Implantable Doppler Removal After Free Flap Monitoring Among Head and Neck Microvascular Surgeons

xlomafota13 shared this article with you from Inoreader Implantable Doppler Removal After Free Flap Monitoring Among Head and Neck Microvascular Surgeons Via The Laryngoscope Objective Investigate current practice patterns of head and neck microvascular reconstructive surgeons when removing an implantable Doppler after free flap surgery. Study Design Cross-sectional survey study. Methods Survey distributed to head and neck microvascular reconstructive surgeons. Data regarding years performing free tissue transfer, case numbers, management of implantable Doppler wire, and complications were collected. Results Eighty-five responses were analyzed (38,000 cases). Sixty-six responders (77.6%) use an implantable Doppler for postoperative monitoring, with 97% using the Cook-Swartz Doppler Flow Monitoring System. Among this group, 65.2% pull the wire after monitoring was complete, 3% cut the wire, and 31.8% have both cut and pulled the wire. Of those who have cut and pulled the wire, 48% report cutting and pulling the wire with equal frequency, 43% formerly pulled the wire and now cut the wire, and 9% previously cut the wire but now pull the wire. Of those who pull the wire, there were two injuries to the pedicle requiring return to the operating for flap salvage, and one acute venous congestion. Of the nine who previously pulled the wire, six (67%) cited concerns with major bleeding/flap compromise as the reason for cutting the wire. Conclusion In this study, most surgeons use an implantable Doppler for monitoring of free flaps postoperatively. In extremely rare instances, pulling the implantable Doppler wire has resulted in flap compromise necessitating revision of the vascular anastomosis. Cutting the wire and leaving the proximal portion in the surgical site has been adopted as a management option. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluating YouTube Videos on Hypoglossal Nerve Stimulation as a Resource for Patients

xlomafota13 shared this article with you from Inoreader Evaluating YouTube Videos on Hypoglossal Nerve Stimulation as a Resource for Patients Via The Laryngoscope Objectives/Hypothesis This study evaluated the quality and comprehensiveness of YouTube videos on hypoglossal nerve stimulation (HNS) for patients. This study also investigated the relationship between video content, video metrics, and popularity. Study Design Cross-sectional study. Methods We identified 150 videos using three search terms: "inspire sleep apnea," "hypoglossal nerve stimulation," and "upper airway stimulation." Videos that were unrelated to the use of HNS for obstructive sleep apnea in adults, operating room recordings, lectures for medical professionals, non-English, or non-audio were excluded. Video quality and comprehensiveness were assessed using modified DISCERN criterion (range: 5–25) and novel content criterion (range: 0–12), respectively. Secondary outcomes included video metrics (views, likes, dislikes, comments, and days since upload) and Video Power Index to measure popularity. Outcomes were stratified by video uploader source (medical institutions, medical companies, individual users, other). Results Users searched YouTube for "inspire sleep apnea" 2.48 times more in 2020 than in 2018. We identified 67 videos for review, with the majority coming from medical institutions (70.2%). Overall, the average-modified DISCERN (13.65 ± 4.88) and novel content (3.87 ± 2.09) scores were low and did not differ between medical institutions or other uploader sources. Higher quality and more comprehensive video content did not correlate with popularity. Conclusion Overall quality and comprehensiveness of information of HNS YouTube videos was low. Given the high demand for information on HNS, there is opportunity for medical institutions to implement new strategies to improve both video content and visibility to patients. Level of Evidence N/A Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Vestibular‐Evoked Myogenic Potential Outcomes Associated with Pediatric Sports‐Related Concussion

