Office‐Based Procedure Training in Laryngology Fellowship Programs

xlomafota13 shared this article with you from Inoreader Office‐Based Procedure Training in Laryngology Fellowship Programs Via The Laryngoscope Objective To assess the current practices and challenges of training office-based procedures to laryngology fellows in the United States. Methods An anonymous web-based survey study was distributed to laryngology fellowship program directors, as listed by the American Laryngological Association. The survey was a 19-item questionnaire with free-text, Likert scale, and multiple-choice answers. Results Twenty-two of 27 program directors (81.4%) replied to the survey. Many programs (8/16) have three or more laryngologists and do more than 10 procedures each week (10/16). Sixty-nine percent (11/16) of directors had not been trained for office procedures in their fellowship. The fellows are allowed to be primary surgeon on 68.75% and 75% of vocal fold augmentation and laser procedures, respectively. The expected competencies for these procedures on graduation are average-moderate and moderate. When program directors asked about the methods used for training, a minority of them use simulators (2/16), procedural checklists (2/16), or structured debriefing (2/16). The most commonly used methods were case-based troubleshooting (13/16) and unstructured debriefing (13/16). Patients being awake and patients' expectations are seen as the most important obstacles. Most of the directors thought office-based procedure training could be improved (14/16). The most common suggestions were using step-wise checklists, simulator-labs, and formal debriefings. Conclusion This is the first study evaluating the training of office-based laryngeal procedures during laryngology fellowship. Given the increasing importance of these procedures in practice and the herein identified barriers and need for improvement, fellowships should investigate the use of systematic training tools to improve fellow competency with office-based procedures. Laryngoscope, 131:2054–2058, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngeal Pathologies Associated with the Genre of Singing and Professional Singing Status in a Treatment‐Seeking Population

xlomafota13 shared this article with you from Inoreader Laryngeal Pathologies Associated with the Genre of Singing and Professional Singing Status in a Treatment‐Seeking Population Via The Laryngoscope Objectives/Hypothesis Singers have high vocal demands and are at increased risk of developing voice disorders. Different singing genres place different technical demands on the voice. However, differences in laryngeal pathology based on genre have not been well-researched. The purpose of this study was to determine the prevalence of laryngeal pathology in different genres of professional and amateur singers who present with a voice complaint. Study Design Retrospective review. Methods Retrospective review of patients seen at a tertiary laryngology practice. Self-identified singers who reported their primary singing genre and categorized their singing as a full-time job, part-time job, or amateur involvement were included. Type and prevalence of pathology were calculated based on genre and professional status. Results Of the 302 self-identified singers, 54% (n = 164) had laryngeal pathology. Among those with pathology, the most common finding was fibrotic lesion (38.4%, 63/164). Genres in which a majority of singers had pathology were other (69.2%, 9/13), choral (64.7%, 11/17), pop (63.2%, 12/19), musical theater (61.4%, 43/70), country (100%, 4/4), and Latin (100%, 2/2). The highest prevalence of pathology was seen in part-time professional singers (62.2%, 41/66) and full-time professionals (60.8%, 62/102), compared to amateurs (45.1%, 60/133). Conclusions Laryngeal pathology is prevalent in singers presenting with a voice complaint. Regardless of genre or professional status, fibrotic lesions were the most common pathological finding. This study provides preliminary data on the prevalence of different laryngeal pathologies found in singers by genre and degree of professional involvement. Level of Evidence 4 Laryngoscope, 131:2076–2080, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current Practices in Endotracheal Tube Size Selection for Adults

xlomafota13 shared this article with you from Inoreader Current Practices in Endotracheal Tube Size Selection for Adults Via The Laryngoscope Objectives/Hypothesis Intubation with inappropriately sized endotracheal tubes (ETT) can cause long-term tracheal and laryngeal injuries often requiring surgical intervention. Although tracheal size has been demonstrated to vary based on height and sex, it is unclear whether these guidelines are regularly implemented in patients undergoing endotracheal intubation. The objective of this study is to determine the rate of appropriate ETT size selection in patients undergoing intubation and assess provider decision making in ETT size selection. Study Design Retrospective cohort study. Methods The study population was all patients who underwent endotracheal intubation over a two-week period at a tertiary academic medical center. Data were collected on patient age, gender, height, BMI, comorbidities, ETT size, duration of intubation, bronchoscopies, and type of practitioner who performed the intubation. A height-based nomogram for ETT size selection was used to determine the recommended ETT size for each patient. Results One hundred five patients met the inclusion criteria. 22% of patients were intubated with an inappropriately large tube, defined as 1.0 mm larger than the recommended size. Women were more likely to be intubated with an inappropriately large ETT (OR = 13.58, P = .001), as were patients with height less than 160 cm (OR = 141, P = .001). Other factors related to disease severity, anticipation for bronchoscopy, and BMI were not risk factors for the use of inappropriately large ETT. Conclusions Although there is compelling evidence that height is a strong predictor of tracheal morphology and appropriate ETT size, height-based guidelines have yet to be universally adopted for ETT size selection. Laryngoscope, 131:1967–1971, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

