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Internal Medicine (Tokyo, Japan) Feb 2024An 83-year-old man diagnosed with multiple myeloma presented with renal failure and hyperkalemia. The patient was treated with calcium polystyrene sulfonate (CPS;...
An 83-year-old man diagnosed with multiple myeloma presented with renal failure and hyperkalemia. The patient was treated with calcium polystyrene sulfonate (CPS; kalimate) for hyperkalemia. On the 10th day after starting CPS, airway obstruction due to the presence of a mass was observed, and the patient died on that same day. Autopsy revealed that the mass was located between the trachea and epiglottis and it was determined to consist of CPS-related mosaic crystals. There was a protrusion within the trachea surrounding the CPS crystals, inflammatory cells, and granulation tissue. This case suggests that CPS is associated with not only gastrointestinal complications, but also with airway complications.
PubMed: 38403775
DOI: 10.2169/internalmedicine.2505-23 -
The Laryngoscope Nov 2023To review treatment and outcomes in patients with congenital cricoid cartilage malformation.
OBJECTIVES
To review treatment and outcomes in patients with congenital cricoid cartilage malformation.
METHODS
Retrospective analysis of patients with diagnosis of congenital cricoid malformation (CCM) treated in a single tertiary pediatric referral center between 1985 and 2022. Patients were grouped according to the morphology of the cricoid cartilage that was diagnosed during endoscopy. We reviewed the treatment strategy(s), decannulation rate, complications, and functional outcomes.
RESULTS
Twenty-nine patients were grouped into four morphological subtypes of cricoid cartilage: 10 patients had a hypoplastic cricoid, eight had an elliptic shape, five had severe anterior thickening, and six an accentuated V-shape posterior cricoid plate. Twenty-four patients underwent surgery, and five were closely followed up without surgical treatment. Eight patients had a tracheostomy prior to surgery, and the majority had a hypoplastic cricoid. Most patients (20 out of 24) required additional procedures postoperatively to achieve an age-appropriate airway. Thirteen patients needed endoscopic dilatation(s) and granulation tissue removal; four needed more aggressive treatment, and three patients required revision open surgery. Decannulation was achieved after a median of 4.5 months in all previously tracheostomized patients. Endoscopy at the last follow-up showed an age-appropriate airway in 27 patients; 20 patients had normal oral feeding, and 11 patients had a normal voice.
CONCLUSION
Endoscopy is important to diagnose CCM and most of the time patients would need only watchful waiting. In this report, surgery was required for patients who continued to remain symptomatic and had a compromised airway. The type of surgery depends on the type of cricoid malformation and the grade of stenosis.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:3185-3191, 2023.
Topics: Child; Humans; Airway Obstruction; Cricoid Cartilage; Laryngostenosis; Retrospective Studies; Treatment Outcome
PubMed: 36856166
DOI: 10.1002/lary.30626 -
European Annals of Otorhinolaryngology,... May 2024Inferior turbinate lateralization via an endonasal approach is a reliable low-risk procedure to correct inferior turbinate hypertrophy resistant to medical treatment....
Inferior turbinate lateralization via an endonasal approach is a reliable low-risk procedure to correct inferior turbinate hypertrophy resistant to medical treatment. This well-established technique provides nasal comfort while conserving the mucosal membrane and physiology of the inferior turbinate, minimizing the postoperative complications (empty nose syndrome) besetting turbinoplasty involving mucosal or submucosal reduction.
Topics: Turbinates; Humans; Hypertrophy; Nasal Obstruction; Rhinoplasty
PubMed: 37872042
DOI: 10.1016/j.anorl.2023.10.016 -
The British Journal of Oral &... Sep 2023Pierre Robin Sequence (PRS) is a congenital craniofacial anomaly distinguished by the presence of micrognathia, glossoptosis, and upper airway obstruction. Cleft palate... (Review)
Review
Pierre Robin Sequence (PRS) is a congenital craniofacial anomaly distinguished by the presence of micrognathia, glossoptosis, and upper airway obstruction. Cleft palate occurs in over 3/4 of patients with PRS. The wide U-shape cleft and airway dysfunction create challenges in clinical management. Currently, disputes exist on the treatment protocol and prognosis of cleft palate management among patients with PRS. This review is focused on the deformity features, intervention timing, technique selection, airway support, and outcome evaluation of cleft palate among patients with PRS, aiming to provide reference to further evolution in the management of PRS-related cleft palate.
