-
Acta Otorrinolaringologica Espanola 2016Tuberculosis is a public health problem for many countries, whether rich or poor. Extranodal ENT locations are rare, and it prevails in the cavum in the pharyngeal...
Tuberculosis is a public health problem for many countries, whether rich or poor. Extranodal ENT locations are rare, and it prevails in the cavum in the pharyngeal region. Based on a 3-year retrospective study of 5 clinical cases, the authors aim to highlight the epidemiological, clinical, radiological, therapeutic and prognostic aspects of this disease. Clinical aspects are not specific and there is often confusion in the differential diagnosis with tumoral lesions. Positive diagnosis is guided by the clinical and the radiological findings, and confirmed by histology.
Topics: Antitubercular Agents; Drug Therapy, Combination; Follow-Up Studies; Humans; Mycobacterium tuberculosis; Pandemics; Pharyngitis; Retrospective Studies; Tomography, X-Ray Computed; Tuberculin Test; Tuberculosis
PubMed: 26277737
DOI: 10.1016/j.otorri.2015.05.004 -
The Laryngoscope Aug 2014Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES/HYPOTHESIS
Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis.
DATA SOURCES
English language literature from 2004 to 2013 REVIEW METHODS: We searched the English language literature for articles published on the subject from 2004 to 2013.
RESULTS
Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third.
CONCLUSION
This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
Topics: Cutaneous Fistula; Fistula; Humans; Laryngectomy; Pharyngeal Diseases; Salvage Therapy; Surgical Flaps
PubMed: 24474684
DOI: 10.1002/lary.24619 -
American Journal of Speech-language... May 2021Purpose The aim of this study was to provide clinicians with an overview of literature relating to dysphagia in spinal muscular atrophy (SMA) to guide assessment and... (Review)
Review
Purpose The aim of this study was to provide clinicians with an overview of literature relating to dysphagia in spinal muscular atrophy (SMA) to guide assessment and treatment. Method In this clinical focus article, we review literature published in Scopus and PubMed between 1990 and 2020 pertaining to dysphagia in SMA across the life span. Original research articles that were published in English were included. Searches were conducted within four themes of inquiry: (a) etiology and phenotypes, (b) respiratory systemic deficits and management, (c) characteristics of natural history dysphagia and its treatment, and (d) dysphagia outcomes with disease-modifying therapies. Articles for the first two themes were selected by content experts who identified the most salient articles that would provide clinicians foundational background knowledge about SMA. Articles for the third theme were identified using search terms, including OR . Search terms for the fourth theme included AND OR . Review of Pertinent Literature Twenty-nine articles were identified. Findings across identified articles support the fact that patients with SMA who do not receive disease-modifying therapy exhibit clinically significant deficits in oropharyngeal swallow function. Few investigations provided systematic information regarding the underlying physiological deficits responsible for this loss in function, the timing of the degradation, or how disease-modifying therapies change these outcomes. Conclusion Future research outlining the physiological and functional oropharyngeal swallowing deficits among patients with SMA who receive disease-modifying therapy is critical in developing standards of dysphagia care to guide clinicians.
Topics: Biological Products; Deglutition Disorders; Humans; Muscular Atrophy, Spinal; Phenotype; Recombinant Fusion Proteins; Research Design
PubMed: 33822657
DOI: 10.1044/2021_AJSLP-20-00217 -
Acta Otorhinolaryngologica Italica :... Dec 2014The pectoralis major myocutaneous flap (PMMF) is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared... (Review)
Review
The pectoralis major myocutaneous flap (PMMF) is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro- or pharyngocutaneous fistula. Herein, we attempt to establish risk factors for fistula formation in reconstructions of mucosal defects in the head and neck using PMMF through retrospective analysis of PMMF performed during 3 years at a single institution, with a total of 84 procedures. There were 69 men and 15 women, with a mean age of 59.5 years. There were 15 cases of partial flap loss, two total flap losses and 31 fistulas. The independent risk factors for fistula formation were preoperative serum hemoglobin < 13 g/dl, preoperative serum albumin < 3.4 g/dl and hypopharynx reconstruction. The PMMF is still a very useful flap and this is the first multivariate analysis analysing risk factors for fistula formation. These findings are helpful in selecting patients with elevated risk of fistula formation, and therefore preventive measures can be undertaken to avoid potentially serious complications.
