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European Archives of... Apr 2024Inferior turbinate hypertrophy is not a rare problem in children, it causes chronic nasal obstruction which can severely impact the quality of life. This study aimed to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Inferior turbinate hypertrophy is not a rare problem in children, it causes chronic nasal obstruction which can severely impact the quality of life. This study aimed to investigate the efficacy and safety of turbinate reduction surgery in children with impaired nasal breathing due to hypertrophied inferior turbinate that's refractory to medical treatment.
METHODS
We included 23 articles with various study designs: randomized controlled trials, single-arm clinical trials, and prospective and retrospective cohort studies. We searched PubMed, Scopus, Cochrane Library, and Web of Science with the relevant keywords till April 9th, 2023. The inclusion criteria were studied with the three prespecified study design that addressed children under 18 years who underwent turbinate reduction with any technique and evaluating the improvement whether by objective or subjective methods.
RESULTS
Studies used objective measures favor turbinate surgery except two that showed no significant difference between pre and postoperative results. All studies used subjective measures showed an improvement postoperatively except one study. Complication rates are rare, with crust formation is being the commonest (6.03%), however, the procedure is generally safe in children. In addition, follow-up periods varied widely between 2 weeks and more than 5 years.
CONCLUSION
Turbinate reduction in children is an effective as a treatment method for nasal blockage due to inferior turbinate hypertrophy which is resistant to medical treatment. It is a safe procedure with low rates of complications, however, due to the heterogenicity of the study designs, with a possible risk of bias we could not conduct a meta-analysis besides our systematic review.
Topics: Child; Humans; Adolescent; Turbinates; Treatment Outcome; Prospective Studies; Retrospective Studies; Quality of Life; Nasal Obstruction; Hypertrophy
PubMed: 37943317
DOI: 10.1007/s00405-023-08327-9 -
Acta Paediatrica (Oslo, Norway : 1992) Jul 2024
Topics: Humans; Airway Obstruction; Foreign Bodies; Suction; Child
PubMed: 38563507
DOI: 10.1111/apa.17229 -
Otolaryngology--head and Neck Surgery :... Jan 2024Internal nasal valve dysfunction is a prevalent cause of nasal obstruction. This systematic review, along with a Meta-analysis, evaluated the efficacy of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Internal nasal valve dysfunction is a prevalent cause of nasal obstruction. This systematic review, along with a Meta-analysis, evaluated the efficacy of temperature-controlled radiofrequency device (RFD) treatment in alleviating nasal obstruction by rectifying nasal valve collapse.
DATA SOURCES
A comprehensive review of studies retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases (up to December 2022) was conducted.
REVIEW METHODS
We included studies that evaluated the quality of life and nasal obstruction scores before and after RFD treatment. In addition, sham-controlled studies were analyzed.
RESULTS
In total, 451 patients across 8 studies were included in the analysis. Patients who underwent RFD treatment reported a significantly enhanced quality of life 24 months after treatment compared to pretreatment scores. The rates of clinically improved states and positive responses regarding quality of life after treatment were 82% and 91%, respectively. Moreover, the disease-specific quality of life, as assessed by the Nasal Obstruction Symptom Evaluation score, significantly improved.
CONCLUSION
RFD may help improve nasal obstruction symptoms. Further randomized clinical studies on larger cohorts are essential to substantiate its efficacy in enhancing nasal valve function.
Topics: Humans; Nasal Obstruction; Quality of Life; Nose; Rhinoplasty; Catheters; Treatment Outcome
PubMed: 37702187
DOI: 10.1002/ohn.522 -
Medical & Biological Engineering &... Aug 2023The human upper airway is comprised of many anatomical volumes. The obstructions in the upper airway volumes are needed to be diagnosed which requires volumetric...
The human upper airway is comprised of many anatomical volumes. The obstructions in the upper airway volumes are needed to be diagnosed which requires volumetric segmentation. Manual segmentation is time-consuming and requires expertise in the field. Automatic segmentation provides reliable results and also saves time and effort for the expert. The objective of this study is to systematically review the literature to study various techniques used for the automatic segmentation of the human upper airway regions in volumetric images. PRISMA guidelines were followed to conduct the systematic review. Four online databases Scopus, Google Scholar, PubMed, and JURN were used for the searching of the relevant papers. The relevant papers were shortlisted using inclusion and exclusion eligibility criteria. Three review questions were made and explored to find their answers. The best technique among all the literature studies based on the Dice coefficient and precision was identified and justified through the analysis. This systematic review provides insight to the researchers so that they shall be able to overcome the prominent issues in the field identified from the literature. The outcome of the review is based on several parameters, e.g., accuracy, techniques, challenges, datasets, and segmentation of different sub-regions. Flowchart of the search process as per PRISMA guidelines along with inclusion and exclusion criteria.
