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Facial Plastic Surgery : FPS Jun 2024Measuring nasal airflow and nasal breathing has been a major goal of rhinology. Many objective methods for measuring nasal airflow or nasal airway resistance or... (Review)
Review
Measuring nasal airflow and nasal breathing has been a major goal of rhinology. Many objective methods for measuring nasal airflow or nasal airway resistance or dimensions provide valuable data but are time-consuming and require expensive equipment and trained technicians, thus making these methods less practical for clinical practice. Peak nasal inspiratory flow (PNIF) measurement is fast, unexpensive, noninvasive, and able to provide an objective evaluation of nasal airflow in real-time. Unilateral PNIF measurements allow separated evaluation of each side of the nasal airway and may prove particularly useful when clinical assessment detects significant asymmetry between both nasal cavities.PNIF measurements are most useful for assessing changes in nasal airflow achieved by any form of therapy, including surgical treatment of the nasal airway. These measurements generally correlate with other objective methods for nasal airway evaluation, but not unequivocally with patient-reported evaluation of nasal breathing. Nevertheless, as low PNIF values prevent the sensation of a suitable nasal breathing, PNIF measurement may also prove useful to optimize the decision of how to best address patients with complaints of nasal airway obstruction.
Topics: Humans; Nasal Obstruction; Airway Resistance; Rhinomanometry; Nasal Cavity; Inhalation; Respiration; Nose; Inspiratory Capacity
PubMed: 38158212
DOI: 10.1055/a-2236-4581 -
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 -
The Journal of Craniofacial Surgery Sep 2023Robin sequence is a congenital issue resulting in airway obstruction, difficulty feeding, and failure to thrive. Mandibular Distraction Osteogenesis is used to improve...
Robin sequence is a congenital issue resulting in airway obstruction, difficulty feeding, and failure to thrive. Mandibular Distraction Osteogenesis is used to improve airway obstruction in these patients, but little data exists characterizing feeding outcomes following surgery. This study aims to evaluate feeding outcomes and weight gain following mandibular distraction for airway correction in infants. A single-center retrospective chart review was conducted, and patients under 12 months old who underwent mandibular distraction between December 2015 and July 2021 were included in the study. The presence of cleft palate, distance of distraction, and polysomnography results were recorded. The primary outcomes were the length of distraction, need for nasogastric tube or G-tube at discharge, time lapsed to achieve full oral feeds, and weight gain (kilogram). Ten patients met the criteria. Of those 10 patients, 4 were syndromic, 7 had a cleft palate, and 4 had a congenital cardiac diagnosis. The average length of stay postsurgery was 28 days. Eight patients achieved full oral feeds in an average of 65.6 days. Five patients required nasogastric tube or G-tube at discharge, with 3 of these patients later transitioning to full oral feeds. All patients gained weight 3 months postsurgery with an average of 0.521 kg/mo. Patients who achieved full oral feeds gained an average of 0.549 kg/mo. Patients with supplementation gained an average of 0.454 kg/mo. All patients demonstrated improvement in airway obstruction with an average postoperative apnea hypopnea index of 1.64. Further investigation is necessary to identify challenges seen in feeding after mandibular distraction osteogenesis and improve care.
Topics: Humans; Infant; Retrospective Studies; Cleft Palate; Treatment Outcome; Mandible; Airway Obstruction; Osteogenesis, Distraction; Pierre Robin Syndrome; Weight Gain
PubMed: 37431904
DOI: 10.1097/SCS.0000000000009551 -
Respirology (Carlton, Vic.) Jun 2024
Topics: Humans; Spirometry; Pulmonary Disease, Chronic Obstructive; Airway Obstruction; Forced Expiratory Volume
PubMed: 38438271
DOI: 10.1111/resp.14699 -
The Nigerian Postgraduate Medical... 2023Tracheostomy is a life-saving procedure; the benefits and frequency of procedures being performed have led to frequent reviews of indication in many regions of the...
INTRODUCTION
Tracheostomy is a life-saving procedure; the benefits and frequency of procedures being performed have led to frequent reviews of indication in many regions of the world. The aim is to establish the indications, diagnosis and complications of tracheostomy performed in the past 10 years in a tertiary hospital in Lagos.