xlomafota13 shared this article with you from Inoreader Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia Via The Laryngoscope Objectives/Hypothesis Hearing plays an important role in the maintenance of vocal control in normal individuals. In patients with spasmodic dysphonia (SD), however, the ability to maintain sustained control of phonation is impaired. The origins of SD are unknown, and it is unclear whether auditory feedback-dependent vocal control is compromised in these patients. Study Design Prospective case-control study. Methods We tested 15 SD patients and 11 age-matched controls. Voice recordings were performed while subjects repeated the vowel /e/ and auditory feedback of their vocal sounds was altered in real-time to introduce a pitch-shift (±2 semitones), presented back to subjects using headphones. Recordings were analyzed to determine voice changes following the pitch-shifted feedback. Results were further compared with patient demographics and subjective measures of dysphonia, including the Voice Handicap Index (VHI). Results Despite considerable pitch variability and vocal breaks, SD patients exhibited significantly higher average vocal pitch compensation than control subjects. SD patients also exhibited greater variability than controls. However, there were no significant correlations between vocal compensation and patient demographics, although there was a significant inverse correlation with VHI. Conclusions In this pilot study, patients with SD exhibited increased sensitivity to altered auditory feedback during sustained phonation. These results are consistent with recent theories of SD as a disorder of sensory-motor feedback processing, and suggest possible avenues for future investigation. Level of Evidence 3 Laryngoscope, 131:2070–2075, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intracordal Injection of Basic Fibroblast Growth Factor in 100 Cases of Vocal Fold Atrophy and Scar

xlomafota13 shared this article with you from Inoreader Intracordal Injection of Basic Fibroblast Growth Factor in 100 Cases of Vocal Fold Atrophy and Scar Via The Laryngoscope Objectives/Hypothesis Vocal fold atrophy, scar, and sulcus reduce the vibratory function of the vocal fold mucosa, which causes severe refractory dysphonia. We have reported encouraging preliminary results using an intracordal injection of basic fibroblast growth factor (bFGF) and showed improvement in phonatory parameters and voice. The present study summarizes our experience with 100 cases of stiffened vocal folds that were treated with bFGF injections. Study Design Retrospective chart review with Interstitial Review Board (IRB) approval. Methods Local injection of bFGF was performed in 100 cases of vocal fold pathology, which included 43 cases of vocal fold atrophy, 41 cases with scar, and 16 cases with sulcus. Ten micrograms of bFGF were injected into the vocal folds under topical anesthesia 4 times in each patient. Therapeutic outcomes were examined with maximum phonation time (MPT), voice handicap index-10 (VHI-10), and GRBAS scale. Results MPT, VHI-10, and GRBAS scores significantly improved in all pathology groups. An improvement on the VHI-10 greater than five points was observed in 82% of atrophy cases, 78% of scar cases, and 67% of sulcus cases. Improvement on the VHI-10 was significantly better in the atrophy group than the scar or sulcus groups. The mild/moderate cases of scar and sulcus showed better improvement than severe cases. Conclusions The current large case series indicates positive effects of intracordal injection of bFGF for improvement of voice with no severe adverse events. The effects appeared best for cases of atrophy, while the treatment of severe scar and sulcus requires further improvement. Level of Evidence 4 Laryngoscope, 131:2059–2064, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Abnormal Laryngeal Electromyography Findings in Asymptomatic Adults Across the Age Spectrum

