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Anesthesia and Analgesia Apr 2022Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia.
METHODS
We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy.
RESULTS
Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74-0.87), 0.71 (0.58-0.82), and 0.75 (0.62-0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70-0.87), 0.71 (0.57-0.82), and 0.72 (0.45-0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84-0.90), 0.77 (0.73-0.81), 0.78 (0.74-0.81), and 0.71 (0.67-0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17-0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01-0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08-0.39 cm; P = .004), respectively.
CONCLUSIONS
Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.
Topics: Adult; Anesthesia, General; Humans; Intubation, Intratracheal; Laryngoscopy; Respiratory System; Ultrasonography
PubMed: 34914641
DOI: 10.1213/ANE.0000000000005839 -
Heliox for inducible laryngeal obstruction (vocal cord dysfunction): A systematic literature review.Laryngoscope Investigative... Apr 2019To perform a systematic literature review on the use of Heliox with patients with inducible laryngeal obstruction/vocal cord dysfunction to: i) identify current evidence... (Review)
Review
OBJECTIVES
To perform a systematic literature review on the use of Heliox with patients with inducible laryngeal obstruction/vocal cord dysfunction to: i) identify current evidence base; and ii) establish the methodological quality of published research.
METHODS
Articles published up to March 2018 were searched for key words and terms using Cochrane Library, MEDLINE, PubMed, CINAHL, EMBASE and Dynamed. Studies were included if they presented original research into the use of Heliox for vocal cord dysfunction.
RESULTS
Only three studies met the inclusion criteria for review. All reported favorable results for the use of Heliox as an adjunctive therapy for vocal cord dysfunction but none had sufficient methodological quality to support their conclusions.
CONCLUSION
Despite review articles recommending the use of Heliox in vocal cord dysfunction, there is a lack of good quality research to support this conclusion. There is a need for further research to investigate the effectiveness of Heliox as an adjunctive therapy for vocal cord dysfunction.
LEVEL OF EVIDENCE
4.
PubMed: 31024997
DOI: 10.1002/lio2.229 -
Paediatric Respiratory Reviews Jun 2018Extremely premature (EP) infants are at increased risk of left vocal cord paralysis (LVCP) following surgery for patent ductus arteriosus (PDA). (Review)
Review
CONTEXT
Extremely premature (EP) infants are at increased risk of left vocal cord paralysis (LVCP) following surgery for patent ductus arteriosus (PDA).
OBJECTIVE
A Systematical Review was conducted to investigate the incidence and outcomes of LVCP after PDA ligation in EP born infants.
DATA SOURCES
Searches were performed in Cochrane, Medline, Embase, Cinahl and PsycInfo.
STUDY SELECTION
Studies describing EP infants undergoing PDA surgery and reporting incidence of LVCP were included.
DATA EXTRACTION AND SYNTHESIS
Study details, demographics, incidence of LVCP, diagnostic method and reported outcomes were extracted. DerSimonian and Laird random effect models with inverse variance weighting were used for all analyses.
STUDY APPRAISAL
The Newcastle-Ottawa scale for observational studies was used for quality assessment.
RESULTS
21 publications including 2067 infants were studied. The overall pooled summary estimate of LVCP incidence was 9.0% (95% CI 5.0, 15.0). However, the pooled incidence increased to 32% when only infants examined with laryngoscopy were included. The overall risk ratio for negative outcomes was higher in the LVCP group (2.20, 95% CI 1.69, 2.88, p = 0.01) compared to the non-LVCP-group.
CONCLUSIONS
Reported incidence of LVCP varies widely. This may be explained by differences in study designs and lack of routine vocal cords postoperative assessment. LVCP is associated with negative outcomes in EP infants. The understanding of long-term outcomes is scarce. Routine laryngoscopy may be necessary to identify all cases of LVCP, and to provide correct handling for infants with LVCP.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Extremely Premature; Ligation; Observational Studies as Topic; Postoperative Complications; Risk Assessment; Vocal Cord Paralysis
PubMed: 29336933
DOI: 10.1016/j.prrv.2017.11.001 -
Life (Basel, Switzerland) Apr 2023The recurrent laryngeal nerve (RLN) is the structure responsible for sensory and motor innervation of the larynx, and it has been shown that its lesion due to a lack of... (Review)
Review
Systematic Review and Meta-Analysis: Recurrent Laryngeal Nerve Variants and Their Implication in Surgery and Neck Pathologies, Using the Anatomical Quality Assurance (AQUA) Checklist.
