Τρίτη 11 Μαΐου 2021

Auricular Perichondrium Graft for Septal Perforation Repair

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Ann Otol Rhinol Laryngol. 2021 May 10:34894211015738. doi: 10.1177/00034894211015738. Online ahead of print.

ABSTRACT

OBJECTIVES: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition g raft when auricular cartilage is harvested for structural or aesthetic graft material.

METHODS: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft.

RESULTS: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction.

CONCLUSION: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

PMID:33971755 | DOI:10.1177/00034894211015738

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Mapping the Risk Factors of Pharyngocutaneous Fistula After Salvage Laryngectomies

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Abstract

To evaluate the postoperative surgical wound infection prevalence rates of patients undergoing SL, identify the causative organism and determine predisposing factors leading to infection. A retrospective study of all consecutive patients who underwent salvage total laryngectomy at our unit between 2015 and 2020 was performed. The following parameters were also analyzed: age, smoking history, pre and postoperative albumin level, history of radio and chemo-radiotherapy, reconstruction with pectoralis flap, intraoperative tracheoesophageal puncture, and tumor stage. A total of 12 of the 21 patients (57%) experienced a postoperative infection after SL during the study period. 82% of those patients whose preoperative albumin level below 3gm/dl developed postoperative infection. There is a significant increase (p < 0.01) in infection in patients with N1 and 2 stage tumor (68%) compared with the N0 stage tumors (40%). Multivariate analysis showed that preoperativ e albumin and nodal stage were significant risk factors for postoperative infection.

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Can We Conquer Advanced Head and Neck Cancer? Current Status and Future Directions

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Clin Exp Otorhinolaryngol. 2021 May;14(2):145-146. doi: 10.21053/ceo.2021.00458. Epub 2021 Apr 30.

NO ABSTRACT

PMID:33971695 | DOI:10.21053/ceo.2021.00458

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The Choice of Anesthetic Agents for Endoscopic Sinus Surgery: Can Sinus Surgeons Be Involved?

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Clin Exp Otorhinolaryngol. 2021 May;14(2):147-148. doi: 10.21053/ceo.2021.00395. Epub 2021 Apr 30.

NO ABSTRACT

PMID:33971696 | DOI:10.21053/ceo.2021.00395

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Length of the Cricoid and Trachea in Children: Predicting Intubation Depth to Prevent Subglottic Stenosis

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Objective

Define the length of the subglottis and trachea in children to predict a safe intubation depth.

Methods

Patients <18 years undergoing rigid bronchoscopy from 2013 to 2020 were included. The carina and inferior borders of the cricoid and true vocal folds were marked on a bronchoscope and distances were measured. Patient age, weight, height, and chest height were recorded. Four styles of cuffed pediatric endotracheal tubes (ETT) were measured and potential positions of each cuff and tip were calculated within each trachea using five depth of intubation scenarios. Multivariate linear regression was performed to identify predictors of subglottic and tracheal length.

Results

Measurements were obtained from 210 children (141 male, 69 female), mean (SD) age 3.21 (3.66) years. Patient height was the best predictor of subglottic length (R 2: 0.418): Length sg (mm) = 0.058 * height (cm) + 2.8, and tracheal length (R 2: 0.733): Length t (mm) = 0.485 * height (cm) + 21.3. None of the depth of intubation scenarios maintained a cuff‐free subglottis for all ETT styles investigated. A formula for depth of intubation: Length di (mm) = 0.06 * height (cm) + 8.8 found that no ETT cuffs would be in the subglottis and all tips would be above the carina.

Conclusion

Current strategies for determining appropriate depth of intubation pose a high risk of subglottic ETT cuff placement. Placing the inferior border of the vocal cords 0.06 * height (cm) + 8.8 from the superior border of the inflated ETT cuff may prevent subglottic cuff placement and endobronchial intubation.

