Salivary bypass tube in total laryngectomy: Systematic review and meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader Salivary bypass tube in total laryngectomy: Systematic review and meta‐analysis via Head & Neck Abstract The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of postoperative pharyngocutaneous fistula (PCF) and pharyngeal stenosis (PS). This study was conducted in conformity with the PRISMA statement. 1960 patients with a median age of 62.0 years were included. A SBT was placed in 980 (50%) patients (SBT group). The cumulative PCF incidence in the SBT group was 15.8% (95% CI: 9.3–23.6). The measured pooled OR comparing PCF incidence in patients with SBT compared to those without was 0.40 (95% CI: 0.24–0.65). The pooled PS incidence in the SBT group was 12.3% (95% CI: 5.4–21.6). The measured pooled OR comparing PS incidence in patients with SBT compared to those without was 0.43 (95% CI: 0.24–0.65). PCF and PS could be prevented by the intra-operative placement of a SBT. View on Web

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MRI has a limited role in investigating odynophagia if examination is normal: a binary logistic regression analysis of 484 patients presenting to a tertiary head and neck clinic

alexandrossfakianakis shared this article with you from Inoreader MRI has a limited role in investigating odynophagia if examination is normal: a binary logistic regression analysis of 484 patients presenting to a tertiary head and neck clinic via Clinical Otolaryngology Abstract Introduction Investigation of head and neck cancers places a significant burden on the National Health Service and effective resource allocation is of perpetual importance. Existing risk calculators are designed to stratify the likelihood of underlying malignancy according to symptoms, but are less relevant in secondary care as they do not integrate clinical examination findings (e.g. naso-endoscopy). We looked to evaluate the utility of magnetic resonance imaging (MRI) in investigating patients with unilateral odynophagia and a normal clinical examination. Methods A retrospective analysis was conducted over a 54-month period; 484 consecutively-recruited adult patients who underwent MRI of the neck for suspected malignancy were included. Imaging reports, case notes, and histopathology results were reviewed. Patients with previously diagnosed/treated malignancy, undergoing surveillance, or those with pathology of the salivary glands, oral cavity or thyroid gland, were excluded. A multivariate binary logistical regression model was performed to calculate the odds ratios and probabilities of malignancy for each presenting symptom, with and without negative nasoendoscopy findings. Results The overall incidence of malignancy within the cohort was 173/484 patients (35.7%; 95% CI 31.5 – 40.2%) with no cases of malignancy in patients presenting with odynophagia and a normal nasoendoscopy (0/39). The presence of a neck lump was significantly associated with malignancy, (OR 2.03 p = 0.001; 95% CI 1.59 – 2.58), as was dysphagia (OR 1.52 p = 0.009; 95%CI 1.11 - 2.11). Conversely, globus was found to have an inverse association (OR 0.41 p < 0.001; 95% CI 0.24 – 0.70). Summary New patients presenting with odynophagia alone and normal endoscopy or globus have a low likelihood of underlying malignancy, justifying reassurance and follow-up in the event of persistent symptoms. Contrariwise, patients with a neck lump, dysphagia, odynophagia and multiple concurrent aerodigestive tract symptoms, or an abnormal endoscopy have a high likelihood of underlying malignancy and should be investigated accordingly. View on Web

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A systematic review of the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with obstructive sleep apnoea

alexandrossfakianakis shared this article with you from Inoreader A systematic review of the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with obstructive sleep apnoea via Clinical Otolaryngology Abstract Introduction Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA. Methods We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was done. The protocol of this systematic review was registered with PROSPERO (CRD42021273451). Results A total of 1836 patients from ten observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported. Conclusion Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria. View on Web

