Diagnostic Accuracy Outcomes of Office‐Based (Outpatient) Biopsies in patients with Laryngopharyngeal Lesions: A Systematic Review

xlomafota13 shared this article with you from Inoreader Diagnostic Accuracy Outcomes of Office‐Based (Outpatient) Biopsies in patients with Laryngopharyngeal Lesions: A Systematic Review Via Clinical Otolaryngology Abstract Introduction In-office biopsy (IOB) using local anaesthetic for laryngopharyngeal tumours has become an increasingly popular approach since the advent of distal chip endoscopes. Although a wide range of studies advocate use in clinical practice, the widespread application of the procedure is hampered by concerns regarding diagnostic accuracy. Methods A systematic review following the PRISMA guidelines was conducted to assess the diagnostic accuracy of IOBs performed via flexible endoscopy. In addition, an analysis of potentially modifiable factors that may affect diagnostic accuracy was performed. PubMed, EMBASE, The Cochrane Library, Web of Science, CINAHL were used in the literature database search. Results 875 studies were identified, 16 of which were included into the systematic review. 1572 successful biopsies were performed using flexible endoscopy. 1283 cases were accurately diagnosed in the outpatient setting (81.6%). 289 samples did not provide an accurate diagnosis (18.4%). The median sensitivity of IOBs was 73%, the specificity was 96.7%. Analysis of variable factors did not show any significant differences in method of approach, size of equipment (forceps), additional lighting system or learning curve. Conclusion IOBs are a viable tool for diagnostic workup of laryngopharyngeal tumours. Clinicians should be wary of reported limitations of IOBs when benign or pre-malignant diagnoses are made. In cases suspicious of malignancy, confirmatory investigation should be conducted. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta‐analysis

xlomafota13 shared this article with you from Inoreader Direct Oral Anticoagulants versus Vitamin K Antagonists in epistaxis patients: a systematic review and meta‐analysis Via Clinical Otolaryngology Abstract Objective Epistaxis is the most common otolaryngological emergency and up to one third of patients in treated on an inpatient basis take oral anticoagulants (OAC). Direct oral anticoagulants (DOAC), an OAC subgroup, have been on the market since 2010 and are being increasingly prescribed due to the cardiologic and hematologic guidelines that favour them over vitamin K antagonists (VKA), the older of the OAC subgroups. The present study aims to investigate which subgroup of epistaxis patients taking OACs has a more favourable outcome. Design/Setting A systematic review and meta-analysis were performed according to the PRISMA 2020 statement using the PubMed and Cochrane Library databases. Continuous data was analysed and standardized mean difference (SMD) was calculated according to Hedges' g. Dichotomous data was analysed and the Mantel-Haenszel method was applied to establish the odds ratio (OR). Heterogeneity was assessed according to the I2 statistics. Main Outcome/Results A total of 8 reports covering 1390 patients were included in the final synthesis. The pooled analysis demonstrated significantly shorter hospital stays in the DOAC group (SMD= -0.22, 95% CI -0.42 to -0.02, P= .03) and a significantly higher rate of posterior bleeding in the VKA group (OR= .39, 95% CI .23 to .68, P= .001). No statistically significant differences with regard to recurrence rates, admission rates, the need for transfusion, or surgical intervention (P= .57, .12, .57 and .38 respectively) were found. Conclusion According to this meta-analysis, epistaxis patients taking DOACs have a more favourable outcome than patients taking VKAs. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tongue Edema Secondary to Suspension Laryngoscopy

xlomafota13 shared this article with you from Inoreader Reply to Tongue Edema Secondary to Suspension Laryngoscopy Via Journal of Voice In our article titled "Tongue Edema Secondary to Suspension Laryngoscopy," we presented two patients who underwent prolonged suspension micro laryngoscopy (SML) and developed edema of the tongue that was severe enough that intensive care unit admission with airway monitoring was required.1 At the time of its acceptance for publication in the Journal of Voice on September 23, 2019, the complication of tongue edema following SML had not been reported. We were surprised that this problem had not been described in the literature. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reweighting of Binaural Localization Cues in Bilateral Cochlear-Implant Listeners

