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Facial Plastic Surgery : FPS Jun 2024Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of...
Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of midfacial growth. However, there is a paucity of data evaluating complication and revision rates post-nasal septal surgery in the pediatric population. In addition, there is evidence to suggest that failure to treat nasal obstruction in children may itself result in facial deformity and/or developmental delay. The aim of this systematic review is to evaluate the efficacy and safety of septal surgery in pediatric patients with nasal obstruction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase, and the Cochrane Library were searched. Original studies in pediatric patients (<18 years of age) with nasal obstruction were eligible for inclusion. Patients with cleft lip or palate as their primary diagnosis were excluded. Our primary outcomes were patient-reported outcome measures (PROMs), postsurgical complications, and revision rates. Secondary outcomes included surgical technique, anatomical considerations, and anthropometric measurements. Eighteen studies were included (1,080 patients). Patients underwent septoplasty, septorhinoplasty, rhinoplasty, or a combination of procedures for nasal obstruction. Obstruction was commonly reported secondary to trauma, nasal septal deviation, or congenital deformity. The mean age of the patients was 13.04 years with an average follow-up of 41.8 months. In all, 5.6% patients required revision surgery and there was an overall complication rate of 7.8%. Septal surgery for nasal obstruction in children has low revision and complication rates. However, a pediatric-specific outcome measure is yet to be determined. Larger prospective studies with long-term follow-up periods are needed to determine the optimal timing of nasal surgery for nasal obstruction in the pediatric population.
Topics: Humans; Nasal Obstruction; Rhinoplasty; Child; Nasal Septum; Postoperative Complications; Reoperation; Adolescent; Patient Reported Outcome Measures
PubMed: 38035612
DOI: 10.1055/a-2219-9266 -
Pediatric Pulmonology Feb 2024Tracheostomies are indicated in children to facilitate long-term ventilatory support, aid in the management of secretions, or manage upper airway obstruction. Children... (Review)
Review
Tracheostomies are indicated in children to facilitate long-term ventilatory support, aid in the management of secretions, or manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad-spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centers. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from pediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy-associated infections; this is largely based on the theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy-associated infections remains largely unproven. This systematic review summarizes the current evidence base for antimicrobial selection, duration, and administration route in pediatric tracheostomy-associated infections. It also highlights significant variation in practice between centers and the urgent need for further prospective evidence to guide the management of these vulnerable patients.
Topics: Child; Humans; Tracheostomy; Trachea; Respiratory Tract Infections; Postoperative Complications; Anti-Bacterial Agents
PubMed: 38010838
DOI: 10.1002/ppul.26766 -
The Laryngoscope Jun 2024Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long-term efficacy of septoplasty is unclear, and no literature reviews have... (Review)
Review
BACKGROUND
Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long-term efficacy of septoplasty is unclear, and no literature reviews have examined long-term outcomes of septoplasty with or without turbinate modification. This systematic review aimed to evaluate the long-term efficacy of septoplasty with or without turbinate modification in improving nasal obstruction.
DATA SOURCES
PubMed, EMBASE, Cochrane CENTRAL.
METHODS
A systematic review of the literature was conducted using the aforementioned databases. Studies reporting outcomes 12+ months after functional septoplasty with or without turbinate surgery for nasal obstruction were included. Septorhinoplasties, concurrent sinus surgery, pediatric studies, and studies where septoplasty was performed for indications other than nasal obstruction were excluded.
RESULTS
After screening, 35 studies with 4,432 patients were included. Mean weighted post-operative follow-up time was 29.1 months (range 12-120 months). All studies reported significant improvement in subjective and objective outcomes at long-term follow-up compared to baseline. When comparing short-term (<12 months) to long-term (≥12 months) outcomes, four studies noticed that subjective outcomes worsened slightly over time, but no study found a significant change in objective outcomes over time. In addition, 23 studies reported patient satisfaction and/or improvement rates, with 75.4% (2,348/3,113) of patients expressing satisfaction/improvement at an average of 27.0 months after surgery.
CONCLUSIONS
Overall, septoplasty with or without turbinate modification shows significant improvement in obstructive symptoms at long-term follow-up per both objective and subjective measures. Whether outcomes may worsen slightly over time remains indeterminate based on mixed results in the literature.
LEVEL OF EVIDENCE
N/A Laryngoscope, 134:2525-2537, 2024.