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The use of MRI in a tertiary smell and taste clinic: lessons learned based on a retrospective analysis

alexandrossfakianakis shared this article with you from Inoreader The use of MRI in a tertiary smell and taste clinic: lessons learned based on a retrospective analysis via Clinical Otolaryngology Abstract Background Olfactory dysfunction (OD) is a common but underreported problem that can significantly impact a patient's quality of life. OD is prevalent in over 5% of the adult population and can be broadly categorised into conductive and sensorineural causes. Magnetic Resonance Imaging (MRI) can form part of the diagnostic work up, although its exact role is often debated. Objectives The aim of this study was to evaluate the value of MRI in managing patients with OD. Design/ Method A retrospective analysis of the records of patients presenting to a national smell and taste clinic over a five-year period was performed. Variables included demographics, endoscopic findings, final diagnosis, psychophysical smell test and imaging results. Results A total of 409 patients, with an age range of 10-93 years, underwent clinical assessment and smell testing, of which 172 patients (42%) had MRI scans. Imaging in younger age-groups was associated with a higher rate of positive findings, however identifiable causes for OD were recorded across the range. MRI provided both diagnostic and prognostic information in those with idiopathic, traumatic, and congenital causes of OD. For example, MRI provided information on the extent or absence of gliosis in those with a head trauma history allowing further treatment and prognosis. Conclusion We recommend the adjunct use of MRI in patients with a clear history and examination findings of head injury, congenital cases and in apparent idiopathic cases. MRI should be requested to compliment clinical findings with a view to aiding decision-making on treatment and prognosis independent of patient's age. View on Web

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The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users

alexandrossfakianakis shared this article with you from Inoreader The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users via The Laryngoscope CI users face significant difficulty with music perception, which negatively impacts sound quality and music appreciation. Our study demonstrates commercially available vocal boost software can be used to improve the perception of musical sound quality appraisals among CI users, which may contribute positively to quality of life. Given these findings, front-end vocal manipulations and settings should be considered as an adjunct to current methods of hearing accessibility and accommodations for CI music listening experiences. Objective To evaluate the impact of vocal boost manipulations on cochlear implant (CI) musical sound quality appraisals. Methods An anonymous, online study was distributed to 33 CI users. Participants listened to auditory tokens and assessed the musical quality of acoustic stimuli with vocal boosting and attenuation using a validated sound quality rating scale. Four versions of real-world musical stimuli were created: a version with +9 dB vocal boost, a version with −9 dB vocal attenuation, a composite stimulus containing a 1,000 Hz low-pass filter and white noise ("anchor"), and an unaltered version ("hidden reference"). Subjects listened to all four versions and provided ratings based on a 100-point scale that reflected the perceived sound quality difference of the music clip relative to the reference excerpt. Results Vocal boost increased musical sound quality ratings relative to the reference clip (11.7; 95% CI, 1.62–21.8, p = 0.016) and vocal attenuation decreased musical sound quality ratings relative to the reference clip (28.5; 95% CI, 18.64–38.44, p < 0.001). When comparing the non-musical training group and musical training group, there was a significant difference in musical sound quality rating scores for the vocal boost condition (21.2; 95% CI: 1.76–40.7, p = 0.028). Conclusions CI-mediated musical sound quality appraisals are impacted by vocal boost and attenuation. Musically trained CI users to report greater musical sound quality enhancement with a vocal boost with respect to CI users with no musical training background. Implementation of front-end vocal boost manipulations in music may improve sound quality and music appreciation among CI users. Level of Evidence II (Individual cohort study) Laryngoscope, 2022 View on Web

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Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

alexandrossfakianakis shared this article with you from Inoreader Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era via The Laryngoscope Osteoradionecrosis (ORN) of the skull base and the craniovertebral junction is a challenging complication of radiation therapy. We describe an endoscopic-assisted approach for the management of ORN of the skull base using fascia lata for microvascular free tissue transfer. This approach is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. Objectives Osteoradionecrosis (ORN) of the skull base and craniovertebral junction is a challenging complication of radiation therapy (RT). Severe cases often require surgical intervention through a multi-modal approach. With the evolution in endoscopic surgery and advances in skull base reconstruction, there is an increasing role for microvascular free tissue transfer (MFTT). We describe an endoscopic-assisted approach for the management of ORN of the skull base using fascia lata for MFTT. Study Design Retrospective case series. Methods Between 2017 and 2021, a review of all cases in which fascia lata MFTT was utilized for skull base ORN was performed. Patient demographics, preoperative characteristics, and postoperative outcomes with long-term follow-up were reviewed. Results Five patients were identified. Mean duration to onset of ORN was 17 months following RT. A trial of antibiotics, hyperbaric oxygen (HBO), and/or limited debridement was attempted without success. Refractory pain and progressive osteomyelitis were unifying symptoms. All patients underwent endoscopic debridement of the affected region of ORN prior to MFTT. Vascularized fascia lata was inset through a combined endonasal and transoral corridor. There was improvement in chronic pain in the postop setting with no patients requiring continued antibiotics or HBO therapy. Mean post-op follow-up was 23 months. Conclusions With continued evolution in endoscopic, minimally invasive approaches, there is an expanding indication for early surgical management in refractory ORN. Fascia lata MFTT is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification

alexandrossfakianakis shared this article with you from Inoreader Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification via The Laryngoscope Objective To investigate the clinical patterns and disease evolution of laryngopharyngeal reflux (LPR) patients. Methods Patients with LPR diagnosed by hypopharyngeal-esophageal impedance-pH monitoring were prospectively followed in three medical centers. Symptoms and findings were assessed with reflux symptom score (RSS) and reflux sign assessment (RSA). Patients were treated with 3-to 9-month diet and combination of proton pump inhibitors, alginate or magaldrate. Patients were followed for 3 years to determine the clinical evolution of symptoms over time. LPR that did not recur was defined as acute. Recurrent LPR consisted of reflux with one or several recurrences yearly despite successful treatment. Chronic LPR was reflux with a chronic course of symptoms. Predictive indicators of clinical evolution were investigated. Results One hundred forty patients and 82 healthy individuals completed the evaluations. Among patients, 41 (29.3%), 57 (40.7%), and 42 (30.0%) had acute, recurrent, or chronic LPR respectively. Baseline quality of life-RSS (QoL-RSS) and RSS total scores were significantly higher in chronic LPR patients. The post-treatment decrease of QoL-RSS and RSS of acute LPR patients were significantly faster as compared to recurrent and chronic patients. QoL-RSS >5 reported adequate sensitivity (94.2) and specificity (75.3). QoL-RSS thresholds defined acute (QoL-RSS = 6–25), recurrent (QoL-RSS = 26–38), and chronic (QoL-RSS > 38) LPR. Conclusion Baseline QoL-RSS may predict the clinical course of LPR patients: acute, recurrent, or chronic. A novel classification system that groups patients according to the longevity, severity, and therapeutic response of symptoms was proposed: the International Federation of Otorhinolaryngological Societies Classification of LPR. Level of Evidence III Laryngoscope, 2022 View on Web

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Long‐Term Outcomes of End‐Flexible‐Rigidscopic Transoral Surgery for Pharyngolaryngeal Cancer

alexandrossfakianakis shared this article with you from Inoreader Long‐Term Outcomes of End‐Flexible‐Rigidscopic Transoral Surgery for Pharyngolaryngeal Cancer via The Laryngoscope Objective End-flexible-rigidscopic transoral surgery (E-TOS) is a new and minimally invasive transoral surgery for resection of Tis-selected T3 pharyngolaryngeal cancers. We evaluated long-term oncological outcomes and whether postoperative voice and swallowing function were preserved following E-TOS. Methods In this retrospective single-center study, 154 patients treated with E-TOS using a curved retractor, flexible-tip rigid endoscope, and thin curved instruments were included. Their survival rate, larynx preservation rate, and disease control rate were estimated using the Kaplan–Meier method. Postoperative voice function was evaluated using both objective and subjective tests. Postoperative swallowing function was assessed using the Hyodo score and the functional outcome swallowing scale. Results The 3-year and 5-year overall survival, disease-specific survival, disease-free survival, laryngectomy-free survival, local control, and loco-regional control rates post E-TOS were 89.8% and 82.2%, 95.6% and 92.3%, 78.5% and 70.3%, 87.2% and 80.9%, 93.9% and 92.5%, and 87.2% and 85.7%, respectively. Both objective and subjective postoperative voice and swallowing function tests were within normal limits in more than 90% of the patients. Conclusion E-TOS is an effective, safe, low-cost, and minimally invasive transoral surgery for Tis-selected T3 pharyngolaryngeal cancer; it also preserves postoperative voice, larynx, and swallowing function. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational Fluid Dynamics Study