xlomafota13 shared this article with you from Inoreader Vestibular‐Evoked Myogenic Potential Outcomes Associated with Pediatric Sports‐Related Concussion Via The Laryngoscope Objectives/Hypothesis To 1) characterize vestibular-evoked myogenic potential responses in children and young adults with sports-related concussion (SRC) histories as compared with a normal healthy control group, and 2) correlate VEMP characteristics to SRC/sport history outcomes. Study Design Prospective cohort study. Methods Seventy-six children and young adults with and without a history of SRC received cervical and ocular VEMP testing using a 500 Hz tone burst air conduction stimuli. VEMP response parameters (response rates, peak latencies, and peak-to-peak amplitudes) were assessed. Other clinical vestibular measures were performed. In the SRC group, sport history outcomes including number of SRC sustained over a lifetime, years of playing contact sports, and length of time playing contact sports were collected via in-person questionnaire. Results Children and young adults with SRC had significantly reduced oVEMP responses and peak-to-peak amplitudes and greater amplitude response asymmetries between left and right ear. There was no effect of group on cVEMP findings. A greater frequency of SRCs sustained throughout a lifetime, a greater number of contact sports played, and a longer duration of playing a contact sport correlated with significantly poorer VEMP response characteristics. Conclusions Our results suggest that SRC and repeated subclinical head impact events have an effect on oVEMP outcomes. SRC may affect the utricle, superior vestibular nerve, and/or brainstem-mediated vestibular-ocular-reflex pathway. The prevalence of post-concussion-related dizziness is becoming increasingly common in a pediatric-otology clinic, thus performing VEMP testing in youth post-SRC provides an objective, noninvasive, and cost-effective method for monitoring the effects of sports-related impact on the vestibular system and related neural pathways. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radiological Assessment of High Anterior Septal Deviation and Its Impact on Sinus Access

xlomafota13 shared this article with you from Inoreader Radiological Assessment of High Anterior Septal Deviation and Its Impact on Sinus Access Via The Laryngoscope Objectives/Hypothesis High anterior septal deviation (HASD) is an underreported anatomic variant that can affect the decision to perform septoplasty for access during sinus surgery and ease of postoperative debridement. This study aims to 1) describe an objective method of assessing HASD, and 2) explore its prevalence and implications for performing septoplasty. Study Design Retrospective cross-sectional study. Methods Computed tomography scans from 2014 to 2020 were retrospectively reviewed. Two independent observers measured the following with respect to midline: distance to septum (SDD), distance to lateral nasal wall (LNW), and septal deviation angle (SDA). Results A total of 147 patients were included, with excellent interrater reliability across 99 patients (0.8–0.9). Mean measurements across all patients were SDD (2.77 mm ± 1.34), SDD/LNW (0.26 ± 0.12), and SDA (8.9° ± 4.0). Of 102 patients who underwent sinus surgery, 47 received septoplasty. Compared to the non-septoplasty cohort, the septoplasty cohort had a greater mean SDD (3.61 mm ± 1.48 vs. 2.27 mm ± 0.95; d = 1.10 [95% CI 0.67–1.51]), SDD/LNW (0.34 ± 0.13 vs. 0.21 ± 0.09; d = 1.18 [95% CI 0.76–1.60]), and SDA (11.1° ± 4.3 vs. 7.3° ± 3.4; d = 1.00 [95% CI 0.58–1.40]). Receiver operating characteristic cutoffs were SDD ≥2.43 mm, SDD/LNW ≥0.25, and SDA ≥7.6°, corresponding to a 49%–58% prevalence of HASD. Conclusion HASD is relatively common and the methods described herein can reliably assess its dimensions. Measurements of SDD, SDD/LNW, and SDA exceeding cutoffs determined by this study may represent clinically significant deflections prompting consideration of septoplasty. These methods may aid in preoperative planning. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reducing Opioid Prescribing and Consumption After Surgery

xlomafota13 shared this article with you from Inoreader Reducing Opioid Prescribing and Consumption After Surgery Via JAMA Otolaryngology–Head & Neck Surgery Online First Many patients receive their first opioid prescription from a surgeon. While surgery is a large concern for most patients, receiving an opioid prescription may seem more incidental. Yet 1 of every 17 patients who uses an opioid after otolaryngologic surgery continues to require opioids long after postoperative care has been completed. Overall, 1 of every 25 adults in the US regularly uses prescription opioid medications. For years, opioids have been assumed to be the de facto choice for pain management after surgery, but evidence is accumulati ng that nonopioid medications are highly effective for postoperative pain and may offer substantial advantages compared with opioids in improved safety. Despite this growing awareness, in a 2018 survey of American Rhinological Society members, 94% of respondents reported prescribing opioids after endoscopic sinus surgery, with an average of 27 opioid tablets prescribed. If prescribing opioids means opening a Pandora's box without additional efficacy, then what should be their legitimate role after surgery? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of Laryngeal Botulinum Neurotoxin Injection With Work Productivity for Patients With Spasmodic Dysphonia

xlomafota13 shared this article with you from Inoreader Association of Laryngeal Botulinum Neurotoxin Injection With Work Productivity for Patients With Spasmodic Dysphonia Via JAMA Otolaryngology–Head & Neck Surgery Online First This case series examines whether employed patients with spasm odic dysphonia experience voice-related work productivity impairment before with treatment botulinum neurotoxin injection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A dosing algorithm for individualized radioiodine treatment of cats with hyperthyroidism