Level of Evidence

4 Laryngoscope, 2021

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A Comparison of an Artificial Intelligence Tool to Fundamental Frequency as an Outcome Measure in People Seeking a More Feminine Voice

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Objectives/Hypothesis

An artificial intelligence (AI) tool was developed using audio clips of cis‐male and cis‐female voices based on spectral analysis to assess %probability of a voice being perceived as female (%Prob♀). This program was validated with 92% accuracy in cisgender speakers. The aim of the study was to assess the relationship of f o on %Prob♀ by a validated AI tool in a cohort of trans females who underwent intervention to feminize their voice with behavioral modification and/or surgery.

Study Design

Cohort study.

Methods

Fundamental frequency (f o) from prolonged vowel sounds (f o/a/) and f o from spontaneous speech (f o‐sp) were measured using the Kay Pentax Computerized Speech Lab (Montvale, NJ) in trans females postintervention. The same voice samples were analyzed by the AI tool for %Prob♀. Chi‐square analysis and regression models were performed accepting >50% Prob♀ as female voice.

Results

Forty‐two patients were available for analysis after intervention. f o‐sp post‐treatment was positively correlated with %Prob♀ (R = 0.645 [P < .001]). Chi‐square analysis showed a significant association between AI %Prob♀ >50% for the speech samples and f o‐sp >160 Hz (P < .01). Sixteen of 42 patients reached an f o‐sp >160 Hz. Of these, the AI program only perceived nine patients as female (>50 %Prob♀).

Conclusion

Patients with f o‐sp >160 Hz after feminization treatments are not necessarily perceived as having a high probability of being female by a validated AI tool. AI may represent a useful outcome measurement tool for patients undergoing gender affirming voice care.

Level of Evidence

3 Laryngoscope, 2021

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Intratympanic Steroid Injection Complicated by Iatrogenic Perilymphatic Fistula: A Cautionary Tale

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Intratympanic (IT) steroid therapy is a mainstay treatment for sudden sensorineural hearing loss (SSNHL) for both initial therapy and salvage therapy. We report a rare case of iatrogenic perilymphatic fistula that resulted from trauma during an IT steroid injection for SSNHL. We discuss the diagnosis and treatment in the current case and compare it with previous reports from the literature. Laryngoscope, 2021

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Recognizing oneself in the encounter with others: Meaningful moments in systemic therapy for social anxiety disorder in the eyes of patients and their therapists after the end of therapy

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by Rebecca Hilzinger, Javiera Duarte, Barbara Hench, Christina Hunger, Jochen Schweitzer, Mariane Krause, Martina Fischersworring

Objective

The objective of this study is to characterize and describe meaningful moments in the context of systemic psychotherapy, from the point of view of patients and their therapists, after the end of therapy. The therapy studied is a manualized, monitored systemic therapy for social anxiety disorder.

Method

Semi-structured follow-up interviews were conducted separately with five patients and their therapists (N = 10). Methodological triangulation was used: Grounded theory was used to code the transcripts as described by Charmaz. Then the passages of the selected code "meaningful moment" were evaluated using thematic comparison, in line with Meuser & Nagel.

Findings

Three categories involving meaningful moments were identified: (1) meeting other patients in group therapy session, (2) therapeutic resource orientation and (3) recognizing oneself in a diagnosis or pattern of behaviour. These categories emerged as contexts related to the occurrence of meaning ful moments from a subjective perspective.

Discussion

Meaningful moments seem to be consistently related to the therapist input and to specific interventions or settings, both from the perspective of the patients and the therapists. Two tandems each described a coincident moment. One central aspect of all 14 moments is that the patients and therapists described patients being able to acquire another outlook on themselves.