alexandrossfakianakis shared this article with you from Inoreader Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational Fluid Dynamics Study via The Laryngoscope This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics measurements. We found that lower nasal mucosal temperature and higher heat flux anteriorly correlate with a perception of improved unilateral nasal patency in healthy individuals. Objectives Recent evidence suggests that detection of nasal mucosal temperature, rather than direct airflow detection, is the primary determinant of subjective nasal patency. This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics (CFD) measurements. Methods Healthy adult participants completed Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS) questionnaires. A temperature probe measured nasal mucosal temperature at the vestibule, inferior turbinate, middle turbinate, and nasopharynx bilaterally. Participants underwent a CT scan, used to create a 3D nasal anatomy model to perform CFD analysis of nasal mucosal and inspired air temperature and heat flux along with mucosal surface area where heat flux >50 W/m2 (SAHF50). Results Eleven participants with a median age of 27 (IQR 24; 48) were recruited. Probe-measured temperature values correlated strongly with CFD-derived values (r = 0.87, p < 0.05). Correlations were seen anteriorly in the vestibule and inferior turbinate regions between nasal mucosal temperature and unilateral VAS (r = 0.42–0.46; p < 0.05), between SAHF50 and unilateral VAS (r = −0.31 to −0.36; p < 0.05) and between nasal mucosal temperature and SAHF50 (r = −0.37 to −0.41; p < 0.05). Subjects with high patency (VAS ≤10) had increased heat flux anteriorly compared with lower patency subjects (VAS >10; p < 0.05). Conclusion Lower nasal mucosal temperature and higher heat flux within the anterior nasal cavity correlates with a perception of improved unilateral nasal patency in healthy individuals. Level of Evidence 4 Laryngoscope, 2022 View on Web

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The role of intraoral scanners in the shade matching process: a systematic review

alexandrossfakianakis shared this article with you from Inoreader The role of intraoral scanners in the shade matching process: a systematic review via Journal of Prosthodontics ABSTRACT Purpose The variation in findings with regards to accuracy and precision of intraoral scanners for shade selection are no doubt confusing for clinicians who may find it difficult to make evidence-based decisions. The aim of this systematic review is to provide a comprehensive and in-depth assessment of available studies to determine the viability of using intraoral scanners for the purpose of shade matching. The PICO guided research question is as follows: when shade matching, are intraoral scanners as valid as visual or other digital shade measuring devices in determining tooth colors. Methods Electronic databases including PubMed/MEDLINE, SCOPUS, EBSCO, Cochrane, and ProQuest were systematically searched for articles published between January 1, 2011 and December 30, 2021 using the main search terms: "intraoral scanners", "scanners", "TRIOS", "CEREC", "Planmeca", "Medit", "digital dentistry" in concurrence with one of the following keywords: "EasyShade" OR "shade selection" OR "shade matching" OR "shade" OR "tooth color" OR "tooth shade" OR "digital shade matching". Bibliographies of included articles and the following journals were searched for relevant articles: Journal of Prosthetic Dentistry, Journal of Prosthodontics, Journal of Esthetic and Restorative Dentistry, Journal of Advanced Prosthodontics and Journal of Dentistry. A total of 15 articles were included in the review. Results Intraoral scanners are highly repeatable for shade matching, and outperformed visual shade matching. Accuracy varied significantly between studies, with the majority recommending the use of visual shade matching to confirm/verify the intraoral scanner results. Setting intraoral scanners to the Vita 3D Master shade guide improved both accuracy and precision. Shade matching with intraoral scanners may be influenced by external factors such as ambient light sources and incorrect use or manipulation. Conclusion Intraoral scanners set to the Vita 3D Master shade guide may be used for shade matching, but shade should be verified with visual shade matching. Further studies are required to address limitations of current studies. This article is protected by copyright. All rights reserved View on Web

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