xlomafota13 shared this article with you from Inoreader A dosing algorithm for individualized radioiodine treatment of cats with hyperthyroidism Via radioactive iodine J Vet Intern Med. 2021 Aug 5. doi: 10.1111/jvim.16228. Online ahead of print. ABSTRACT BACKGROUND: Radioiodine (131 I) is the treatment of choice for hyperthyroidism in cats, but current 131 I-dosing protocols can induce iatrogenic hypothyroidism and expose azotemia. OBJECTIVES: To develop a cat-specific algorithm to calculate the lowest 131 I dose to resolve hyperthyroidism, while minimizing risk of iatrogenic hypothyroidism and subsequent az otemia. ANIMALS: One thousand and four hundred hyperthyroid cats treated with 131 I. METHODS: Prospective case series (before-and-after study). All cats had serum concentrations of thyroxine (T4 ), triiodothyronine (T3 ), and thyroid-stimulating hormone (TSH) measured (off methimazole ≥1 week). Using thyroid scintigraphy, each cat's thyroid volume and percent uptake of 99m Tc-pertechnatate (TcTU) were determined. An initial 131 I dose was calculated by averaging dose scores for T4 /T3 concentrations, thyroid volume, and TcTU; 80% of that composite dose was administered. Twenty-four hours later, percent 131 I uptake was measured, and additional 131 I administered, as needed, to deliver an adequate radiation dose to the thyroid tumor(s). Serum concentrations of T4 , TSH, and creatinine were determined 6 to 12 months later. RESULTS: The median calculated 131 I dose was 1.9 mCi (range, 1.0-10.6 mCi); 1380 cats required additional 131 I administration on day 2. Of the cats, 1047 (74.8%) became euthyroid, 57 (4.1%) became overtly hypothyroid, 240 (17.1%) became subclinically hypothyroid, and 56 (4%) remained hyperthyroid. More overtly (71.9%) and subclinically (39.6%) hypothyroid cats developed azotemia than euthyroid cats (14.2%; P < .0001). CONCLUSIONS AND CLINICAL IMPORTANCE: Our algorithm for calculating individual 131 I doses resulted in cure rates similar to historical treatment rates, despite much lower 131 I doses. This algorithm appears to lower prevalence of both 131 I-induced overt hypothyroidism and azotemia. PMID:34351027 | DOI:10.1111/jvim.16228 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of endoscopic and open resection of sinonasal malignancies: a systematic review and meta-analysis

xlomafota13 shared this article with you from Inoreader Outcomes of endoscopic and open resection of sinonasal malignancies: a systematic review and meta-analysis Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 20:S1808-8694(21)00127-0. doi: 10.1016/j.bjorl.2021.06.004. Online ahead of print. ABSTRACT OBJECTIVE: To compare the efficacy of endoscopic and open resection of sinonasal malignancies. METHODS: The search was performed using PubMed (1950-2020), Embase (1974-2020), the Cochrane library, and the website clinicaltrials.gov. The hazard ratio, HR, 95% confidence interval, CI, of the rates of overall survival and disease-free survival and the demographic characteristics of the included studies were extracted and analyzed. Pooled analysis was conducted with the studies' individual patient data, using log-rank test, Kaplan-Meier survival, and Cox regression analysis. RESULTS: Of 1939 articles retrieved, 23 articles were included. Overall, 1373 cases were incorporated into the final analysis, 653 (47.56%) of which underwent the surgery through an endoscopic approach, whereas 720 (52.44%) cases uti lized the open approach. The overall survival was comparable between endoscopic and open resection (HR = 0.84 [95% CI: 0.65-1.07], p = 0.16; random effects analysis). Pooled analysis with Cox regression revealed signifcant differences in overall survival (HR = 0.568 [95%CI:0.380-0.849], p = 0.006) and disease-free survival (HR = 0.628 [95%CI:0.424-0.929], p = 0.02) between endoscopic and open approaches. CONCLUSION: The aggregated evidence suggests the survival outcome of endoscopic resection is comparable or greater than that of open resection of sinonasal malignancies. PMID:34348855 | DOI:10.1016/j.bjorl.202 1.06.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Determining attributed factors of hearing handicap in individuals with auditory sensory and neural pathology