xlomafota13 shared this article with you from Inoreader Abnormal Laryngeal Electromyography Findings in Asymptomatic Adults Across the Age Spectrum Via The Laryngoscope Objectives/Hypothesis Laryngeal electromyography (LEMG) is a diagnostic tool for patients with suspected neurogenic abnormalities of the larynx. LEMG is often used with the assumption that any abnormality is symptom-/disease-related. We sought to determine the prevalence of abnormal LEMG findings in a group of healthy asymptomatic adults across a large age spectrum. Study Design Open, prospective study, gender-match and age balanced by decade. Methods Forty-six healthy participants (age 20–78) underwent LEMG, including 178 muscles. Participants had no history of voice problems, normal VHI-10, and normal flexible laryngoscopy. Qualitative and quantitative LEMG (bilateral) were performed involving the thyroarytenoid–lateral cricoarytenoid muscle complex (TA-LCA) and cricothyroid (CT) muscles. LEMG parameters included evaluation for fibrillation potentials, sharp waves, reduced recruitment, polyphasic potentials, electrical synkinesis, and measurement of turns per second. Results Of participants, 4% had at least one abnormal qualitative finding (slightly reduced recruitment or two to three discrete polyphasic potentials). There were no findings of fibrillation potentials or sharp waves. There were no abnormal qualitative findings in the CT muscles tested. Of participants, 16% had at least one abnormal synkinesis finding. LEMG qualitative abnormalities and quantitative abnormalities do not appear to correlate with gender or age. Conclusion Abnormal qualitative and quantitative LEMG findings were uncommon and minor in severity in our group of asymptomatic healthy adults. The likelihood of abnormal LEMG results in asymptomatic adults was 2.2% for qualitative findings, 9.3% for synkinesis, and 5.4% for turns/s. Level of Evidence 3 Laryngoscope, 131:2065–2069, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Factors influencing rehabilitation effect in prelingually deafened late implanted cochlear implant users, and the construction of a nomogram

xlomafota13 shared this article with you from Inoreader Factors influencing rehabilitation effect in prelingually deafened late implanted cochlear implant users, and the construction of a nomogram Via Clinical Otolaryngology Abstract Objectives Our study aimed to identify potential factors that may influence rehabilitation outcomes in late-implanted adolescents and adults with prelingual deafness and to construct a user-friendly nomogram. Design This cross-sectional study included 120 subjects under 30 years of age who had received cochlear implantation at a single medical center. The Categories of Auditory Performance (CAP) scale was used to evaluate the rehabilitation outcomes. A nomogram was constructed by using the R and EmpowerStats software. Results Univariate analysis indicated higher rates of auditory performance improvement in younger aged subjects. Residual hearing and regular implant use were more frequently seen among subjects with auditory performance improvement. Multivariate analysis identified residual hearing (Hazard Ratio, 6.11; 95% Confidence Interval, 1.83-20.41; P<0.01), age group (Hazard Ratio, 0.31; 95% Confidence Interval, 0.14-0.83; P=0.02) and regular CI use (Hazard Ratio, 7.79; 95% Confidence Interval, 2.50-24.20; P<0.01) as independent predictors for auditory performance improvement. The nomogram's predictive performance was satisfactory as shown by the calibration curve and Receiver operating characteristic (ROC) curve. Conclusions Factors such as residual hearing, younger age, and regular CI use are associated with auditory performance improvement in this cochlear implant user population. The nomogram model also demonstrates a satisfactory predictive performance. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quantification of endolymphatic hydrops and its correlation with Meniere’s disease clinical features

xlomafota13 shared this article with you from Inoreader Quantification of endolymphatic hydrops and its correlation with Meniere's disease clinical features Via Clinical Otolaryngology Abstract Objective We aimed to quantitatively evaluate the degree of endolymphatic hydrops and its correlation with the clinical features of Meniere's disease. Methods We retrospectively collected data from patients with Meniere's disease who underwent gadolinium-enhanced magnetic resonance imaging (MRI) at our department from January 2018 to December 2019. Mimics software was used to perform three-dimensional modeling of the labyrinth, and volume information was obtained to calculate the endolymphatic hydrops index (EHI). A correlation analysis was conducted with data from pure tone audiometry, electrocochleography (EchoG), vestibular myogenic-evoked potential (VEMP) testing, caloric testing and video head impulse testing (vHIT). A two-dimensional method was also employed to calculate the hydrops ratio(HR) of cochlea and vestibule. The test-retest reliability of EHI /HR from different operators was evaluated. Results A total of 23 affected ears were examined, the endolymphatic hydrops index was significantly correlated with Meniere's disease stage, low-frequency hearing threshold, EchoG summating potential/action potential ratio (−SP/AP), and VEMP binaural asymmetry ratio, but no significant correlation was observed between endolymphatic hydrops index and the caloric test or vHIT. The Intraclass correlation coefficient (ICC) of EHI data calculated by two otologists was 0.946(p< 0.001). And the ICC of cochlea and vestibule Hydrops Ratio were 0.844 and 0.832(p< 0.001). Conclusion Mimics software can be used to quantitatively evaluate the degree of endolymphatic hydrops and have shown higher test-retest reliability than traditional two-dimensional evaluation method. Endolymphatic hydrops correlates with clinical data, such as Meniere's disease stage, low-frequency hearing threshold, EchoG, and VEMP asymmetry ratio. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The power and potential of BIOMAP to elucidate host‐microbiome interplay in skin inflammatory diseases

