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Otolaryngology--head and Neck Surgery :... Oct 2023(1) Compare proportions of collapse, obstruction, or mixed instances on drug-induced sleep endoscopy findings of obese and nonobese children with obstructive sleep...
OBJECTIVE
(1) Compare proportions of collapse, obstruction, or mixed instances on drug-induced sleep endoscopy findings of obese and nonobese children with obstructive sleep disordered breathing. (2) Determine the frequency of collapse in general between both groups.
STUDY DESIGN
Retrospective case-control study.
SETTING
Tertiary pediatric center.
METHODS
Obese (body mass index >95 percentile) children presenting with obstructive sleep disordered breathing (>33 on the pediatric sleep questionnaire) were identified from a prospectively kept surgical database. Only those who had undergone drug-induced sleep endoscopy were eligible. Age and sex pair-matched nonobese children were identified. Only nonsyndromic, neurologically normal, surgically naïve patients were included. The frequency of obstructive, collapse, and mixed pharyngeal patterns was documented in both groups. A comparison of proportions was then undertaken (χ test).
RESULTS
Over a 5-year period, 73 consecutive children with obesity were identified (40 males; mean of 8.5 ± 3.0 years, 2.8-13.1). They were matched with 73 nonobese children (8.4 ± 3.0 years, 2.6-14.1). The obese group exhibited significantly more pharyngeal collapses (62:47) (p = .0021 odds ratio [OR] 3.358, 95% confidence interval [CI] 1.52-7.42). The proportion of pharyngeal findings on drug-induced sleep endoscopy was significantly different (p = .000129) between the 2 groups; obese (61 mixed: 3 obstruction: 9 collapse) and nonobese (48 mixed: 22 obstruction: 4 collapse).
CONCLUSION
The predominance of hypopharyngeal collapse in children with obesity may explain the likelihood of failure of surgery directed at obstructive findings. This may also strengthen the case for drug-induced sleep endoscopy in this group at the initial surgery to guide it rather than after the failure of adenotonsillectomy.
Topics: Male; Humans; Child; Retrospective Studies; Case-Control Studies; Polysomnography; Sleep Apnea, Obstructive; Endoscopy; Sleep Apnea Syndromes; Sleep; Obesity; Pharyngeal Diseases; Airway Obstruction
PubMed: 37087678
DOI: 10.1002/ohn.345 -
Advances in Therapy Sep 2023The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo... (Review)
Review
INTRODUCTION
The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo salvage TL compared with primary TL. Published meta-analyses include heterogeneous studies making the conclusions difficult to interpret. The objectives of this scoping review were to explore the reconstructive techniques potentially available for primary TL and to clarify which could be the best technique for each clinical scenario.
METHODS
A list of available reconstructive techniques for primary TL was built and the potential comparisons between techniques were identified. A PubMed literature search was performed from inception to August 2022. Only case-control, comparative cohort, or randomized controlled trial (RCT) studies were included.
RESULTS
A meta-analysis of seven original studies showed a PCF risk difference (RD) of 14% (95% CI 8-20%) favoring stapler closure over manual suture. In a meta-analysis of 12 studies, we could not find statistically significant differences in PCF risk between primary vertical suture and T-shaped suture. Evidence for other pharyngeal closure alternatives is scarce.
CONCLUSION
We could not identify differences in the rate of PCF between continuous and T-shape suture configuration. Stapler closure seems to be followed by a lower rate of PCF than manual suture in those patients that are good candidates for this technique.
Topics: Humans; Cutaneous Fistula; Laryngeal Neoplasms; Laryngectomy; Pharyngeal Diseases; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies
PubMed: 37436593
DOI: 10.1007/s12325-023-02561-7 -
The Pediatric Infectious Disease Journal Jul 2022We report a case of Mycobacterium avium complex infection of the retropharyngeal space in a 20-month-old girl. We also summarize the published literature on the... (Review)
Review
We report a case of Mycobacterium avium complex infection of the retropharyngeal space in a 20-month-old girl. We also summarize the published literature on the pathogenesis and management of nontuberculous mycobacterial infections of the retropharynx.
