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Acta Otorhinolaryngologica Italica :... Feb 2022Development and validation of a confocal laser endomicroscopy (CLE) classification score for the larynx and pharynx.
OBJECTIVE
Development and validation of a confocal laser endomicroscopy (CLE) classification score for the larynx and pharynx.
METHODS
Thirteen patients (154 video sequences, 9240 images) with laryngeal or pharyngeal SCC were included in this prospective study between October 2020 and February 2021. Each CLE sequence was correlated with the gold standard of histopathological examination. Based on a dataset of 94 video sequences (5640 images), a scoring system was developed. In the remaining 60 sequences (3600 images), the score was validated by four CLE experts and four head and neck surgeons who were not familiar with CLE.
RESULTS
Tissue homogeneity, cell size, borders and clusters, capillary loops and the nucleus/cytoplasm ratio were defined as the scoring criteria. Using this score, the CLE experts obtained an accuracy, sensitivity, and specificity of 90.8%, 95.1%, and 86.4%, respectively, and the CLE non-experts of 86.2%, 86.4%, and 86.1%. Interobserver agreement Fleiss' kappa was 0.8 and 0.6, respectively.
CONCLUSIONS
CLE can be reliably evaluated based on defined and reproducible imaging features, which demonstrate a high diagnostic value. CLE can be easily integrated into the intraoperative setting and generate real-time, in-vivo microscopic images to demarcate malignant changes.
Topics: Humans; Larynx; Lasers; Microscopy, Confocal; Pharynx; Prospective Studies
PubMed: 35129541
DOI: 10.14639/0392-100X-N1643 -
American Journal of Physiology.... Aug 2021Swallowing is a critical function for survival and development in human neonates and requires cross-system coordination between neurological, airway, and digestive... (Review)
Review
Swallowing is a critical function for survival and development in human neonates and requires cross-system coordination between neurological, airway, and digestive motility systems. Development of pharyngoesophageal motility is influenced by intra- and extrauterine development, pregnancy complications, and neonatal comorbidities. The primary role of these motility reflex mechanisms is to maintain aerodigestive homeostasis under basal and adaptive biological conditions including oral feeding, gastroesophageal reflux, and sleep. Failure may result in feeding difficulties, airway compromise, dysphagia, aspiration syndromes, and chronic eating difficulties requiring prolonged tube feeding. We review the integration of cross-systems physiology to describe the basis for physiological and pathophysiological neonatal aerodigestive functions.
Topics: Deglutition; Esophagus; Humans; Infant, Newborn; Pharynx; Reflex
PubMed: 34105355
DOI: 10.1152/ajpgi.00480.2020 -
European Archives of... Sep 2022To assess the efficacy of posterior pharyngeal wall augmentation using septal or conchal cartilages with other bulks-according to the persistent gap and the individual... (Observational Study)
Observational Study
PURPOSE
To assess the efficacy of posterior pharyngeal wall augmentation using septal or conchal cartilages with other bulks-according to the persistent gap and the individual anatomy of each patient-in improving velopharyngeal function in patients who acquired persistent velopharyngeal insufficiency (VPI) post-adenoidectomy.
METHODS
Observational descriptive prospective case series of 24 patients (their ages ranged between 3 and 26 years) who developed persistent VPI post-adenoidectomy (more than 3 months) although they had normal speech resonance before adenoidectomy.
RESULTS
The present study demonstrated that statistically significant improvement in auditory perceptual assessment (APA) was found regarding all obligatory speech disorders and unintelligibility of speech. Significant improvement was observed in the degree of velar mobility, size of the persistent gap, and the gap distance between velum and posterior pharyngeal wall at rest and during phonation in post-operative evaluation versus pre-operative. A significant change was observed in the closure pattern of the velopharyngeal port (VPP) as all patients turned to coronal closure.
CONCLUSIONS
Posterior pharyngeal wall augmentation could be used in VPI post-adenoidectomy up to 7 mm and lead to better speech outcomes. Also, it revealed that using conchal and/or septal cartilage as a graft regardless of the patient's age is a safe procedure.
Topics: Adenoidectomy; Child, Preschool; Cleft Palate; Humans; Infant; Pharynx; Speech Disorders; Treatment Outcome; Velopharyngeal Insufficiency
PubMed: 35527305
DOI: 10.1007/s00405-022-07406-7 -
Anatomical Record (Hoboken, N.J. : 2007) Aug 2020Numerous chameleon species possess an out-pocketing of the trachea known as the gular pouch. After surveying more than 250 specimens, representing nine genera and 44...