Topics: Humans; Nasal Septum; Nasal Obstruction; Turbinates; Rhinoplasty; Treatment Outcome
PubMed: 37991145
DOI: 10.1002/lary.31193 -
International Forum of Allergy &... Mar 2024The placebo effect observed in clinical trials evaluating medical treatments for chronic rhinosinusitis (CRS) is not well understood. This systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The placebo effect observed in clinical trials evaluating medical treatments for chronic rhinosinusitis (CRS) is not well understood. This systematic review and meta-analysis sought to characterize the placebo effect present within CRS outcomes.
METHODS
A systematic review of PubMed, Scopus, and Cumulated Index in Nursing and Allied Health Nursing (CINAHL) was performed. Randomized controlled trials (RCTs) evaluating medical treatments for CRS versus placebo were included. We assessed patient-reported (sino-nasal outcome test 22 [SNOT-22], nasal obstruction, sense of smell, nasal obstruction visual analogue score [VAS], sense of smell VAS, anterior rhinorrhea, and postnasal drip) and objective (Lund-Mackay Computed tomography (CT) score, peak nasal inspiratory flow [PNIF], nasal polyp scores, 40-item Smell Identification Test, serum IgE, and blood eosinophil levels) outcomes.
RESULTS
Twenty-one RCTs were included, comprising 1437 patients (mean age 49.2 years). Biologics were the most common treatment investigated (n = 9). Eleven studies administered background steroids along with placebo. Following placebo administration, multiple patient-reported outcomes significantly decreased, including SNOT-22 (mean difference -9.49, 95% confidence interval [CI] [-11.26, -7.73]), nasal obstruction (-0.33 [-0.54, -0.13]), sense of smell (-0.22 [-0.33, -0.11]), nasal obstruction VAS (-2.47 [-2.87, -2.06]), and loss of smell VAS (-2.31 [-4.14, -0.47]) scores. For objective measures, significant changes occurred in Lund-Mackay CT score (-0.82, [-1.48, -0.16]) and PNIF (4.70, [4.76, 24.64]) with placebo. Placebo arms had the greatest impact when no background medications were used.
CONCLUSIONS
Placebo treatments have a statistically and potentially clinically significant effect on patient-reported and some objective CRS outcomes. Further investigation is required to fully understand placebo effect, which could improve assessment of RCTs and impact patient care.
Topics: Humans; Middle Aged; Nasal Obstruction; Rhinosinusitis; Rhinitis; Nasal Polyps; Sinusitis; Chronic Disease; Placebo Effect; Randomized Controlled Trials as Topic
PubMed: 37985206
DOI: 10.1002/alr.23302 -
Cureus Oct 2023Muco-obstructive lung disease is a new classification under the diseases of respiratory tract. A lot of discussion is still going on regarding this new group of... (Review)
Review
Muco-obstructive lung disease is a new classification under the diseases of respiratory tract. A lot of discussion is still going on regarding this new group of diseases. It is characterised by obstruction of the respiratory tract with a thick mucin layer. Usually in normal individuals, the mucus is swept out of the respiratory system while coughing in the form of sputum or phlegm, but if the consistency of the mucus is thick, or the amount is heavy or there is a certain defect in the ciliary function of the respiratory tract, the mucus is not cleared and it gets accumulated in the lungs alveoli, therefore blocking it. The mucus trapped in the distal airways cannot be cleared by coughing therefore forming a layer in the alveoli and bronchioles. Long-standing condition causes inflammation and infection. This new group of diseases specifically includes chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), primary ciliary dyskinesia (PCD) and non-cystic fibrosis bronchiectasis (NCFB). Asthma, although an obstructive disease of the lung, is not particularly included under muco-obstructive lung disease. The major symptoms with which these diseases present are sputum production, chronic cough and acute exacerbations of the condition. The mucus adheres to the lung parenchyma causing airway obstruction and hyperinflation. In this article, we will see how muco-obstructive lung diseases affect the normal physiology of the respiratory system and how is it different from other obstructive and restrictive lung diseases. We will individually look into all the four conditions that come under the category of muco-obstructive lung diseases.
