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The Pediatric Infectious Disease Journal Aug 2023Laryngeal coccidioidomycosis is a rare but life-threatening manifestation of coccidioidomycosis. Data in children are sparse and limited to case reports. We conducted... (Review)
Review
BACKGROUND
Laryngeal coccidioidomycosis is a rare but life-threatening manifestation of coccidioidomycosis. Data in children are sparse and limited to case reports. We conducted this study to review the characteristics of laryngeal coccidioidomycosis in children.
METHODS
We performed a retrospective review of patients ≤21 years of age with laryngeal coccidioidomycosis who were treated from January 2010 to December 2017. We collected demographic data, clinical and laboratory studies and patient outcomes.
RESULTS
Five cases of pediatric laryngeal coccidioidomycosis were reviewed. All children were Hispanic and 3 were female. The median age was 1.8 years and the median duration of symptoms before diagnosis was 24 days. The most common symptoms included fever (100%), stridor (60%), cough (100%) and vocal changes (40%). Airway obstruction requiring tracheostomy and/or intubation for airway management was present in 80%. The most frequent location of lesions was the subglottic area. Coccidioidomycosis complement fixation titers were frequently low and culture/histopathology of laryngeal tissue was necessary to make a definitive diagnosis. All patients required surgical debridement and were treated with antifungal agents. None of the patients had recurrence during the follow-up period.
CONCLUSIONS
This study suggests that laryngeal coccidioidomycosis in children presents with refractory stridor or dysphonia and severe airway obstruction. Favorable outcomes can be achieved with a comprehensive diagnostic work-up and aggressive surgical and medical management. With the rise in cases of coccidioidomycosis, physicians should have a heightened awareness regarding the possibility of laryngeal coccidioidomycosis when encountering children who have visited or reside in endemic areas with stridor or dysphonia.
Topics: Child; Female; Humans; Infant; Male; Airway Obstruction; Antifungal Agents; Coccidioidomycosis; Dysphonia; Respiratory Sounds; Retrospective Studies
PubMed: 37200514
DOI: 10.1097/INF.0000000000003961 -
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 -
Plastic and Reconstructive Surgery.... Sep 2023Robin sequence (RS) describes a heterogeneous population with micrognathia, glossoptosis, and upper airway obstruction (UAO). Workup, treatment, outcomes assessment, and...
BACKGROUND
Robin sequence (RS) describes a heterogeneous population with micrognathia, glossoptosis, and upper airway obstruction (UAO). Workup, treatment, outcomes assessment, and research inclusion are widely variable. Despite several classifications and algorithms, none is broadly endorsed. The objective of this investigation was to develop and trial a novel classification system designed to enhance clinical communication, treatment planning, prognostication, and research.
METHODS
This is a retrospective cross-sectional study. A classification system was developed with five elements: micrognathia, nutrition, airway, palate, syndrome/comorbidities (MicroNAPS). Definitions and a framework for "stage" assignment (R0-R4) were constructed. Stage "tongue-based airway obstruction" (TBAO) was defined for infants with glossoptosis and UAO without micrognathia. MicroNAPS was applied to 100 infants with at least 1-year follow-up. Clinical course, treatment, airway, and feeding characteristics were assessed. Descriptive and analytic statistics were calculated and a value less than 0.05 was considered significant.
RESULTS
Of the 100 infants, 53 were male. Mean follow-up was 5.0 ± 3.6 years. R1 demonstrated feeding-predominant mild RS for which UAO was managed nonoperatively but gastrostomy tubes were prevalent. R2 was characterized by airway-predominant moderate RS, typically managed with mandibular distraction or tongue-lip adhesion, with few gastrostomy tubes and short lengths-of-stay. R3 denoted severe RS, with similar UAO treatment to R2, but with more surgical feeding tubes and longer admissions. R4 represented a complex phenotype with 33% tracheostomies, protracted hospitalizations, and delayed palatoplasty. R0 ("at risk") and TBAO groups displayed the most variability.
CONCLUSIONS
MicroNAPS is easy to use and associated with relevant disease characteristics. We propose its adoption in clinical and research settings.
PubMed: 37744769
DOI: 10.1097/GOX.0000000000005283 -
Facial Plastic Surgery : FPS Dec 2023Patients often present with a complaint of nasal blockage, either primarily, or in conjunction with aesthetic concerns. The evaluation of the patient with nasal...