xlomafota13 shared this article with you from Inoreader Determining attributed factors of hearing handicap in individuals with auditory sensory and neural pathology Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 21:S1808-8694(21)00126-9. doi: 10.1016/j.bjorl.2021.06.003. Online ahead of print. ABSTRACT INTRODUCTION: There is a modest relationship between speech perception skills and perceived hearing handicap in individuals with hearing loss. In this study, an attempt is made at linking psychoacoustic results and speech perception skills to understand the subjective handicap and quality of life. OBJECTIVE: To investigate how speech perception in noise (signal to noise ratio-50), difference limen frequency, temporal modulation transfer function, hearing handicap inventory for adults, and quality of life in auditory neuropathy spectrum disorder differs from sensorineural hearing loss. Further we attempt to discern attributed factors of hearing handicap in auditory neuropathy spectrum disorder and sensorineural hearing loss. METHODS: A cross-sectional study with comparative and correlational research designs were utilized. Eighty-four participants were grouped into sensorineural hearing loss (n = 49), and auditory neuropathy spectrum disorder (n = 35) was sub-grouped into mild, moderately severe, and severe. We evaluated signal to noise ratio-50, difference limen frequency, and temporal modulation transfer function. In addition, hearing handicap inventory for adults, and quality of life questionnaires were administered. RESULTS: Mild auditory neuropathy spectrum disorder showed impairment in speech perception and discriminating frequency, which were similar to the severe sensory neural hearing loss. Temporal resolution impairment in auditory neuropathy spectrum disorder mild was significantly higher than in each sub-groups of sensorineural hearing loss. The severity of the hearing handicap in was similar to severe sensorineural hearing loss, quality of life was equally affected in sensorineural hearing loss and auditory neuropathy spectrum disorder. In sensorineural hearin g loss, signal to noise ratio-50 was positively related, and quality of life was negatively related to hearing handicap. In auditory neuropathy spectrum disorder, no contributory factors were related to hearing handicap. CONCLUSION: Mild auditory neural pathology demonstrates impairment in speech recognition and psychoacoustic skills similar to severe cochlear pathology. In sensorineural hearing loss, hearing handicap is predicted from quality of life and speech perception, but none of the contributory factors predicted hearing handicap in auditory neuropathy spectrum disorder. PMID:34348857 | DOI:10.1016/j.bj orl.2021.06.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Microanatomic analyses of extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve

xlomafota13 shared this article with you from Inoreader Microanatomic analyses of extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 20:S1808-8694(21)00129-4. doi: 10.1016/j.bjorl.2021.06.006. Online ahead of print. ABSTRACT OBJECTIVE: To investigate microanatomic organizations of the extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve. METHODS: Nerve samples were dissected in 12 postmortem autopsies, and histomorphometric analyses were conducted. RESULTS: There was no significant difference between the right and left sides of the nerve samples for the nerve area, fascicle area, number of fascicles and average number of axons. The lowest mean fascicle number was found in the hypoglossal nerve (4.9 ± 1.4) while the highest was in great auricular nerve (11.4 ± 6.8). The highest nerve area (3,182,788 ± 838,430 μm2), fascicle area (1,573,181 ± 457,331 μm2) and axon number (14,772 ± 4402) were in hypoglossal nerve (p < 0.05). The number of axon s per unit nerve area was higher in the facial nerve, truncus temporofacialis, truncus cervicofacialis and hypoglossal nerve, which are motor nerves, compared to the sural nerve and great auricular nerve, which are sensory nerves (p < 0.05). The number of axons per unit fascicle area was also higher in motor nerves than in sensory nerves (p < 0.05). CONCLUSION: In the present study, it was observed that each nerve contained a different number of fascicles and these fascicles were different both in size and in the number of axons they contained. All these variables could be the reason why the desired outcomes cannot always be achieved in nerve reconstruction. PMID:34348859 | DOI:10.1016/j.bjorl.2021.06.006 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Validation of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy

xlomafota13 shared this article with you from Inoreader Validation of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 20:S1808-8694(21)00124-5. doi: 10.1016/j.bjorl.2021.06.002. Online ahead of print. ABSTRACT INTRODUCTION: Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria. OBJECTIVE: This study aims to validate an eight-point score for the correct assessment of malignancy. METHODS: We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in H&E staining as a standard of reference. A total of six examiners evaluated the sequences bas ed on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics. RESULTS: Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86. CONCLUSION: The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis. PMID:34348858 | DOI:10.1016/j.bjorl.2021.06.002 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.