Topics: Aged; Cutaneous Fistula; Female; Fistula; Head and Neck Neoplasms; Humans; Male; Middle Aged; Myocutaneous Flap; Oral Fistula; Pectoralis Muscles; Pharyngeal Diseases; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Risk Factors
PubMed: 25762830
DOI: No ID Found -
Dysphagia Dec 2022There has been a recent shift towards proactive dysphagia intervention in motor neurone disease (MND) to maintain physiological reserve. Pharyngeal high-resolution... (Review)
Review
There has been a recent shift towards proactive dysphagia intervention in motor neurone disease (MND) to maintain physiological reserve. Pharyngeal high-resolution manometry (PHRM) can quantify swallowing pathophysiology to inform and evaluate proactive dysphagia intervention. This study aims to explore the current use of PHRM as a dysphagia evaluation in adults with MND. A scoping review based on the Joanna Briggs Framework was completed. Four electronic databases (PubMed, EMBASE, CINAHL and Web of Science core) were searched (inception to March 2021) by two independent researchers. Data were analysed according to (i) PHRM protocol and analysis methods and the feasibility of same, (ii) swallow biomechanics data and (iii) dysphagia intervention effects as measured by PHRM. Six studies with 78 people with MND (PwMND) were included. There was considerable variation in PHRM protocol and analysis methods. Five studies reported a 100% completion rate and three studies reported no adverse events. Swallow biomechanics data were reported across all studies. The effects of sensory stimulation, increased bolus consistency, effortful swallow and cricopharyngeal myotomy were evaluated using PHRM with 20 PwMND across four studies with varying effects. Literature on the use of PHRM in PwMND is limited. Variability in PHRM methods restricts comparison of metrics. PHRM appears to be a feasible tool for PwMND. PHRM can provide novel swallow physiology data in PwMND and quantify discrete effects of compensatory and surgical dysphagia interventions not detectable by videofluoroscopy or FEES. Further research on the effects of proactive dysphagia intervention as measured by PHRM is required.
Topics: Adult; Humans; Deglutition Disorders; Deglutition; Manometry; Pharynx; Motor Neuron Disease
PubMed: 35235032
DOI: 10.1007/s00455-022-10418-4 -
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 -
Clinical Otolaryngology : Official... Jan 2020High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The...
Differences in the diagnostic value between fiberoptic and high definition laryngoscopy for the characterisation of pharyngeal and laryngeal lesions: A multi-observer paired analysis of videos.
OBJECTIVES
High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes.
DESIGN
Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice.
SETTING
A tertiary referral hospital.
PARTICIPANTS
In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order.
MAIN OUTCOME MEASURES
Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes.
RESULTS
HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P = .03), differentiating malignant from benign lesions (91.7% vs 79.8%; P = .03) and prediction of specific histological entities (59.7% vs 47.2%; P < .01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P < .01).
CONCLUSIONS
HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.
Topics: Adult; Aged; Aged, 80 and over; Female; Fiber Optic Technology; Humans; Image Enhancement; Laryngeal Diseases; Laryngoscopy; Male; Middle Aged; Pharyngeal Diseases; ROC Curve; Retrospective Studies; Video Recording
PubMed: 31747481
DOI: 10.1111/coa.13476 -
The British Journal of Radiology May 2020To study if pre-treatment CT texture features in locally advanced squamous cell carcinoma of laryngo-pharynx can predict long-term local control and laryngectomy free...
Tumor radiomic features complement clinico-radiological factors in predicting long-term local control and laryngectomy free survival in locally advanced laryngo-pharyngeal cancers.
OBJECTIVE
To study if pre-treatment CT texture features in locally advanced squamous cell carcinoma of laryngo-pharynx can predict long-term local control and laryngectomy free survival (LFS).
METHODS
Image texture features of 60 patients treated with chemoradiation (CTRT) within an ethically approved study were studied on contrast-enhanced images using a texture analysis research software (TexRad, UK). A filtration-histogram technique was used where the filtration step extracted and enhanced features of different sizes and intensity variations corresponding to a particular spatial scale filter (SSF): SSF = 0 (without filtration), SSF = 2 mm (fine texture), SSF = 3-5 mm (medium texture) and SSF = 6 mm (coarse texture). Quantification by statistical and histogram technique comprised mean intensity, standard-deviation, entropy, mean positive pixels, skewness and kurtosis. The ability of texture analysis to predict LFS or local control was determined using Kaplan-Meier analysis and multivariate cox model.
RESULTS
Median follow-up of patients was 24 months (95% CI:20-28). 39 (65%) patients were locally controlled at last follow-up. 10 (16%) had undergone salvage laryngectomy after CTRT. For both local control & LFS, threshold optimal cut-off values of texture features were analyzed. Medium filtered-texture feature that were associated with poorer laryngectomy free survival were entropy ≥4.54, ( = 0.006), kurtosis ≥4.18; = 0.019, skewness ≤-0.59, = 0.001, and standard deviation ≥43.18; = 0.009). Inferior local control was associated with medium filtered features entropy ≥4.54; p 0.01 and skewness ≤ - 0.12; = 0.02. Using fine filters, entropy ≥4.29 and kurtosis ≥-0.27 were also associated with inferior local control ( = 0.01 for both parameters). Multivariate analysis showed medium filter entropy as an independent predictor for LFS and local control ( < 0.001 & = 0.001).
CONCLUSION
Medium texture entropy is a predictor for inferior local control and laryngectomy free survival in locally advanced laryngo-pharyngeal cancer and this can complement clinico-radiological factors in predicting prognosticating these tumors.
ADVANCES IN KNOWLEDGE
Texture features play an important role as a surrogate imaging biomarker for predicting local control and laryngectomy free survival in locally advanced laryngo-pharyngeal tumors treated with definitive chemoradiation.