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COVID-19 and periodontitis: reflecting on a possible association

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Recent studies have demonstrated a relationship between the severe clinical course of COVID-19 and other chronic diseases such as: cardiovascular disease, hypertension, diabetes mellitus, obesity and chronic r...
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The diagnostic predictive value of neutrophil-to-lymphocyte ratio in thyroid cancer adjusted for tumor size

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by Taek Yoon Cheong, Sang Duk Hong, Keun-Woo Jung, Yoon Kyoung So

The role of systemic inflammation has not been clearly defined in thyroid cancers. There have been conflicting reports on whether systemic inflammatory markers have predictive value for thyroid cancers. We aimed to evaluate the association between systemic inflammatory markers and clinicopathological factors in thyroid cancers and to assess their predictive value for thyroid cancers in detail. Five hundred thirty-one patients who underwent surgery for thyroid nodules were included. The patient population consisted of 99 individuals (18.6%) with benign thyroid nodules and 432 individuals (81.4%) with thyroid cancers. In 432 patients with thyroid cancers, neutrophil-to-lymphocyte ratio (NLR) was significantly higher in the cases with tumors greater than 2 cm than in those with tumors less than 2 cm. (p = 0.027). NLR and platelet-to-lymphocyte ratio (PLR) were significantly higher in cases with lateral lymph node metastasis (LNM) than in those without LNM (p = 0.007 and 0. 090, respectively). The nodule size was significantly higher in benign thyroid nodules than in thyroid cancers (p p = 0.011), but not in those with nodules less than 2 cm. In thyroid cancers, preoperative NLR was associated with pathological prognosticators such as tumor size and lateral lymph node metastasis. When the size difference between thyroid cancers and benign thyroid nodules was adjusted, NLR could be a significant predictor of thyroid cancers.
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Presentation of External Ear Rosai-Dorfman Disease With Laryngeal Involvement

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Ear Nose Throat J. 2021 May 11:1455613211016704. doi: 10.1177/01455613211016704. Online ahead of print.

ABSTRACT

Rosai-Dorfman disease (RDD) is a rare benign systemic histiocytic proliferation characterized by massive lymph node enlargement and sometimes associated with extranodal involvement. Even though it is considered to be benign, death can occur depending on the extent and location. Our case highlights a primary extranodal site of the right pinna with extension through the Eustachian tube to the subglottis. A previously healthy 15-year-old female presented with 1-year right pinna swelling, slowly enlarging and becoming more bothersome. An incisional biopsy was performed on the ear along with S100 staining yielding a diagnosis. After multidisciplinary case discussion, clofarabine monotherapy and systemic therapy for Langerhans cell histiocytosis has started. Rosai-Dorfman disease can be a general disorder, often affecting the lymph nodes. Unlike a nodal disease, extranodal disease could involve any site on the patient's anatomy. Head and neck lesions are the most common extranodal lesions. Rosai-Dorfman disease is self-limited in more than 20% of the cases with spontaneous regression without intervention; 70% of the patients have noticeable symptoms and vital organ involvement requiring treatments such as surgery, steroids, radiation, and chemotherapy. In our case, the patient had wide involvement and presented without any serious breathing diffic ulties; we decided to start with monotherapy with chemotherapy and systematic glucocorticoid treatment.

PMID:33973483 | DOI:10.1177/01455613211016704

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A Large Intratemporal Facial Nerve Schwannoma Presenting as an Occluding External Auditory Canal Mass

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Ear Nose Throat J. 2021 May 11:1455613211016706. doi: 10.1177/01455613211016706. Online ahead of print.

ABSTRACT

Facial nerve schwannomas are rare, benign, slow-growing tumors that can occur in any segment of the facial nerve, although 71% of cases are intratemporal. Surgical resection can lead to facial nerve injury. Facial function recovery after reanimation is usually not better than House-Brackmann (HB) grade III. Thus, for cases of intratemporal facial nerve schwannomas (IFNSs) with favorable facial function (HB grade I or II), observation by periodic magnetic resonance imaging is the mainstay of management. Here, we present a case of a large IFNS with normal facial function in which the mass fully occluded the external auditory canal. The occlusion caused squamous debris to accumulate, potentially leading to cholesteatoma. Faced with this therapeutic dilemma, we chose surgical resection with the patient's informed consent. Stripping surgery was achieved with normal postoperative facial function. There was no postoperative facial paralysis or recurrence at 2-year follow-up. We describe the experience of diagnosis and treatment process for this case, and discuss the possibility of total resection of the tumor with preserving the integrity of facial nerve.

PMID:33973479 | DOI:10.1177/01455613211016706

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