INTRODUCTION
The recurrent laryngeal nerve (RLN) is the structure responsible for sensory and motor innervation of the larynx, and it has been shown that its lesion due to a lack of surgical rigor led to alterations such as respiratory obstruction due to vocal cords paralysis and permanent phonation impairment. The objectives of this review were to know the variants of the RLN and its clinical relevance in the neck region.
METHODS
This review considered specific scientific articles that were written in Spanish or English and published between 1960 and 2022. A systematic search was carried out in the electronic databases MEDLINE, WOS, CINAHL, SCOPUS, SCIELO, and Latin American and Caribbean Center for Information on Health Sciences to compile the available literature on the subject to be treated and was enrolled in PROSPERO. The included articles were studies that had a sample of RLN dissections or imaging, intervention group to look for RLN variants, or the comparison of the non-recurrent laryngeal nerve (NRLN) variants, and finally, its clinical correlations. Review articles and letters to the editor were excluded. All included articles were evaluated through quality assessment and risk of bias analysis using the methodological quality assurance tool for anatomical studies (AQUA). The extracted data in the meta-analysis were interpreted to calculate the prevalence of the RLN variants and their comparison and the relationship between the RLN and NRLN. The heterogeneity degree between included studies was assessed.
RESULTS
The included studies that showed variants of the RLN included in this review were 41, a total of 29,218. For the statistical analysis of the prevalence of the RLN variant, a forest plot was performed with 15 studies that met the condition of having a prevalence of less than 100%. As a result, the prevalence was shown to be 12% (95% CI, SD 0.11 to 0.14). Limitations that were present in this review were the publication bias of the included studies, the probability of not having carried out the most sensitive and specific search, and finally, the authors' personal inclinations in selecting the articles.
DISCUSSION
This meta-analysis can be considered based on an update of the prevalence of RLN variants, in addition to considering that the results show some clinical correlations such as intra-surgical complications and with some pathologies and aspects function of the vocal cords, which could be a guideline in management prior to surgery or of interest for the diagnostic.
PubMed: 37240722
DOI: 10.3390/life13051077 -
Ear, Nose, & Throat Journal Nov 2022Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive... (Review)
Review
INTRODUCTION
Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive cancer. Narrow band imaging (NBI) endoscopy has been introduced to improve early diagnosis of benign and malignant laryngeal lesions. The aim of this literature review was to evaluate the accuracy of preoperative evaluation of vocal fold leukoplakia with NBI endoscopy in comparison with histology.
METHODS
A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using 3 different databases: PubMed, Embase, and Scopus. The included articles in the systematic review were identified combining each of the following terms: "narrow band imaging" OR "NBI," [AND] with each of these terms: "laryngeal leukoplakia," OR "vocal fold leukoplakia," OR "vocal cord leukoplakia."
RESULTS
The articles that fully met the inclusion criteria were 5 case series, conducted between January 2010 and February 2018, and published between 2017 and 2019. The selected articles included 312 patients (86% males and 14% females), affected by 382 vocal cord leukoplakia, evaluated with NBI endoscopy and that underwent surgical microlaryngoscopy with biopsy. Based on the studies included in the review, accuracy of NBI in predicting malignancy within leukoplakia ranged from 81% to 97.8%, demonstrating to be an accurate method to predict the risk of malignant transformation of vocal fold leukoplakia.
CONCLUSION
Narrow band imaging can help otolaryngologists in the decision-making process on the necessity to perform a biopsy and transoral surgery or long-term follow-up. Larger studies are necessary to confirm the high association of NBI evaluation of the epithelium surrounding the leukoplakia with the histological diagnosis.
Topics: Endoscopy; Endoscopy, Gastrointestinal; Female; Humans; Laryngeal Neoplasms; Leukoplakia; Male; Narrow Band Imaging; Vocal Cords
PubMed: 33213196
DOI: 10.1177/0145561320973770 -
Journal of Craniovertebral Junction &... 2022Spondyloptosis is a rare presentation of cervical spine traumatism where listhesis is more than 100%. Traumatic cervical spine spondyloptosis (TCS) is one of the least... (Review)
Review
BACKGROUND
Spondyloptosis is a rare presentation of cervical spine traumatism where listhesis is more than 100%. Traumatic cervical spine spondyloptosis (TCS) is one of the least discussed forms of cervical spine traumatisms because of its rarity and the gravity of patient's condition, limiting good management, and the number of reported cases.