Numerous chameleon species possess an out-pocketing of the trachea known as the gular pouch. After surveying more than 250 specimens, representing nine genera and 44 species, we describe two different morphs of the gular pouch. Species of the genera Bradypodion and Chamaeleo, as well as Trioceros goetzei, all possess a single gular pouch (morph one) formed from ventral expansion of soft tissue where the larynx and trachea meet. Furcifer oustaleti and Furcifer verrucosus possess from one to four gular pouches (morph two) formed by the expansion of soft tissue between sequential hyaline cartilage rings of the trachea. In Trioceros melleri, examples of both morphs of the gular pouch were observed. Morphometric data are presented for 100 animals representing eight species previously known to possess a gular pouch and two additional species, Bradypodion thamnobates and Bradypodion transvaalense. In the species with the absolutely and relatively largest gular pouch, Chamaeleo calyptratus, a significant difference was found between sexes in its width and volume, but not its length. In C. calyptratus, we show that an inflated gular pouch is in contact with numerous hyoid muscles and the tongue. Coupled with the knowledge that C. calyptratus generates vibrations from the throat region, we posit that the tongue (M. accelerator linguae and M. hyoglossus) and supporting hyoid muscles (i.e., Mm. sternohyoideus profundus et superficialis and Mm. mandibulohyoideus) are involved in the production of vibrations to produce biotremors that are amplified by the inflated gular pouch and used in substrate-borne communication.
Topics: Animal Communication; Animals; Lizards; Neck Muscles; Pharynx; Trachea; Vibration
PubMed: 31680478
DOI: 10.1002/ar.24313 -
Brazilian Journal of Otorhinolaryngology 2022
Topics: Humans; Otolaryngology; Robotics; Pharynx; Nose
PubMed: 36064818
DOI: 10.1016/j.bjorl.2022.08.001 -
Arquivos de Gastroenterologia 2020Gastroesophageal reflux disease is associated with slower transit of the bolus through the pharynx and upper esophageal sphincter. Functional heartburn has similar...
BACKGROUND
Gastroesophageal reflux disease is associated with slower transit of the bolus through the pharynx and upper esophageal sphincter. Functional heartburn has similar symptoms to gastroesophageal reflux disease, however, the symptoms are not caused by reflux.
OBJECTIVE
The aim of this investigation was to evaluate oral and pharyngeal transit in patients with functional heartburn, with the hypothesis that, similar to patients with gastroesophageal reflux disease, they have changes in pharyngeal and upper esophageal sphincter transit time.
METHODS
Oral and pharyngeal transit was evaluated by videofluoroscopy in eight women with functional heartburn, five with mild dysphagia for solid foods, and 12 female controls. Controls and patients swallowed in duplicate 5 mL and 10 mL of liquid and paste boluses.
RESULTS
No difference in the oral or pharyngeal transit time was found between patients and controls. No aspiration of bolus into the airways was detected in any individual. Pharyngeal residues were detected in the same proportion of swallows, in patients (12.5%) and controls (15.0%), after swallows of 10 mL paste bolus.
CONCLUSION
Oral, pharyngeal and upper esophageal sphincter transit time are similar in patients with functional heartburn to healthy controls.
Topics: Deglutition; Deglutition Disorders; Female; Gastroesophageal Reflux; Heartburn; Humans; Manometry; Pharynx
PubMed: 32609156
DOI: 10.1590/S0004-2803.202000000-28 -
Frontiers in Immunology 2023
Topics: Humans; Nasopharynx; Oropharynx
PubMed: 37325661
DOI: 10.3389/fimmu.2023.1206747 -
BMC Microbiology Oct 2021Fusobacterium nucleatum (F. n) is an important opportunistic pathogen causing oral and gastrointestinal disease. Faecalibacterium prausnitzii (F. p) is a next-generation...
BACKGROUND
Fusobacterium nucleatum (F. n) is an important opportunistic pathogen causing oral and gastrointestinal disease. Faecalibacterium prausnitzii (F. p) is a next-generation probiotic and could serve as a biomarker of gut eubiosis/dysbiosis to some extent. Alterations in the human oral and gut microbiomes are associated with viral respiratory infection. The aim of this study was to characterise the oral and fecal bacterial biomarker (i.e., F. n and F. p) in COVID-19 patients by qPCR and investigate the pharyngeal microbiome of COVID-19 patients through metagenomic next-generation sequencing (mNGS).
RESULTS
Pharyngeal F. n was significantly increased in COVID-19 patients, and it was higher in male than female patients. Increased abundance of pharyngeal F. n was associated with a higher risk of a positive SARS-CoV-2 test (adjusted OR = 1.32, 95% CI = 1.06 ~ 1.65, P < 0.05). A classifier to distinguish COVID-19 patients from the healthy controls based on the pharyngeal F. n was constructed and achieved an area under the curve (AUC) of 0.843 (95% CI = 0.688 ~ 0.940, P < 0.001). However, the level of fecal F. n and fecal F. p remained unaltered between groups. Besides, mNGS showed that the pharyngeal swabs of COVID-19 patients were dominated by opportunistic pathogens.