Topics: Female; Humans; Infant; Mycobacterium Infections, Nontuberculous; Mycobacterium avium-intracellulare Infection; Pharyngeal Diseases
PubMed: 35421046
DOI: 10.1097/INF.0000000000003548 -
Topics in Stroke Rehabilitation Sep 2019: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. : A Cross-sectional study. 73 videofluoroscopic swallow studies...
: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. : A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and were also subdivided into young adults and older persons. . The mean PRT was divided into times shorter and longer than 250 ms. : No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A: = .673; B: = 1.000) and longer (A: = .435; B: = .847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: = .260; B: = .732) and G2 (A: = .586; B: = .104). : No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Deglutition Disorders; Female; Functional Laterality; Humans; Male; Middle Aged; Pharyngeal Diseases; Reaction Time; Stroke
PubMed: 31154954
DOI: 10.1080/10749357.2019.1623519 -
Ear, Nose, & Throat Journal Sep 2021
Topics: Adolescent; Calculi; Humans; Male; Medical Illustration; Palatine Tonsil; Pharyngeal Diseases; Tonsillectomy
PubMed: 32182137
DOI: 10.1177/0145561320908484 -
Otolaryngology--head and Neck Surgery :... Feb 2016Piriform fossa sinus tracts (PFSTs) are a recognized cause of recurrent deep neck infections in the pediatric population. Conventional management has historically... (Review)
Review
BACKGROUND
Piriform fossa sinus tracts (PFSTs) are a recognized cause of recurrent deep neck infections in the pediatric population. Conventional management has historically required open resection, but over recent years minimally invasive endoscopic approaches to obliterate the pharyngeal opening of the sinus have been performed in many centers. However, there is a lack of clear evidence regarding the success rate and safety of these approaches.
OBJECTIVE
To determine the success rate of endoscopic management of PFST through a systematic review of the existing literature.
DATA SOURCES
MEDLINE (1964-2014) and bibliographies of identified papers.
REVIEW METHODS
Two authors independently reviewed 170 abstracts and identified relevant studies for full-text review. Data were independently extracted from those studies, and the Oxford Centre for Evidence-Based Medicine guidelines were used to classify the level of evidence.
RESULTS
Thirteen studies met the inclusion criteria, comprising a total of 84 patients. All included studies were evidence level 4 (case series). Various methods of obliterating the PFST were described: electrocautery (n = 39), laser (n = 19), trichloroacetic acid (n = 19), silver nitrate (n = 4), combination of silver nitrate and laser (n = 2), and fibrin glue (n = 1). The success rate for endoscopic management of PFST was 89.3% overall (90.5% in primary cases and 85.7% in revision cases). The only adverse event reported was temporary vocal cord immobility in 2.4% (n = 2) of cases.
CONCLUSION
Endoscopic management of pediatric PFST appears to be safe and effective, as a primary option and for revision after open surgery.
Topics: Cautery; Child; Electrocoagulation; Endoscopy; Humans; Laser Therapy; Otorhinolaryngologic Surgical Procedures; Pharyngeal Diseases; Pyriform Sinus
PubMed: 26527612
DOI: 10.1177/0194599815613286 -
The Laryngoscope Apr 2023To assess the predictive value of various risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy. (Review)
Review
OBJECTIVES
To assess the predictive value of various risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy.
METHODS
The characteristics of each study were collected from six databases up to January of 2022. Risk for bias was assessed using the QUADAS-2 tool.