Topics: Carcinoma, Squamous Cell; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Pharyngeal Neoplasms; Prospective Studies; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32101463
DOI: 10.1259/bjr.20190857 -
Journal of Veterinary Internal Medicine Nov 2022Videofluoroscopic swallow studies (VFSS) utilizing penetration-aspiration (P-A) scoring assesses airway protection in people. On VFSS, penetration (ingesta or secretions...
BACKGROUND
Videofluoroscopic swallow studies (VFSS) utilizing penetration-aspiration (P-A) scoring assesses airway protection in people. On VFSS, penetration (ingesta or secretions immediately cranial to the vocal folds) and aspiration (material caudal to the vocal folds) are associated with increased risk of lung injury in people. Penetration-aspiration (P-A) scoring has been validated in animal models, but the incidence of P-A, clinical signs (CS), and dysphagic disorders associated with P-A in dogs are unknown.
OBJECTIVES
Using VFSS, identify the incidence of P-A, compare CS between dogs with and without P-A, and identify predisposing dysphagic abnormalities for P-A.
ANIMALS
One hundred client-owned dogs.
METHODS
Sequential VFSS and associated medical records from dogs presenting to the veterinary teaching hospitals at Auburn University (n = 53) and the University of Missouri (n = 47) were retrospectively reviewed. Statistical comparisons were made using Mann-Whitney tests, one-way analysis of variance (ANOVA) on ranks, multiple linear regression, and Spearman rank order correlation (P < .05).
RESULTS
On VFSS, the incidence of pathologic P-A was 39%. No significant differences in CS were found between dogs with or without P-A (P > .05), with 14/39 dogs with P-A presenting without respiratory CS. Pharyngeal (P < .001) and esophageal (P = .009), but not oral-preparatory (P = .2) dysphagia was more common with P-A. Pharyngeal weakness (P < .001) and esophago-oropharyngeal reflux (EOR; P = .05) were independent predictors of P-A and were moderately and weakly positively correlated with P-A score respectively (P < .001, r = 0.489; P = .04, r = 0.201).
CONCLUSIONS
Penetration-aspiration occurs in dogs in the absence of respiratory CS (i.e., occult P-A). Dogs with pharyngeal weakness and EOR should be considered at risk for P-A.
Topics: Dogs; Animals; Incidence; Fluoroscopy; Retrospective Studies; Video Recording; Deglutition Disorders; Dog Diseases
PubMed: 36259261
DOI: 10.1111/jvim.16553 -
JAMA Internal Medicine Feb 2020The role of herpes simplex virus (HSV) reactivation on morbidity and mortality in patients in the intensive care unit requiring mechanical ventilation remains unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
The role of herpes simplex virus (HSV) reactivation on morbidity and mortality in patients in the intensive care unit requiring mechanical ventilation remains unknown.
OBJECTIVE
To determine whether preemptive treatment with intravenous acyclovir reduces the duration of mechanical ventilation in patients with HSV oropharyngeal reactivation.
DESIGN, SETTING, AND PARTICIPANTS
A double-blind, placebo-controlled randomized clinical trial was conducted in 16 intensive care units in France. Participants included 239 adults (age, >18 years) who received mechanical ventilation for at least 96 hours and continued to receive mechanical ventilation for 48 hours or more, with HSV oropharyngeal reactivation. Patients were enrolled between February 2, 2014, and February 22, 2018.
INTERVENTIONS
Participants were randomized to receive intravenous acyclovir, 5 mg/kg, 3 times daily for 14 days or a matching placebo.
MAIN OUTCOMES AND MEASURES
The primary end point was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included mortality at 60 days. Main analyses were conducted on an intention-to-treat basis.
RESULTS
Of 239 patients enrolled and randomized, 1 patient withdrew consent, leaving 238 patients, with 119 patients in both the acyclovir and placebo (control) groups (median [IQR] age, 61 [50-70] years; 76 [32%] women) available for primary outcome measurement. On day 60, the median (IQR) numbers of ventilator-free days were 35 (0-53) for acyclovir recipients and 36 (0-50]) for controls (P = .17 for between-group comparison). Among secondary outcomes, 26 patients (22%) and 39 patients (33%) had died at day 60 (risk difference, 0.11, 95% CI, -0.004 to 0.22, P = .06). The adverse event frequency was similar for both groups (28% in the acyclovir group and 23% in the placebo group, P = .40), particularly acute renal failure post randomization affecting 3 acyclovir recipients (3%) and 2 controls (2%). Four patients (3%) in the acyclovir group vs none in the placebo group stopped the study drug for treatment-related adverse events.
CONCLUSIONS AND RELEVANCE
In patients receiving mechanical ventilation for 96 hours or more with HSV reactivation in the throat, use of acyclovir, 5 mg/kg, 3 times daily for 14 days, did not increase the number of ventilator-free days at day 60, compared with placebo. These findings do not appear to support routine preemptive use of acyclovir in this setting.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02152358.
Topics: Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Female; France; Herpes Simplex; Humans; Male; Middle Aged; Oropharynx; Pharyngeal Diseases; Respiration, Artificial; Respiratory Insufficiency; Treatment Outcome; Virus Activation
PubMed: 31841577
DOI: 10.1001/jamainternmed.2019.5713