Patients often present with a complaint of nasal blockage, either primarily, or in conjunction with aesthetic concerns. The evaluation of the patient with nasal obstruction involves a comprehensive history and a detailed physical examination. The nose is an organ in which form and function are inseparable, and as such, examination of the patient with nasal obstruction must focus not only the internal structures that may cause obstruction of the nasal airway, but also the external structure of the nose as it impacts nasal breathing. Detailed facial analysis and a systematic nasal examination will reveal details regarding nasal obstruction due to internal sources such as septal deviation, turbinate hypertrophy, or nasal lining abnormalities, and structural abnormalities such as nasal valve collapse or external nasal deformity. This approach, in categorizing each component of the nasal exam and its findings, allows the surgeon to formulate an appropriate treatment plan that emerges from the details of the examination.
Topics: Humans; Nasal Obstruction; Esthetics, Dental; Nasal Septum; Nose Deformities, Acquired; Rhinoplasty
PubMed: 37402402
DOI: 10.1055/a-2122-7251 -
Journal of Stomatology, Oral and... Sep 2023This study aimed to evaluate deep odontogenic infection (DOI) spread and features utilizing head and neck computed tomography (CT) imaging.
PURPOSE
This study aimed to evaluate deep odontogenic infection (DOI) spread and features utilizing head and neck computed tomography (CT) imaging.
MATERIAL AND METHODS
Patients with acute DOI and preoperative contrast-enhanced CT-imaging were included in the study. Infection spaces, radiological features of these infections, CT imaging-based compromised airway and patients' background factors were evaluated and associations between these and need for postoperative mechanical ventilation (MV) were reported.
RESULTS
Altogether 262 hospitalized patients were included in the final analysis. Typically affected spaces were submandibular (74%), mandibular buccal/vestibular (37%), and sublingual (26%). Retropharyngeal (1%), mediastinal (1%) and danger space (1%) involvements were unusual. The infections were quite evenly distributed between multispace abscesses (53%) and other infections (47%). In multivariate analysis, CT-based compromised airway (OR 5.6, CI 95%, 2.9-10.9, P <0.001), midline crossing (OR 3.3, CI 95%, 1.2-8.8, P = 0.018) and extension at the level or below hyoid body (OR 2.4, CI 95% 1.2-5.1, P = 0.016) predicted the need for MV. Other radiological findings and patients' background variables remained statistically non-significant for MV.
CONCLUSION
Anterolateral and superior spread to the neck is typical in DOIs, whereas caudal progression is rare. Postoperative need for MV can be well recognized from CT.
Topics: Humans; Tomography, X-Ray Computed; Abscess; Neck; Radiography; Airway Obstruction
PubMed: 36781108
DOI: 10.1016/j.jormas.2023.101424 -
Respiratory Medicine Sep 2023Airway stent removal has traditionally been associated with a high complication rate. Most studies on stent removal are over a decade old, prior to newer anti-cancer... (Review)
Review
BACKGROUND
Airway stent removal has traditionally been associated with a high complication rate. Most studies on stent removal are over a decade old, prior to newer anti-cancer therapies, and by including non-contemporary and uncovered metal stents, may not reflect the current practices. We review our experience at Mount Sinai Hospital to report outcomes of stent removal with more contemporary practices.
METHODS
A retrospective review was carried out of all the airway stent removals performed between 2018 to 2022, in adult patients with benign or malignant airway diseases. Stents inserted and removal for stent trials for tracheobronchomalacia were excluded from the final analysis.
RESULTS
Forty-three airway stents removals in 25 patients were included. Twenty-five (58%) stents were removed in 10 patients with benign diseases, and 18 (42%) stents were removed in the remaining 15 patients with malignant diseases. Patients with benign disease were more likely to have their stent removed (OR 3.88). 63% of the stents removed were silicone. The most common reasons for stent removal were migration (n = 14, 31.1%) and treatment response (n = 13, 28.9%). Rigid bronchoscopy was used in 86% of cases. Ninety-eight percent of removals were accomplished in a single procedure. The median time to removal of stents was 32.5 days. Three complications were noted: hemorrhage (n = 1, 2.3%) and stridor (n = 2, 4.6%); one not directly related to the stent removal.
CONCLUSIONS
Covered metal or silicone airway stents, in the era of contemporary stents, better cancer-directed therapies and surveillance bronchoscopies, can be removed safely with the use of rigid bronchoscopy.
Topics: Adult; Humans; Treatment Outcome; Stents; Bronchoscopy; Tracheobronchomalacia; Silicones; Retrospective Studies; Airway Obstruction
PubMed: 37301524
DOI: 10.1016/j.rmed.2023.107320 -
Cancers Mar 2024Malignant Central Airway Obstruction (MCAO) presents a significant challenge in lung cancer management, with notable morbidity and mortality implications. While...
BACKGROUND
Malignant Central Airway Obstruction (MCAO) presents a significant challenge in lung cancer management, with notable morbidity and mortality implications. While bronchoscopy is the established diagnostic standard for confirming MCAO and assessing obstruction subtype (intrinsic, extrinsic, mixed) and severity, Computed Tomography (CT) serves as an initial screening tool. However, the extent of agreement between CT and bronchoscopy findings for MCAO remains unclear.