RESULTS
A total of 58 studies in 9845 patients were included in the analysis. The incidence of PCF was 21.69%, 95% confidence intervals (CI) [0.20; 0.24] in the included studies. Age (OR = 1.33, 95% CI [1.12; 1.58]), postoperative anemia (OR = 2.29, 95% CI [1.47; 3.57]), diabetes mellitus (OR = 1.81, 95% CI [1.20; 2.71]), tumor site (above or below the glottis) (OR = 1.47, 95% CI [1.15; 1.88]), previous radiation therapy (OR = 2.06, 95% CI [1.56; 2.72]), previous tracheostomy (OR = 1.26, 95% CI [1.04; 1.53]), surgery timing (salvage vs. primary) (OR = 2.08, 95% CI [1.46; 2.97]), extended total laryngectomy (including pharyngectomy) (OR = 1.96, 95% CI [1.28; 3.00]), primary tracheoesophageal puncture (OR = 0.61, 95% CI [0.40; 0.93]), and postoperative hypoproteinemia (OR = 9.98, 95% CI [3.68; 27.03]) were significantly associated with the occurrence of PCF. In view of predictive ability, postoperative hypoproteinemia showed the highest accuracy (sensitivity = 51%, specificity = 90%, area under the curve = 0.84).
CONCLUSION
Multiple patient-, disease-, and surgery-related factors are risk factors for PCF. In particular, postoperative hypoproteinemia could be a good predictive factor for PCF in patients undergoing total laryngectomy. Laryngoscope, 133:742-754, 2023.
Topics: Humans; Laryngectomy; Laryngeal Neoplasms; Postoperative Complications; Retrospective Studies; Cutaneous Fistula; Risk Factors; Pharyngeal Diseases; Hypoproteinemia
PubMed: 35769042
DOI: 10.1002/lary.30278 -
European Journal of Radiology Jul 2016Fluid collections in the retropharyngeal space (RPS) result from a wide spectrum of diseases, including retropharyngeal abscess, cervical osteomyelitis, and calcific... (Review)
Review
Fluid collections in the retropharyngeal space (RPS) result from a wide spectrum of diseases, including retropharyngeal abscess, cervical osteomyelitis, and calcific tendinitis of the longus colli muscle. These conditions should be managed by different specialties; beginning with care in the emergency room, physicians from orthopedics, pediatrics, otolaryngology, and oncology are in charge of the treatment. Since these diseases demonstrate similar fluid collections in the RPS on computed tomography (CT) and magnetic resonance imaging (MRI), the radiologist's diagnosis based on the characteristic imaging findings is very important to identify the primary disease. Also, since some of the diseases require immediate surgical intervention to avoid life-threatening mediastinitis or airway obstruction, radiologists must distinguish these diseases correctly and provide recommendations for their management to physicians. Understanding clinical features and imaging findings of these fluid collections in the RPS is crucial for the best care.
Topics: Body Fluids; Emergencies; Humans; Magnetic Resonance Imaging; Pharyngeal Diseases; Pharynx; Tomography, X-Ray Computed
PubMed: 27235871
DOI: 10.1016/j.ejrad.2016.04.001 -
The Laryngoscope Jul 2024Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap-assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap-assisted closure.
DATA SOURCES
Pubmed/Medline, CINAHL, and CENTRAL.
REVIEW METHODS
An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted.
RESULTS
Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure.
CONCLUSION
The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.
Topics: Humans; Laryngectomy; Salvage Therapy; Surgical Flaps; Network Meta-Analysis; Postoperative Complications; Cutaneous Fistula; Pharyngeal Diseases; Laryngeal Neoplasms; Incidence; Fistula
PubMed: 38238878
DOI: 10.1002/lary.31287 -
European Respiratory Review : An... Dec 2018Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are... (Review)
Review
Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.
Topics: Anti-Asthmatic Agents; Asthma; Comorbidity; Disease Progression; Ear Diseases; Health Status; Humans; Lung; Nose Diseases; Pharyngeal Diseases; Quality of Life; Remission Induction; Risk Factors; Treatment Outcome
PubMed: 30463872
DOI: 10.1183/16000617.0056-2018