Topics: Humans; Cleft Palate; Airway Obstruction; Pierre Robin Syndrome; Prognosis; Outcome Assessment, Health Care
PubMed: 37453893
DOI: 10.1016/j.bjoms.2023.06.003 -
American Journal of Orthodontics and... Jul 2023Rapid maxillary expansion (RME) expands the maxillary dentition laterally and improves nasal airway obstruction. However, the incidence of nasal airway obstruction...
INTRODUCTION
Rapid maxillary expansion (RME) expands the maxillary dentition laterally and improves nasal airway obstruction. However, the incidence of nasal airway obstruction improvement after RME is approximately 60%. This study aimed to clarify the beneficial effects of RME on nasal airway obstruction in specific pathologic nasal airway diseases (nasal mucosa hypertrophy and obstructive adenoids) using computer fluid dynamics.
METHODS
Sixty subjects (21 boys; mean age 9.1 years) were divided into 3 groups according to their nasal airway condition (control, nasal mucosa hypertrophy, and obstructive adenoids), and those requiring RME had cone-beam computed tomography images taken before and after RME. These data were used to evaluate the nasal airway ventilation condition (pressure) using computer fluid dynamics and measure the cross-sectional area of the nasal airway.
RESULTS
The cross-sectional area of the nasal airway significantly increased after RME in all 3 groups. The pressures in the control and nasal mucosa groups significantly reduced after RME but did not change significantly in the adenoid group. The incidence of improvement in nasal airway obstruction in the control, nasal mucosa, and adenoid groups was 90.0%, 31.6%, and 23.1%, respectively.
CONCLUSIONS
The incidence of improvement in nasal airway obstruction after RME depends on the nasal airway condition (nasal mucosa hypertrophy and obstructive adenoids). In patients with nonpathologic nasal airway conditions, the obstruction may be sufficiently improved with RME. Furthermore, to some extent, RME may be effective in treating nasal mucosa hypertrophy. However, because of obstructive adenoids, RME was ineffective in patients with nasal airway obstruction.
Topics: Male; Humans; Child; Nasal Obstruction; Adenoids; Palatal Expansion Technique; Hydrodynamics; Nasal Mucosa; Cone-Beam Computed Tomography; Hypertrophy
PubMed: 37191595
DOI: 10.1016/j.ajodo.2023.04.014 -
Otolaryngologic Clinics of North America Jun 2024Nasal obstruction is common in patients with obstructive sleep apnea (OSA) and may variably impact symptoms and severity of OSA. It is associated with decreased... (Review)
Review
Nasal obstruction is common in patients with obstructive sleep apnea (OSA) and may variably impact symptoms and severity of OSA. It is associated with decreased continuous positive airway pressure (CPAP) compliance, and both medical and surgical management of nasal obstruction have resulted in increased CPAP adherence. Treatment of OSA with comorbid rhinitis via topical nasal steroids demonstrates a beneficial impact on daytime sleepiness. Isolated nasal surgery has been shown to result in decreased daytime sleepiness and snoring, with minimal effect on OSA severity.
Topics: Humans; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Nasal Obstruction; Rhinitis; Nasal Surgical Procedures; Snoring
PubMed: 38072728
DOI: 10.1016/j.otc.2023.11.002 -
Respirology (Carlton, Vic.) Jul 2024Malignant Central Airway Obstruction (MCAO) encompasses significant and symptomatic narrowing of the central airways that can occur due to primary lung cancer or... (Review)
Review
Malignant Central Airway Obstruction (MCAO) encompasses significant and symptomatic narrowing of the central airways that can occur due to primary lung cancer or metastatic disease. Therapeutic bronchoscopy is associated with high technical success and symptomatic relief and includes a wide range of airway interventions including airway stents. Published literature suggests that stenting practices vary significantly across the world primarily due to lack of guidance. This document aims to address this knowledge gap by addressing relevant questions related to airway stenting in MCAO. An international group of 17 experts from 17 institutions across 11 countries with experience in using airway stenting for MCAO was convened as part of this guideline statement through the World Association for Bronchology and Interventional Pulmonology (WABIP). We performed a literature and internet search for reports addressing six clinically relevant questions. This guideline statement, consisting of recommendations addressing these six PICO questions, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with expert experience when necessary. Panel members participated in the development of the final recommendations using the modified Delphi technique.