Topics: Humans; Airway Obstruction; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Larynx; Pharynx; Paranasal Sinuses
PubMed: 37248380
DOI: 10.1007/s11517-023-02842-x -
Acta Otorrinolaringologica Espanola 2024Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the... (Meta-Analysis)
Meta-Analysis Review
Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. This beneficial effect is evident since the first to third month after surgery. However, for solid conclusions, a standard way to measure MCTT should be stablished, as well as a method to appropriately describe the extension of the surgery.
Topics: Humans; Mucociliary Clearance; Turbinates; Nasal Mucosa; Nasal Obstruction; Hypertrophy
PubMed: 37722657
DOI: 10.1016/j.otoeng.2023.09.002 -
American Journal of Otolaryngology 2024This systematic review and meta-analysis evaluates and compares the effects of two treatments that ablate the posterior nasal nerves for rhinitis-related symptoms:... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review and meta-analysis evaluates and compares the effects of two treatments that ablate the posterior nasal nerves for rhinitis-related symptoms: cryotherapy and radiofrequency neurolysis.
METHODS
We reviewed studies retrieved from PubMed, SCOPUS, Embase, the Web of Science and the Cochrane database up to June 2023. Papers reporting quality-of-life and rhinitis-related symptom scores before and after cryotherapy, and sham-controlled studies, were analyzed.
RESULTS
In total, 738 patients enrolled in 10 studies were evaluated. Both cryotherapy and radiofrequency neurolysis significantly improved rhinitis-related symptoms including congestion, itching, rhinorrhea, and sneezing, and quality of life during 12 months of follow-up. Radiofrequency neurolysis was significantly more effective than cryotherapy in terms of reducing total nasal symptom scores at up to 12 months postoperatively. In terms of individual symptoms, itching, rhinorrhea, and congestion were significantly alleviated or tended to be reduced more by radiofrequency neurolysis than by cryotherapy. The improvements in the minimal clinically important difference in total nasal symptom scores (1.0 point) after 3 months of cryotherapy and radiofrequency therapy were 81.8 % and 92.7 %, respectively.
CONCLUSIONS
Cryotherapy and radiofrequency neurolysis both improved rhinitis-symptom and quality-of-life scores. Especially, radiofrequency neurolysis showed the better effectiveness for improving the nasal symptoms related to the rhinitis than cryotherapy.
Topics: Humans; Quality of Life; Nasal Obstruction; Rhinitis; Ablation Techniques; Rhinorrhea; Pruritus
PubMed: 38039909
DOI: 10.1016/j.amjoto.2023.104130 -
European Archives of... Jul 2024The failure rate and risk factors of upper airway surgery with drug induced sleep endoscopy (DISE) remain unknown in the treatment of obstructive sleep apnea (OSA). This... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The failure rate and risk factors of upper airway surgery with drug induced sleep endoscopy (DISE) remain unknown in the treatment of obstructive sleep apnea (OSA). This review aims to analyze the failure rate of upper airway surgery with DISE and identify obstruction sites for surgical failure.
METHODS
A systematic review was conducted using PubMed, Embase, Web of Science, and Google Scholar until May 20th, 2023. We included studies that used DISE to assess obstructive sites before upper airway surgery and reported surgical failure rates and outcomes in patients with OSA.
RESULTS
25 studies with a total of 1522 patients were included in the systematic review and meta-analysis. Upper airway surgery guided by DISE had a relatively low failure rate of 37% (95% CI 0.31-0.44) in the random effects model (I = 85.97%, P < 0.001). According to the velum, oropharynx, tongue base, and epiglottis (VOTE) scoring system, major risk factors for surgical failure included circumferential collapse at the velum, lateral wall collapse and small tonsils at the oropharynx, anterior-posterior lingual collapse and complete collapse at the tongue base. High body mass index and large preoperative apnea hypopnea index were also risk factors for OSA surgical failure.
CONCLUSIONS
Upper airway surgery guided by DISE in patients with OSA had a low failure rate of 37%. DISE can identify obstruction sites associated with surgical failure and guide single-level and multi-level surgeries.
Topics: Humans; Endoscopy; Risk Factors; Sleep Apnea, Obstructive; Treatment Failure
PubMed: 38324055
DOI: 10.1007/s00405-024-08484-5 -
Sleep & Breathing = Schlaf & Atmung May 2024This study aimed to conduct a meta-analysis and systematic review of drug-induced sleep endoscopy (DISE) in pediatric conventional obstructive sleep apnea-hypopnea... (Meta-Analysis)
Meta-Analysis
PURPOSE
This study aimed to conduct a meta-analysis and systematic review of drug-induced sleep endoscopy (DISE) in pediatric conventional obstructive sleep apnea-hypopnea syndrome (OSAHS) without previous upper airway surgery, or comorbidity, to evaluate the change in treatment strategies and to identify obstructive sites observed during DISE. This study aimed to explore the role of DISE in the management of pediatric conventional OSAHS.