CONCLUSIONS
Pharyngeal but not fecal F. n was significantly increased in COVID-19 patients, clinicians should pay careful attention to potential coinfection. Pharyngeal F. n may serve as a promising candidate indicator for COVID-19.
Topics: Adult; Biomarkers; COVID-19; Carrier State; Coinfection; Dysbiosis; Feces; Female; Fusobacterium Infections; Fusobacterium nucleatum; High-Throughput Nucleotide Sequencing; Humans; Male; Metagenomics; Microbiota; Middle Aged; Pharynx; Sex Factors
PubMed: 34635053
DOI: 10.1186/s12866-021-02336-6 -
International Journal of Computer... Apr 2021The main purpose of this work was to develop an efficient approach for segmentation of structures that are relevant for diagnosis and treatment of obstructive sleep...
PURPOSE
The main purpose of this work was to develop an efficient approach for segmentation of structures that are relevant for diagnosis and treatment of obstructive sleep apnea syndrome (OSAS), namely pharynx, tongue, and soft palate, from mid-sagittal magnetic resonance imaging (MR) data. This framework will be applied to big data acquired within an on-going epidemiological study from a general population.
METHODS
A deep cascaded framework for subsequent segmentation of pharynx, tongue, and soft palate is presented. The pharyngeal structure was segmented first, since the airway was clearly visible in the T1-weighted sequence. Thereafter, it was used as an anatomical landmark for tongue location. Finally, the soft palate region was extracted using segmented tongue and pharynx structures and used as input for a deep network. In each segmentation step, a UNet-like architecture was applied.
RESULTS
The result assessment was performed qualitatively by comparing the region boundaries obtained from the expert to the framework results and quantitatively using the standard Dice coefficient metric. Additionally, cross-validation was applied to ensure that the framework performance did not depend on the specific selection of the validation set. The average Dice coefficients on the test set were [Formula: see text], [Formula: see text], and [Formula: see text] for tongue, pharynx, and soft palate tissues, respectively. The results were similar to other approaches and consistent with expert readings.
CONCLUSION
Due to high speed and efficiency, the framework will be applied for big epidemiological data with thousands of participants acquired within the Study of Health in Pomerania as well as other epidemiological studies to provide information on the anatomical structures and aspects that constitute important risk factors to the OSAS development.
Topics: Algorithms; Deep Learning; Female; Germany; Humans; Magnetic Resonance Imaging; Male; Observer Variation; Palate, Soft; Pharynx; Risk Factors; Sleep Apnea, Obstructive; Tongue
PubMed: 33770362
DOI: 10.1007/s11548-021-02333-0 -
Brazilian Journal of Otorhinolaryngology 2022Several clinical practice guidelines have been produced and disseminated for the evaluation of a neck mass. However, to date, the quality and methodologic rigor of these... (Review)
Review
OBJECTIVE
Several clinical practice guidelines have been produced and disseminated for the evaluation of a neck mass. However, to date, the quality and methodologic rigor of these clinical practice guidelines have not been appraised. Therefore, this study set out to identify and assess the methodologic quality of national and international guidelines for the evaluation and management of neck masses in adults.
METHODS
We conducted a comprehensive search of EMBASE, MEDLINE/PubMed, SCOPUS and grey literature sources until September 2020. The quality of these guidelines was assessed by four reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Domain scores were considered acceptable quality if they scored >60%, and Intraclass Correlation Coefficients (ICC) were calculated to assess agreement among the appraisers.
RESULTS
Seven guidelines were assessed for evaluation. Among these, only the American Academy of Otolaryngology (AAO), Cancer Care Manitoba (CCMB), and the American Society of Clinical Oncology (ASCO) achieved an overall rating of "high". The remaining four guidelines achieved ratings of either "average" or "low". The "Scope and Purpose" domain achieved the highest mean score (94.4%±5.0%), and lowest was "Applicability" (51.5%±29.2%). ICC analysis showed substantial to very good agreement across all domains (0.75-0.98).
CONCLUSION
These findings highlight the variability in methodologic quality of guidelines for the evaluation and management of adult neck mass. The results from this analysis highlight the need to improve guidelines development process for this topic and may guide the selection and use of these guidelines in clinical practice.
Topics: Academies and Institutes; Adult; Humans; Pharynx; United States
PubMed: 33879419
DOI: 10.1016/j.bjorl.2021.03.005