METHODS
This is a 10-year retrospective study of all patients who had tracheostomies for various indications from 2010 to 2019. Patient medical records were analysed for demographic profile, diagnosis, indication, elective or emergency tracheostomy, surgeon's rank, technique of decannulation and type of complications. All the variables in the data were imputed and analyzed using the IBM Statistical Package for the Social Sciences version 27. Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequency and percentage.
RESULTS
Four hundred and eighty-six tracheostomies were carried out during the period under review, and 440 patients had complete data retrieved. The age group of 0-9 years constituted the most common age for tracheostomy (18%). The most common indication for tracheostomy was for relief of upper airway obstruction in 53.4%. Neoplasms (40%) and trauma (30.7%) constituted primary diagnosis requiring tracheostomies. Amongst the paediatric age group with upper airway obstruction, infections (31.8%) and foreign body inhalation (24.3%) constituted the most common primary diagnosis. Stoma infection and peristomal granulation tissue were the most common early complication (21.8%) and late complication (43.4%), respectively.
CONCLUSION
Relief of upper airway obstruction from neoplasm remains the most common indication for tracheostomy, and peristomal granulation infection was the most common complication.
Topics: Child; Humans; Infant, Newborn; Infant; Child, Preschool; Retrospective Studies; Tertiary Care Centers; Tracheostomy; Nigeria; Airway Obstruction
PubMed: 38037787
DOI: 10.4103/npmj.npmj_226_23 -
Facial Plastic Surgery Clinics of North... Feb 2024The cleft lip is one of the most common craniofacial abnormalities seen worldwide. The lip and primary rhinoplasty repairs are performed together in a single surgery for... (Review)
Review
The cleft lip is one of the most common craniofacial abnormalities seen worldwide. The lip and primary rhinoplasty repairs are performed together in a single surgery for patients aged 3 to 6 months. The intermediate rhinoplasty has fallen out of favor due to more advanced approaches at primary rhinoplasty. However, it still plays a role in addressing severe nasal airway obstruction or correcting anatomic differences causing emotional distress from social ridicule. The article reviews the incidence of cleft lip, discusses its development and variant anatomy, and examines the approaches to surgical repair of the cleft clip, primary and intermediate rhinoplasties.
Topics: Humans; Cleft Lip; Rhinoplasty; Nasal Obstruction
PubMed: 37981414
DOI: 10.1016/j.fsc.2023.08.001 -
Journal of Plastic, Reconstructive &... May 2024Cleft lip nasal deformity (CLND)-associated nasal airway obstruction (CL-NAO) may be inadequately characterized, with its functional implications subsequently... (Review)
Review
BACKGROUND
Cleft lip nasal deformity (CLND)-associated nasal airway obstruction (CL-NAO) may be inadequately characterized, with its functional implications subsequently underappreciated and neglected. The purpose of this systematic review is to (1) summarize the available assessment results in CL-NAO, (2) evaluate the reliability of current assessment tools, and (3) identify ongoing gaps and inconsistencies for future study.
METHODS
A systematic search of the MEDLINE, EMBASE, and Scopus databases was performed for articles studying CL-NAO. Articles focusing on noncleft populations or surgical techniques were excluded. Extracted data included information about study design, patient demographics, medical history, and assessment scores.
RESULTS
Twenty-six articles met criteria for inclusion. Assessments included patient-reported outcome measures (PROMs), anatomic characterizations of CLND, and nasal airflow and resistance studies. Objective assessments were generally more reliable than subjective assessments in CLND. Unilateral CLND was better represented in the literature than bilateral CLND. For unilateral CLND, the cleft side was more obstructed than the noncleft side, with stereotyped patterns of anterior nasal deformity but varied middle and posterior deformity patterns. Overall, there was considerable heterogeneity in study design regarding stratification of CLND cohorts by age, cleft phenotype and laterality, and surgical history.
CONCLUSIONS
A wide range of subjective and objective assessment tools were used to characterize CL-NAO, including PROMs, anatomic measurements, and airflow and resistance metrics. Overall, objective assessments of CL-NAO were more reliable than subjective surveys, which may have resulted from variable expectations regarding nasal patency in the CLND population combined with large heterogeneity in study design.