xlomafota13 shared this article with you from Inoreader Reweighting of Binaural Localization Cues in Bilateral Cochlear-Implant Listeners Via Journal of the Association for Research in Otolaryngology Abstract Normal-hearing (NH) listeners rely on two binaural cues, the interaural time (ITD) and level difference (ILD), for azimuthal sound localization. Cochlear-implant (CI) listeners, however, rely almost entirely on ILDs. One reason is that present-day clinical CI stimulation strategies do not convey salient ITD cues. But even when presenting ITDs under optimal conditions using a research interface, ITD sensitivity is lower in CI compared to NH listeners. Since it has recently been shown that NH listeners change their ITD/ILD weighting when only one of the cues is consistent with visual information, such reweighting might add to CI listeners' low perceptual contribution of ITDs, given their daily exposure to reliable ILDs but unreliable ITDs. Six bilateral CI listeners completed a multi-day lateralization training visually reinforcing ITDs, flanked by a pre- and post-measurement of ITD/ILD weights without visual reinforcement. Using direct electric stimulation, we p resented 100- and 300-pps pulse trains at a single interaurally place-matched electrode pair, conveying ITDs and ILDs in various spatially consistent and inconsistent combinations. The listeners' task was to lateralize the stimuli in a virtual environment. Additionally, ITD and ILD thresholds were measured before and after training. For 100-pps stimuli, the lateralization training increased the contribution of ITDs slightly, but significantly. Thresholds were neither affected by the training nor correlated with weights. For 300-pps stimuli, ITD weights were lower and ITD thresholds larger, but there was no effect of training. On average across test sessions, adding azimuth-dependent ITDs to stimuli containing ILDs increased the extent of lateralization for both 100- and 300-pps stimuli. The results suggest that low-rate ITD cues, robustly encoded with future CI systems, may be better exploitable for sound localization after increasing their perceptual weight via training. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cochlear nerve continuity preservation during retrosigmoid ablative osteotomy of the internal auditory canal for advanced vestibular schwannomas

xlomafota13 shared this article with you from Inoreader Cochlear nerve continuity preservation during retrosigmoid ablative osteotomy of the internal auditory canal for advanced vestibular schwannomas Via hno HNO. 2021 Nov 23. doi: 10.1007/s00106-021-01116-y. Online ahead of print. ABSTRACT The data of 86 patients with retrosigmoid microsurgical resection of vestibular schwannoma in tumor stage Koos II-IV were evaluated. In more than two thirds of the cases it was shown that the cochlear nerve followed the facial nerve, which is easily identified by electroneurography, in recurrent similar patterns in the region of the internal auditory canal. Starting from the fundus, this facil itated early identification and thus preservation of continuity of the cochlear nerve in the course of the internal auditory canal. This was of particular importance when safe functional preservation could not be guaranteed due to tumor size or formation despite intraoperative derivation of somatosenoric potentials, but when the possibility of subsequent hearing rehabilitation with a cochlear implant should be granted. Preoperative MRI sequences gave an indication of the possible nerve courses in some cases, but intraoperative imaging in the internal auditory canal was superior to MRI. PMID:34812915 | DOI:10.1007/s00 106-021-01116-y View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

False Hypercortisolemia Due to Abnormal Albumin-Cortisol Binding in a Patient with Familial Dysalbuminemic Hyperthyroxinemia

xlomafota13 shared this article with you from Inoreader False Hypercortisolemia Due to Abnormal Albumin-Cortisol Binding in a Patient with Familial Dysalbuminemic Hyperthyroxinemia Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Middle Transclival Endoscopic Endonasal Resection of a Ventral Pontine Cavernous Malformation

xlomafota13 shared this article with you from Inoreader Middle Transclival Endoscopic Endonasal Resection of a Ventral Pontine Cavernous Malformation Via leak of cerebrospinal fluid World Neurosurg. 2021 Nov 3;158:34-35. doi: 10.1016/j.wneu.2021.10.142. Online ahead of print. ABSTRACT The surgical management of lesions within or around the brainstem is usually associated with significant morbidity. Even though several safe entry zones have been described for brainstem lesions, especially cavernous malformations (CMs), their resection remains a challenge due to the convergence of highly functional nerve tracts and nuclei in this rather small structure. Moreover, the ventral location of some of these lesions usually calls for complex surgical approaches involving extensive bone drilling and significant manipulation of neurovascular structures. The expanded endoscopic endonasal approach has been subject to considerable advancements, widening the range of lesions accessible through this route. In this operative video, we describe the surgical nuances of an endoscopic endonasal transclival resection of a ventral pontine CM (F igures 1 and 2). A pedicled nasoseptal flap was harvested for reconstruction, gaining access to the sphenoid rostrum, which was resected. The sellar floor was removed to expose the middle third of the clivus, which was drilled out until posterior fossa dura mater was identified. A centered dural incision was performed to expose the ventral pons and basilar artery. Using image guidance, a limited pial incision over the most superficial aspect of the lesion allowed a prompt drainage of the hematoma and resection of the CM. The surgical cavity was directly inspected through the endoscope, confirming a complete resection. Reconstruction was carried out in a multilayered fashion. The patient presented a postoperative cerebrospinal fluid leak, which resolved with a lumbar drain. Neurologic status remained unchanged after surgery, with the patient displaying a favorable clinical outcome (Video 1). PMID:34740828 | DOI:10.1016/j.wneu.2021.10.142 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The efficacy of corticosteroid after facial nerve neurorrhaphy: a systematic review and meta-analysis of randomized controlled trial

