 4–12 months after treatment. Results The success rate was significantly higher in the CO2 group than in the TAA group (94.9% vs. 77.6%, p = .023). After 4 months of treatment, the GM recurrence rate was comparable between the two groups (13.5% vs. 18.4%, p = .562). The CO2 laser group had one case of perforation and one case of severe vertigo, whereas one participant in the TAA cauterisation group experienced hearing loss. Conclusion Both TAA cauterisation and CO2 laser vaporisation are safe and effective treatments for GM. The success rate of CO2 laser vaporisation for treating GM is higher than that of TAA cauterisation. Recurrence rates are comparable within 1 year. View on Web

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The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness – neuroimaging and clinical results

AlexandrosSfakianakis shared this article with you from Inoreader The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness – neuroimaging and clinical results via European Review » Neurology OBJECTIVE: Chronic disorders of consciousness are considered as a serious unresolved problem complicated by significant medical, social, and economic burden. Therefore, improving the conditions and facilitating the rehabilitation management of these patients is of particular interest. In recent years, interesting results of the use of spinal cord stimulation in patients with chronic disorders of consciousness appeared in the world literature, which makes the use of this technique promising in this category of patients. PATIENTS AND METHODS: We analyzed the results of high cervical spinal cord stimulation, both, in tonic and "Burst" modes, in 21 patients with chronic disorders of consciousness and severe spasticity managed in the last two years in FRCC ICMR. In 9 of them pre- and post-stimulation fMRI before and right after the stimulation was also performed for brain functional connectivity assessment. RESULTS: Improvement of the consciousness level was observed in 38.1% (n = 8) and a decrease in spasticity was obtained in 52.4% (n=11) of the patients. The difference in CRS-R score before and after spinal cord stimulation was statistically significant (p=0.028). The fMRI results revealed an increase in functional connectivity of the right anterior insula with several areas that are part of the Dorsal Attention, Visual and Default Mode networks after spinal cord stimulation. CONCLUSIONS: Epidural spinal stimulation at the upper cervical spine level demonstrated its effectiveness in patients with chronic diseases of consciousness of various etiology. Evaluation of the effect of specific stimulation modes requires further controlled study in larger group of patients. L'articolo The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness – neuroimaging and clinical results sembra essere il primo su European Review. View on Web

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Structural Connectivity Affecting Aspiration After Stroke

AlexandrosSfakianakis shared this article with you from Inoreader Structural Connectivity Affecting Aspiration After Stroke via Dysphagia In this study, we investigated brain structural connectivity associated with aspiration after unilateral supratentorial stroke. Patients on oral feeding after stroke were divided into liquid aspiration (22 patients) and normal (18 patients) groups based on videofluoroscopic swallowing studies. Voxel-based lesion –symptom mapping and voxel-wise group comparison of fractional anisotropy, mode of anisotropy, and mean diffusivity maps were conducted. Voxel-based lesion–symptom mapping revealed no significant lesion differences between groups. The aspiration group showed significantly increased fractional an isotropy and mode of anisotropy in the anterior limb and the genu of the internal capsule in the right hemisphere. In contrast, the normal group showed significantly increased mean diff... View on Web

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Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life

AlexandrosSfakianakis shared this article with you from Inoreader Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life via Dysphagia This study included a heterogeneous cohort of 273 outpatients who underwent a modified barium swallow study (MBSS). We found significant correlations between MBSImP total scores and FOIS scores and DHI total scores, but not between MBSImP total scores and EAT-10 total scores. Significant correlations were also found between MBSImP item-level component scores and FOIS scores, EAT-10 total scores, and DHI total scores. Detailed item-level analyses revealed the MBSImP components of bolus transport/lingual motion, oral residue, and tongue base retraction were correlated with EAT-10 item-level scores and DHI item-level scores. The clinically modest associations between physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life reveal different factors... View on Web

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