Topics: Humans; Stents; Lung Neoplasms; Airway Obstruction; Bronchoscopy; Pulmonary Medicine; Societies, Medical
PubMed: 38812262
DOI: 10.1111/resp.14764 -
BMJ Open Respiratory Research Nov 2023Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated...
BACKGROUND
Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated with chronic airflow obstruction later in life.
METHODS
We used longitudinal data from 3957 participants of the multinational Burden of Obstructive Lung Disease study. We defined isolated small airways obstruction using the prebronchodilator mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF) if a result was less than the lower limit of normal (
airways obstruction. We defined chronic airflow obstruction as post-bronchodilator FEV/FVC airways obstruction and chronic airflow obstruction at follow-up. We assessed discriminative and predictive ability by calculating the area under the receiver operating curve (AUC) and Brier score. We replicated our analyses in 26 512 participants of the UK Biobank study. RESULTS
Median follow-up time was 8.3 years. Chronic airflow obstruction was more likely to develop in participants with isolated small airways obstruction at baseline (FEF less than the LLN, OR: 2.95, 95% CI 1.02 to 8.54; FEV/FVC less than the LLN, OR: 1.94, 95% CI 1.05 to 3.62). FEF was better than the FEV/FVC ratio to discriminate future chronic airflow obstruction (AUC: 0.764 vs 0.692). Results were similar among participants of the UK Biobank study.
CONCLUSION
Measurements of small airways obstruction can be used as early markers of future obstructive lung disease.
Topics: Humans; Longitudinal Studies; Pulmonary Disease, Chronic Obstructive; Airway Obstruction; Vital Capacity; Forced Expiratory Volume
PubMed: 37989490
DOI: 10.1136/bmjresp-2023-002056 -
Brazilian Journal of Otorhinolaryngology 2024This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom...
OBJECTIVES
This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique.
METHODS
We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients.
RESULTS
Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ± 29.9 and 23.5 ± 26.7, respectively (mean differences of 42.04; [95% CI 27.35-56.73]; p < 0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of -29.02; [95% CI -40.5 to -17.5]; p = 0.0001). Residual septal deviation was verified in 2 patients (7.4%).
CONCLUSION
Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications.
LEVEL OF EVIDENCE
Level 3.
Topics: Humans; Prospective Studies; Rhinoplasty; Female; Male; Adult; Quality of Life; Nasal Septum; Nasal Obstruction; Treatment Outcome; Patient Satisfaction; Young Adult; Middle Aged; Surveys and Questionnaires
PubMed: 38430860
DOI: 10.1016/j.bjorl.2024.101398 -
Facial Plastic Surgery : FPS Jun 2024Assessing patients with complaints of nasal obstruction has traditionally been done by evaluation of the nasal airway looking for fixed or dynamic obstructive locations...
Assessing patients with complaints of nasal obstruction has traditionally been done by evaluation of the nasal airway looking for fixed or dynamic obstructive locations that could impair nasal airflow. Not infrequently, however, symptoms of nasal obstruction do not match the clinical examination of the nasal airway. Addressing this subset of patients may be a challenge to the surgeon. Evaluation of patients with symptoms of nasal obstruction should include a combination of a patient-reported assessment of nasal breathing and at least one objective method for measuring nasal airflow or nasal airway resistance or dimensions. This will allow distinction between patients with symptoms of nasal obstruction and low airflow or high nasal airway resistance and patients with similar symptoms but whose objective evaluation demonstrates normal nasal airflow or normal airway dimensions or resistance. Patients with low nasal airflow or high nasal airway resistance will require treatment to increase nasal airflow as a necessary step to improve symptoms, whereas patients with normal nasal airflow or nasal airway resistance will require a multidimensional assessment looking for less obvious causes of impaired nasal breathing sensation.
Topics: Humans; Nasal Obstruction; Airway Resistance; Algorithms; Rhinomanometry
PubMed: 38301716
DOI: 10.1055/s-0044-1779483