METHODS
A comprehensive search was conducted using both computerized and manual methods to retrieve relevant case studies on DISE-guided treatment of pediatric conventional OSAHS from databases including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, WF, and VIP database. The search period extended from database inception to January 2023. Strict inclusion and exclusion criteria were applied to select relevant literature, and data extraction was performed accordingly. Meta-analysis was conducted using the Stata 16.0 software.
RESULTS
A total of 761 patients from four studies were included in the meta-analysis. All pediatric patients had no history of upper airway surgery, craniofacial abnormalities, or syndromes other than OSAHS. The quality assessment revealed that the included studies were of low methodological quality and consisted of non-randomized case studies. Meta-analysis results indicated that in pediatric patients with OSAHS, the obstruction rates observed during DISE were as follows: nasopharyngeal (adenoid) obstruction 93%, soft palate obstruction 35%, oropharyngeal (tonsil) obstruction 76%, tongue base obstruction 32%, supraglottic obstruction 31%, and multi-level obstruction 60%. DISE led to a change in the conventional surgical approach in 45% (95% CI: 29-60%) of patients with OSAHS, providing individualized treatment plans. Postoperative symptoms and sleep-related parameters improved significantly compared to preoperative values, with DISE findings possibly enhancing surgical success rates and potentially avoiding unnecessary procedures.
CONCLUSION
In some cases, DISE may potentially lead to alterations in conventional surgical approaches for children with OSAHS who had no history of upper airway surgery, craniofacial abnormalities, or other syndromes.. The results of our meta-analysis were in favor of DISE-directed approach for pediatric conventional OSAHS. However, further high-quality randomized controlled trials (RCTs) are warranted in future research to investigate the role of DISE in the management of pediatric OSAHS.
Topics: Humans; Sleep Apnea, Obstructive; Endoscopy; Child
PubMed: 37917282
DOI: 10.1007/s11325-023-02945-7 -
Child's Nervous System : ChNS :... Aug 2023Trans-sellar trans-sphenoidal encephalocele is a rare congenital anomaly, with only around 20 cases having been documented in literature around the world. Surgical...
Trans-sellar trans-sphenoidal encephalocele is a rare congenital anomaly, with only around 20 cases having been documented in literature around the world. Surgical repair of these defects in the pediatric population commonly uses either the transcranial or the transpalatal approach, with the choice of approach being individualized based on the clinical features, age, and associated defects present in the patient. Here, we document a case of a 4-month-old child who presented to us with nasal obstruction, who was diagnosed with this rare entity and successfully underwent a transcranial repair for the same. We also provide a systematic review of all existing case reports that have described this rare condition in the pediatric population, as weel as the different surgical approaches used in each case.
Topics: Humans; Infant; Child; Encephalocele; Nasal Obstruction; Magnetic Resonance Imaging; Facial Bones
PubMed: 37055485
DOI: 10.1007/s00381-023-05956-7 -
The Cleft Palate-craniofacial Journal :... Dec 2023Palate development involves a genetic regulation through a complex molecular mechanism that may be disrupted by environmental factors, resulting in impaired fusion and...
INTRODUCTION
Palate development involves a genetic regulation through a complex molecular mechanism that may be disrupted by environmental factors, resulting in impaired fusion and cleft palate formation. An encounter with a case of cleft palate due to dorsal tongue hamartoma prompted us to perform this systematic review.
OBJECTIVE
To review the clinical profile and management approach for a case with cleft palate and tongue hamartoma.
DESIGN
A systematic literature search was conducted using keywords related to cleft palate and tongue hamartoma in PubMed, Scopus, MEDLINE, and Scielo databases through December 2021, with no time or language restrictions.
PATIENTS, PARTICIPANTS
Studies reporting patients with cleft palate and tongue hamartoma were included.
MAIN OUTCOME MEASURE(S)
Information related to clinical profile, diagnostic tests, histopathology, management, and outcomes were extracted.
UNLABELLED
Fourteen relevant publications were identified with 16 cases reported so far. Among them, thirteen patients were females (81.25%), and 3 were males (18.75%). The age of presentation varied from birth to 19 years. Oral-facial-digital syndrome (type II) was the most commonly associated syndrome.
UNLABELLED
Congenital tongue hamartoma with cleft palate is a rare presentation, which can present as an isolated entity or part of a syndrome. Genetic evaluation is warranted, particularly for multiple hamartomatous lesions. The preferred treatment is immediate excision of hamartoma while following a standard timeline for palatoplasty.
Topics: Male; Female; Humans; Cleft Palate; Tongue Diseases; Tongue; Hamartoma; Syndrome
PubMed: 35881509
DOI: 10.1177/10556656221116001