Topics: Humans; Cleft Lip; Nasal Obstruction; Patient Reported Outcome Measures; Rhinoplasty; Nose
PubMed: 38493539
DOI: 10.1016/j.bjps.2024.02.061 -
The Journal of Allergy and Clinical... Jan 2024Exhaled nitric oxide (Feno) is used as a marker of type-2 airway inflammation in asthma management. Studies with airway challenges demonstrated that a reduction in...
BACKGROUND
Exhaled nitric oxide (Feno) is used as a marker of type-2 airway inflammation in asthma management. Studies with airway challenges demonstrated that a reduction in airway caliber decreases Feno levels.
OBJECTIVE
To evaluate the impact of airway caliber reduction occurring spontaneously in patients with asthma on Feno values in daily clinical practice.
METHODS
In this post hoc analysis, Feno, FEV, and asthma control questionnaire scores were recorded on each visit for 120 (1073 visits) adult patients with asthma. Blood eosinophils were measured intermittently. The intraindividual relationship between Feno and FEV was evaluated via a linear mixed model. The determinants of the individual mean Feno were measured by a stepwise multivariate linear model including individual mean FEV, inhaled corticosteroid dose, asthma control questionnaire score, and blood eosinophils.
RESULTS
Variations in the negative Feno-FEV relationship within individuals at different times were significantly determined by the individual's mean FEV. This relationship did not hold for individuals above the 75th and below the 25th quartiles. The best explanatory variables for individual mean Feno were FEV (+4.3 parts per billion/10%pred) and blood eosinophil count (+1 part per billion per 100 cells/mm).
DISCUSSION
In the presence of variable degrees of heterogeneous patterns of airway inflammation, airway caliber is shown to be an independent and significant determinant of Feno when measured in patients with asthma. We would propose a +4-parts-per-billion correction factor to the measured Feno value for each 10% reduction below 100% predicted FEV. Doing this should improve the rigor of interpretation of Feno as an indicator of type-2 inflammation in patients with low FEV.
Topics: Adult; Humans; Asthma; Respiratory System; Eosinophils; Airway Obstruction; Inflammation; Nitric Oxide; Breath Tests
PubMed: 37634805
DOI: 10.1016/j.jaip.2023.08.027 -
Archivos de Bronconeumologia Jan 2024The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this...
INTRODUCTION
The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts.
METHODS
COPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated.
RESULTS
In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE≥3: 9% and 20%; mMRC≥2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality - 33% and 22% respectively.
CONCLUSIONS
An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Lung; Airway Obstruction; Dyspnea; Comorbidity; Severity of Illness Index; Exercise Tolerance; Body Mass Index; Forced Expiratory Volume
PubMed: 37925245
DOI: 10.1016/j.arbres.2023.10.002 -
Veterinary Medicine and Science Sep 2023The objective of this study was to describe a case of epiglottic entrapment in a cat.
OBJECTIVE
The objective of this study was to describe a case of epiglottic entrapment in a cat.
CASE SUMMARY
A 5-month-old male neutered Russian Blue cat was evaluated for progressive stertorous upper airway sounds, acute onset vestibulopathy and abnormal laryngeal anatomy. Endotracheal intubation was only able to be achieved using videoscopic guidance and identified concern for severe nasopharyngeal stenosis. A computerized tomography scan revealed otitis interna, narrowed nasopharynx and no definitive cause for the stertorous breathing. The cat recovered very slowly from anaesthesia due to concern for airway obstruction following extubation. It was discharged the following day and then passed away at home 2 weeks later. Necropsy revealed that the epiglottis was obscured by 2 cm of redundant mucosal tissue extending from the base of the tongue to the larynx resulting in epiglottic entrapment. Also noted was chronic, severe otitis interna and externa. Upper airway obstruction is suspected to be the cause of sudden death.
NEW OR UNIQUE INFORMATION
To the authors' knowledge, this is the first report of these oropharyngeal anatomic abnormalities in a cat.
Topics: Male; Cats; Animals; Labyrinthitis; Laryngeal Diseases; Epiglottis; Intubation, Intratracheal; Airway Obstruction; Cat Diseases
PubMed: 37465985
DOI: 10.1002/vms3.1211