xlomafota13 shared this article with you from Inoreader The power and potential of BIOMAP to elucidate host‐microbiome interplay in skin inflammatory diseases Via Experimental Dermatology Abstract The two most common chronic inflammatory skin diseases are atopic dermatitis (AD) and psoriasis. The underpinnings of the remarkable degree of clinical heterogeneity of AD and psoriasis are poorly understood and, as a consequence, disease onset and progression are unpredictable and the optimal type and time-point for intervention are as yet unknown. The BIOMAP project is the first IMI (Innovative Medicines Initiative) project dedicated to investigating the causes and mechanisms of AD and psoriasis and to identify potential biomarkers responsible for the variation in disease outcome. The consortium includes 7 large pharmaceutical companies and 25 non-industry partners including academia. Since there is mounting evidence supporting an important role for microbial exposures and our microbiota as factors mediating immune polarization and AD and psoriasis pathogenesis, an entire work package is dedicated to the investigation of skin and gut microbiome linked to AD or psoriasis. The lar ge collaborative BIOMAP project will enable the integration of patient cohorts, data and knowledge in unprecedented proportions. The project has a unique opportunity with a potential to bridge and fill the gaps between current problems and solutions. This review highlights the power and potential of BIOMAP project in the investigation of microbe-host interplay in AD and psoriasis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: a retrospective study

xlomafota13 shared this article with you from Inoreader Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: a retrospective study Via Journal of Otolaryngology - Head & Neck Surgery Multiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and eval... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radioactive iodine does not improve overall survival for patients with aggressive variants of papillary thyroid carcinoma less than 2 cm

xlomafota13 shared this article with you from Inoreader Radioactive iodine does not improve overall survival for patients with aggressive variants of papillary thyroid carcinoma less than 2 cm Via radioactive iodine Surgery. 2021 Aug 10:S0039-6060(21)00571-7. doi: 10.1016/j.surg.2021.05.054. Online ahead of print. ABSTRACT BACKGROUND: Tall cell and diffuse sclerosing variants of papillary thyroid cancer are associated with aggressive features. Radioactive iodine after total thyroidectomy is poorly studied. METHODS: Patients ≥18 years in the National Cancer Data Base from 2004 to 2016 with classic papillary thyroid cancer, tall cell, or diffuse sclerosing 1 mm to 40 mm were identified. Logistic regression identified factors associated with aggressive features. Overall survival was assessed using Kaplan-Meier method and log-rank tests, after propensity score matching for clinicopathological and treatment variables. RESULTS: A total of 155,940 classic papillary thyroid cancer patients, 4,011 tall cell, and 507 diffuse sclerosing were identified. Tall cell patients represented an increasing proportion of the study population during the analysis period, whereas diffuse sclerosing and classic papillary thyroid cancer patients showed a statistically significant decline. Extrathyroidal extension and nodal involvement were more prevalent among tall cell and diffuse sclerosing patients when compared to those diagnosed with classic papillary thyroid cancer (P < .01). Adjuvant radioactive iodine was less frequently used in patients with classic papillary thyroid cancer when compared to tall cell and diffuse sclerosing patients (42.6% vs 62.4%, 59.0%; P < .001, re spectively). Aggressive variants receiving total thyroidectomy versus total thyroidectomy + radioactive iodine propensity score matched across clinicopathologic variables were analyzed. There was no difference in overall survival between the 2 treatment groups for tumors <2 cm (01-1.0 cm, 92.2% vs 84.8%; P = .98); (1.0-2.0 cm, 72.7% vs 88.1%; P = .82). However, overall survival was improved for total thyroidectomy + radioactive iodine propensity score matched patients with tumor sizes 21 to 40 mm versus total thyroidectomy (83.4% vs 70.0%, P = .004). CONCLUSION: For aggressive tumor variants ≤2 cm treated with total thyroidectomy, there is no overall survival advantage provided by the addition of adjuvant radioactive iodine. PMID:34384604 | DOI:10.1016/j.surg.2021.05.054 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.