PubMed: 37954759
DOI: 10.7759/cureus.46866 -
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 -
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 -
The Cochrane Database of Systematic... Oct 2023The Neonatal Task Force of the International Liaison Committee on Resuscitation (ILCOR) makes practice recommendations for the care of newborn infants in the delivery... (Review)
Review
BACKGROUND
The Neonatal Task Force of the International Liaison Committee on Resuscitation (ILCOR) makes practice recommendations for the care of newborn infants in the delivery room (DR). ILCOR recommends that all infants who are gasping, apnoeic, or bradycardic (heart rate < 100 per minute) should be given positive pressure ventilation (PPV) with a manual ventilation device (T-piece, self-inflating bag, or flow-inflating bag) via an interface. The most commonly used interface is a face mask that encircles the infant's nose and mouth. However, gas leak and airway obstruction are common during face mask PPV. Nasal interfaces (single and binasal prongs (long or short), or nasal masks) and laryngeal mask airways (LMAs) may also be used to deliver PPV to newborns in the DR, and may be more effective than face masks.
OBJECTIVES
To determine whether newborn infants receiving PPV in the delivery room with a nasal interface compared to a face mask, laryngeal mask airway (LMA), or another type of nasal interface have reduced mortality and morbidity. To assess whether safety and efficacy of the nasal interface differs according to gestational age or ventilation device.
SEARCH METHODS
Searches were conducted in September 2022 in CENTRAL, MEDLINE, Embase, Epistemonikos, and two trial registries. We searched conference abstracts and checked the reference lists of included trials and related systematic reviews identified through the search.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCT's that compared the use of nasal interfaces to other interfaces (face masks, LMAs, or one nasal interface to another) to deliver PPV to newborn infants in the DR.
DATA COLLECTION AND ANALYSIS
Each review author independently evaluated the search results against the selection criteria, screened retrieved records, extracted data, and appraised the risk of bias. If they were study authors, they did not participate in the selection, risk of bias assessment, or data extraction related to the study. In such instances, the study was independently assessed by other review authors. We contacted trial investigators to obtain additional information. We completed data analysis according to the standards of Cochrane Neonatal, using risk ratio (RR) and 95% confidence Intervals (CI) to measure the effect of the different interfaces. We used fixed-effect models and the GRADE approach to assess the certainty of the evidence.
MAIN RESULTS
We included five trials, in which 1406 infants participated. They were conducted in 13 neonatal centres across Europe and Australia. Each of these trials compared a nasal interface to a face mask for the delivery of respiratory support to newborn infants in the DR. Potential sources of bias were a lack of blinding to treatment allocation of the caregivers and investigators in all trials. The evidence suggests that resuscitation with a nasal interface in the DR, compared with a face mask, may have little to no effect on reducing death before discharge (typical risk ratio (RR) 0.72, 95% CI 0.47 to 1.13; 3 studies, 1124 infants; low-certainty evidence). Resuscitation with a nasal interface may reduce the rate of intubation in the DR, but the evidence is very uncertain (RR 0.68, 95% CI 0.54 to 0.85; 5 studies, 1406 infants; very low-certainty evidence). The evidence is very uncertain for the rate of intubation within 24 hours of birth (RR 0.97, 95% CI 0.85 to 1.09; 3 studies, 749 infants; very low-certainty evidence), endotracheal intubation outside the DR during hospitalisation (RR 1.15, 95% CI 0.93 to 1.42; 1 study, 144 infants; very low-certainty evidence) and cranial ultrasound abnormalities (intraventricular haemorrhage (IVH) grade ≥ 3, or periventricular leukomalacia; RR 0.94, 95% CI 0.55 to 1.61; 3 studies, 749 infants; very low-certainty evidence). Resuscitation with a nasal interface in the DR, compared with a face mask, may have little to no effect on the incidence of air leaks (RR 1.09, 95% CI 0.85 to 1.09; 2 studies, 507 infants; low-certainty evidence), or the need for supplemental oxygen at 36 weeks' corrected gestational age (RR 1.06, 95% CI 0.8 to 1.40; 2 studies, 507 infants; low-certainty evidence). We identified one ongoing study, which compares a nasal mask to a face mask to deliver PPV to infants in the DR. We did not identify any completed trials that compared nasal interfaces to LMAs or one nasal interface to another.