OBJECTIVES
This study aimed to discuss clinical, radiological, and best management tools of the aforementioned pathology.
MATERIALS AND METHODS
Scopus, ScienceDirect, PubMed, and Google Scholar databases were searched for English articles about traumatic cervical spondyloptosis. Titles, abstracts, or author-specified keywords that contain the words "spondyloptosis" AND "cervical" AND "spine" were identified. There were no time limits. In sum, 542 records were identified, 63 records were screened, and 46 records were included in this review, describing 64 clinical cases of traumatic cervical spondyloptosis. The clinical cases of two patients managed at our department are also presented and included. In the end, 66 cases were included in this study. Demographics, clinics, radiology, management tools, and outcome of the reviewed cases were discussed. This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2009. The American Spinal Injury Association Impairment Scale (AIS) score was used to evaluate the clinical presentations.
RESULTS
This review included 66 patients consisting of 46 males (70%) and 20 females (30%), with a mean age of 41 years. The accident was indicated in 62 cases; it was a road traffic accident in 29 cases (46%), a fall in 24 cases (38%), and motor vehicle accident in 15 cases (24%). The lesion was iatrogenic in four patients. Twenty-one patients were received without motor or sensitive deficit and so scored Grade E on AIS, 10 with Grade D, 11 Grade C, four Grade B, and 20 with Grade A. On imaging, spondyloptosis involved the C1-C2 segment in two cases (3%), C2-C3 in three cases (5.5%), C3-C4 in one case (1.5%), C4-C5 in six cases (9%), C5-C6 in nine cases (13%), C6-C7 in 20 cases (30%), and C7-T1 in 26 cases (38%). In all cases, there was either fracture or dislocation in posterior elements. Bilateral pedicles or facet joint fractures were noted in 53% of the 56 patients where the associated lesions were described, but it jumps to 89% when a vertebra is projected in front of another. In two cases, there was no mention of closed reduction via transcranial traction; in 13 cases (20%), it was avoided for a reason (child, patient's refusal,…). In the 51 cases where the traction was clearly applied, 17 cases (33%) were reduced totally; in 13 cases (25%) the reduction was partial; it failed in 19 cases (37%); and in the remaining cases, the result was not clear. Traction weight varied from 4 kg to 27.2 kg, applied from 6 h to 20 days. Where total reduction was achieved, an average weight of 11.9 kg with proximal average time of 6 days was needed, whereas an average of 11.5 kg was needed for partial reduction with proximal average time of 10 days. 62 patients were operated rather in one or two times. Anterior approach was used in 20 patients (32%), a posterior approach in 14 patients (23%), and combined anterior/posterior approaches in 28 patients (45%). In four patients, the outcome was not available; in the remaining 62 cases, an improvement of an initial deficit was noted in 25 patients (40%), conservation of an initial motor force integrity was noted in 19 patients (30%), and nine patients (14.5%) kept the same initial deficit. Few complications were declared: dura tears with cerebrospinal fluid leaks, meningitis, esophageal laceration, and vocal cord paralysis. There was a mortality of 11% (seven cases).
CONCLUSION
Traumatic cervical spine spondyloptosis predominates in the lowest levels of the cervical spine, allowed in all cases by a failure in posterior elements. It is a lesion with the worst clinical presentation. Traumatic cervical spine spondyloptosis is highly instable, imposing urgent reduction followed by surgical stabilization. At the limit of the reviewed cases, outcome is in general good, but mortality is still important.
PubMed: 35386237
DOI: 10.4103/jcvjs.jcvjs_132_21 -
Systematic review of the diagnostic value of magnetic resonance imaging for early glottic carcinoma.Laryngoscope Investigative... Feb 2018In early glottic cancer, accurate assessment of tumor extension, including depth infiltration, is of great importance for both staging, therapeutic approach and... (Review)
Review
OBJECTIVE
In early glottic cancer, accurate assessment of tumor extension, including depth infiltration, is of great importance for both staging, therapeutic approach and systematic comparison of data. Our goal was to assess the diagnostic value of MRI in pre-therapeutic staging of primary early stage (T1 and T2) glottic carcinoma.
STUDY DESIGN
Systematic review of literature.
METHODS
We conducted a systematic search in Pubmed, Embase, and Scopus up to September 23, 2016. Included studies were selected and critically appraised for relevance and validity.