METHODS
To assess the correlation between bronchoscopy and CT, we conducted a retrospective review of 108 patients at Roswell Park Comprehensive Cancer Center, analyzing CT and bronchoscopy results to document MCAO presence, severity, and subtype.
RESULTS
CT correctly identified MCAO in 99% of cases (107/108). Agreement regarding obstruction subtype (80.8%, Cohen's κ = 0.683, < 0.001), and severity (65%, Quadratic κ = 0.657, < 0.001) was moderate. CT tended to equally overestimate (7/19) and underestimate (7/19) the degree of obstruction. CT was also poor in identifying mucosal involvement in mixed MCAO.
CONCLUSIONS
CT demonstrates reasonable agreement with bronchoscopy in detecting obstruction. Nevertheless, when CT indicates a positive finding for MCAO, it is advisable to conduct bronchoscopy. This is because CT lacks reliability in determining the severity of obstruction and identifying the mucosal component of mixed disease.
PubMed: 38610936
DOI: 10.3390/cancers16071258 -
The Journal of Clinical Pediatric... Jan 2024According to modern epidemiological surveys, the prevalence of adenoid hypertrophy in children and adolescents ranges from 42% to 70%. Adenoid hypertrophy can lead to... (Review)
Review
According to modern epidemiological surveys, the prevalence of adenoid hypertrophy in children and adolescents ranges from 42% to 70%. Adenoid hypertrophy can lead to airway obstruction; thus forces a child to breathe through their mouth, thus affecting the normal development of the dental and maxillofacial area, and can lead to malocclusion. Long-term mouth breathing can cause sagittal, vertical and lateral changes in the maxillofacial area. In this article, we review the current research status relating to the association between adenoid hypertrophy, oral breathing and maxillofacial growth and development in children and adolescents. We also discuss the personalized formulation of treatment plans.
Topics: Child; Adolescent; Humans; Adenoids; Malocclusion; Hypertrophy; Airway Obstruction; Mouth Breathing; Maxillofacial Development
PubMed: 38239150
DOI: 10.22514/jocpd.2024.001 -
Facial Plastic Surgery : FPS Jun 2024Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal... (Review)
Review
Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice.
Topics: Humans; Nasal Obstruction; Patient Reported Outcome Measures; Rhinoplasty; Rhinomanometry
PubMed: 37625460
DOI: 10.1055/a-2160-4998 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Aug 2023To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. From January to December 2022, a total of 6 newborns with...
To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. From January to December 2022, a total of 6 newborns with micrognathia and laryngomalacia were included. Preoperative laryngoscopy revealed concomitant laryngomalacia. These micrognathia were diagnosed as Pierre Robin sequences. All patients had grade Ⅱ or higher symptoms of laryngeal obstruction and required oxygen therapy or non-invasive ventilatory support. All patients underwent simultaneous laryngomalacia surgery and mandibular distraction osteogenesis. The shortened aryepiglottic folds were ablated using a low-temperature plasma radiofrequency during the operation. Tracheal intubation was maintained for 3-5 days postoperatively. Polysomnography(PSG) and airway CT examination were performed before and 3 months after the surgery. Among the 6 patients, 4 required oxygen therapy preoperatively and 2 required non-invasiveventilatory support. The mean age of patients was 40 days at surgery. The inferior alveolar nerve bundle was not damaged during the operation, and there were no signs of mandibular branch injury such as facial asymmetry after the surgery. Laryngomalacia presented as mixed type: type Ⅱ+ type Ⅲ. The maximum mandibular distraction distance was 20 mm, the minimum was 12 mm, and the mean was 16 mm. The posterior airway space increased from a preoperative average of 3.5 mm to a postoperative average of 9.5 mm. The AHI decreased from a mean of 5.65 to 0.85, and the lowest oxygen saturation increased from a mean of 78% to 95%. All patients were successfully extubated after the surgery, and symptoms of laryngeal obstruction such as hypoxia and feeding difficulties disappeared. Newborns with micrognathia and laryngomalacia have multi-planar airway obstruction. Simultaneous laryngomalacia surgery and mandibular distraction osteogenesis are safe and feasible, and can effectively alleviate symptoms of laryngeal obstruction such as hypoxia and feeding difficulties, while significantly improving the appearance of micrognathia.
Topics: Humans; Infant, Newborn; Infant; Micrognathism; Laryngomalacia; Treatment Outcome; Mandible; Airway Obstruction; Intubation, Intratracheal; Laryngeal Diseases; Osteogenesis, Distraction; Oxygen; Retrospective Studies
PubMed: 37551568
DOI: 10.13201/j.issn.2096-7993.2023.08.004