xlomafota13 shared this article with you from Inoreader The efficacy of corticosteroid after facial nerve neurorrhaphy: a systematic review and meta-analysis of randomized controlled trial Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Nov 2:S1808-8694(21)00177-4. doi: 10.1016/j.bjorl.2021.09.005. Online ahead of print. ABSTRACT OBJECTIVES: The benefit of corticosteroids following facial nerve neurorrhaphy in the setting of complete transection is questionable. This systematic review and meta-analysis aimed to evaluate corticosteroid efficacy on facial nerve regeneration and functional recovery after complete disruption and neurorrhaphy. METHODS: Randomized controlled trials on both human and animal models from Ovid MEDLINE and Ovid EMBASE studying corticosteroid efficacy in complete facial nerve disruption followed by neurorrhaphy were included. Data were extracted and pooled for meta-analysis. The outcomes were evaluated from electrophysiology, histology, and functional recovery. However, no randomized controlled trial in human was performed. Possibly, performing human trials with histopathology may not be feasible in clinical se tting. RESULTS: Six animal studies (248 participants) met inclusion criteria. Electrophysiologic outcomes revealed no differences in latency (Standardized Mean Difference (SMD) = -1.97, 95% CI -7.38 to 3.44, p = 0.47) and amplitude (SMD = 0.37, 95% CI -0.44 to 1.18, p = 0.37) between systemic corticosteroids and controls. When analysis compared topical corticosteroid and control, the results provided no differences in latency (Mean Difference (MD) = 0.10, 95% CI -0.04 to 0.24, p = 0.16) and amplitude (SMD = 0.01, 95% CI -0.08 to 0.10, p = 0.81). In histologic outcomes, the results showed no differences in axon diameter (MD = 0.13, 95% CI -0.15 to 0.41, p = 0.37) between systemic corticosteroid and control; however, the result in myelin thickness (MD = 0.06, 95% CI 0.04 to 0.08, p < 0.05) favored control group. When comparing systemic corticosteroid with control in eye blinking, the results favored control (MD = 1.33, 95% CI 0.60 to 2.06, p = 0.0004). CONCLUSIONS: This evidence did not show potential benefits of systemic or topical corticosteroid deliveries after facial nerve neurorrhaphy in complete transection when evaluating electrophysiologic, histologic, and functional recovery outcomes in animal models. PMID:34815200 | DOI:10.1016/j.bjorl.2021.09.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical Intervention to Treat Pharyngolaryngeal Stenosis Caused by Behcet's Disease

xlomafota13 shared this article with you from Inoreader Surgical Intervention to Treat Pharyngolaryngeal Stenosis Caused by Behcet's Disease Via ear nose throat Ear Nose Throat J. 2021 Nov 24:1455613211053427. doi: 10.1177/01455613211053427. Online ahead of print. ABSTRACT We aimed to summarize the surgical treatment for pharyngolaryngeal stenosis and discuss prognosis in patients with Behcet's disease. Six cases of pharyngolaryngeal stenosis caused by Behcet's disease were analyzed retrospectively. All underwent surgical treatment for pharyngolaryngeal stenosis after systematic medical treatment. The follow-up time for the 6 patien ts was between 1 and 12 years. Four of the 6 patients underwent adhesiolysis as their first procedure. Two of these 4 experienced recurrence of stenosis within 6 months and underwent flap repair as their second procedure. The remaining two patients underwent flap reconstruction as their first procedure and maintained good swallowing function. Three of the 6 patients underwent preoperative tracheotomy because of dyspnea. Tracheal decannulation was successful in all patients. None of the patients experienced recurrence after their final surgical procedure and all recovered to a near-normal condition. Pharyngolaryngeal stenosis caused by Behcet's disease is a rare but severe complication; surgical intervention should be considered in patients with dysphagia after systematic medical treatment. PMID:34814770 | DOI:10.1177/01455613211053427 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ultrasonography vs Computed Tomography for Papillary Thyroid Cancer Cervical Lymph Node Metastasis

xlomafota13 shared this article with you from Inoreader Ultrasonography vs Computed Tomography for Papillary Thyroid Cancer Cervical Lymph Node Metastasis Via JAMA Otolaryngology–Head & Neck Surgery Online First This systematic review and meta-analysis compares ultrasonogra phy and computed tomography in the preoperative evaluation of papillary thyroid cancer for cervical lymph node metastasis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Trends in Diagnosis of NIFTP and Total Thyroidectomies for Papillary Thyroid Neoplasms

xlomafota13 shared this article with you from Inoreader Trends in Diagnosis of NIFTP and Total Thyroidectomies for Papillary Thyroid Neoplasms Via JAMA Otolaryngology–Head & Neck Surgery Online First This cohort study determines adoption rates of 2 recent strate gies developed to limit overtreatment of low-risk thyroid cancers: a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features, and hemithyroidectomy for selected papillary thyroid carcinomas up to 4 cm in size. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Dermatomyositis With Carcinoma of Unknown Primary Disease

xlomafota13 shared this article with you from Inoreader Dermatomyositis With Carcinoma of Unknown Primary Disease Via JAMA Otolaryngology–Head & Neck Surgery Online First This case report describes a unique case of dermatomyositis in a patient with carcinoma of unknown primary cancer in the head and neck in which neck dissection was a preceding treatment. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.