RESULTS
Seven out of 938 unique articles were selected, including 64 cases. MRI over-staged 6% and under-staged 13% of cT1 and cT2 tumors. However, available data is heterogeneous, very limited and mainly based on subanalysis of a small amount of patients. Reported MRI protocols appear to be suboptimal for small laryngeal lesions. Diagnostic value of MRI for subtle depth infiltration or laryngeal anatomical subsites (eg, laryngeal ventricle, vocal cord, etc.) could not be assessed.
CONCLUSIONS
More studies are needed to assess the diagnostic value of MRI for small glottic tumors.
PubMed: 29492468
DOI: 10.1002/lio2.138 -
European Archives of... Apr 2017Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature... (Review)
Review
Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature provides an overview of the current understanding of the definition, epidemiology, diagnosis and management of EILO. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines the Cochrane, Embase, Ovid MEDLINE and PubMed databases were searched. Four search domains "exercise", "induced", "laryngeal" and "obstruction" were used. Primary searching found 469 records, 308 were excluded following screening of titles and citation. 100 were duplicates, a further 47 studies were excluded after applying inclusion and exclusion criteria. Two studies were identified following cross-referencing. A total of 15 studies were included. The last search date was 6/06/15. Average prevalence in the general adolescent population and athletes was 7.1 and 35.2 %, respectively. Dyspnoea was reported in 96.5, 99 and 100 % of three EILO patient cohorts. Two studies (n = 107) reported continuous laryngoscopy during exercise (CLE) testing could differentiate between patients and controls. In two studies (n = 33) the visual analogue scale (VAS) showed a beneficial effect of endoscopic supraglottoplasty (ES). Thirty-eight out of 43 patients who received two or more laryngeal control therapy sessions (LCT) had improvement or resolution of EILO symptoms. Exercise induced dyspnoea is the most common EILO symptom. EILO has a high occurrence in adolescents and athletes. The CLE test is the current gold standard for EILO diagnostics. Management of EILO includes both surgical and non-surgical interventions.
Topics: Adolescent; Airway Obstruction; Asthma, Exercise-Induced; Diagnosis, Differential; Dyspnea; Exercise; Female; Humans; Laryngeal Diseases; Laryngoscopy; Male; Prevalence; Vocal Cord Dysfunction
PubMed: 27730324
DOI: 10.1007/s00405-016-4338-1 -
Laryngoscope Investigative... Apr 2023To explore whether narrow-band imaging (NBI) endoscopy is accurate in the diagnosis of malignant transformation of vocal cord leukoplakia. (Review)
Review
OBJECTIVE
To explore whether narrow-band imaging (NBI) endoscopy is accurate in the diagnosis of malignant transformation of vocal cord leukoplakia.
METHODS
The PubMed, Embase, Cochrane Library and Web of Science databases were searched to collect data on studies reporting the use of NBI endoscopy as a diagnostic test for diagnosing vocal cord leukoplakia from January 2015 to December 2021. Study design, analysis method, and extraction results were performed according to the PRISMA guidelines. The sensitivity, specificity, pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) were used to summarize the performance metrics of the meta-analysis. Risk of bias data and the quality of the included studies was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2).
RESULTS
Nine studies were finally included in the analysis. The results of the meta-analysis showed that the pooled sensitivity and specificity of NBI endoscopy for diagnosing leukoplakia lesions were 0.76 (95% CI: 0.72-0.8) and 0.93 (95% CI: 0.91-0.95), respectively. The PLR and NLR were 10.09 (95% CI: 6.53-15.59) and 0.22 (95% CI: 0.13-0.38), respectively. The comprehensive diagnostic odds ratio (DOR) was 54.96 (95% CI: 24.32-124.17), and the area under the curve was 0.9584. The eight articles had a low risk of bias risk and one article was unclear.
CONCLUSION
NBI likely has good accuracy for diagnosing malignant transformation of vocal cord leukoplakia. However, multicenter studies and large samples are still needed.
PubMed: 37090880
DOI: 10.1002/lio2.1049 -
The Laryngoscope Sep 2019To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF).
OBJECTIVES
To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF).
METHODS
PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
RESULTS
Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma.
CONCLUSIONS
Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.
Topics: Clinical Trials as Topic; Humans; Laryngeal Diseases; Laryngeal Edema; Laryngopharyngeal Reflux; Polyps; Prospective Studies; Retrospective Studies; Vocal Cords
PubMed: 30892725
DOI: 10.1002/lary.27932