AUTHORS' CONCLUSIONS
Nasal interfaces were found to offer comparable efficacy to face masks (low- to very low-certainty evidence), supporting resuscitation guidelines that state that nasal interfaces are a comparable alternative to face masks for providing respiratory support in the DR. Resuscitation with a nasal interface may reduce the rate of intubation in the DR when compared with a face mask. However, the evidence is very uncertain. This uncertainty is attributed to the use of a new ventilation system in the nasal interface group in two of the five trials. As such, it is not possible to differentiate separate, specific effects related to the ventilation device or to the interface in these studies.
Topics: Infant, Newborn; Humans; Resuscitation; Positive-Pressure Respiration; Respiration, Artificial; Intermittent Positive-Pressure Ventilation; Intubation, Intratracheal
PubMed: 37787113
DOI: 10.1002/14651858.CD009102.pub2 -
The Laryngoscope May 2024To conduct a systematic review and meta-analysis of published articles to assess the impact of inferior turbinate/meatus augmentation in patients diagnosed with empty... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To conduct a systematic review and meta-analysis of published articles to assess the impact of inferior turbinate/meatus augmentation in patients diagnosed with empty nose syndrome (ENS).
DATA SOURCES
PubMed, Cochrane database, Embase, Web of Science, SCOPUS, and Google Scholar.
REVIEW METHODS
Six databases were searched to December 2022. We retrieved studies evaluating improvements in refractory ENS-related symptoms based on various patient-reported outcome measures after inferior turbinate/meatus augmentation.
RESULTS
As a result of meta-analysis, Sinonasal Outcome Test, Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), and depression scores were measured at 1 week; 1, 3, and 6 months; and later than 12 months after intervention for patients with ENS. All scores revealed significant symptom improvement. By reference to the minimal clinically important difference of the ENS6Q (6.25), inferior turbinate/meatus augmentation relieved the nasal symptoms of ENS in the long term. Although the improvements in anxiety scores at 1 week (0.4133 [-0.3366; 1.1633], 0.00, I = NA) and 1 month (0.4525 [-0.0529; 0.9579], I = 0.0%) were not statistically significant, the scores differed significantly at 3 months (0.7351 [0.4143; 1.0559], I = 28.4%), 6 months (0.8297 [0.6256; 1.0337], I = 37.2%), and longer than 12 months (0.7969 [0.4768; 1.1170], I = 0.0%).
CONCLUSION
These data and analysis suggest that performing inferior turbinate/meatus augmentation on ENS patients may improve not only nasal symptom scores but also accompanying psychological problems such as anxiety and depression. Laryngoscope, 134:2005-2011, 2024.
Topics: Humans; Nose Diseases; Nose; Turbinates; Syndrome; Sino-Nasal Outcome Test; Surveys and Questionnaires; Nasal Obstruction
PubMed: 37750541
DOI: 10.1002/lary.31077 -
Clinical Oral Investigations Oct 2023To provide a critical overview of the effect of various orthodontic and/or dentofacial orthopedic interventions on three-dimensional volumetric changes in the upper... (Review)
Review
OBJECTIVE
To provide a critical overview of the effect of various orthodontic and/or dentofacial orthopedic interventions on three-dimensional volumetric changes in the upper airway.
MATERIALS AND METHODS
Four databases were searched for clinical studies concerning 3D volumetric assessments based on CBCT before and after orthodontics interventions. The quality of the studies was assessed using the quality assessment tool of the National Heart, Lung and Blood Institute. After the use of inclusion and exclusion criteria, the pre-and post-treatment volumes were used to visualize the effect of various orthodontics interventions.
RESULTS
A total of 48 studies were included in this review and none of which were RCTs. The quality of all included studies was assessed as medium. Overall, there is a tendency for an increase in airway volumes after various orthodontic interventions, except for studies concerning extraction therapy with fixed appliances in adults, in which both increases and decreases in airway volumes have been reported.
CONCLUSION
Orthodontic treatment by growth modification and non-extraction therapy with fixed appliances, regardless of the malocclusion, generally showed positive effects on the airway volume. Orthodontic treatment in combination with extractions does not provide an unambiguous insight. A consensus on the methodology of the airway measurement and nomenclature is urgently needed in order to gain insight into the effect of different interventions on three-dimensional airway changes.
CLINICAL RELEVANCE
Various orthodontic treatments do not negatively influence the upper airway volume. However, extraction therapy in adults should be chosen with caution, especially in subjects belonging to a group susceptible to airway obstruction.
Topics: Adult; Humans; Spiral Cone-Beam Computed Tomography; Malocclusion
PubMed: 37723313
DOI: 10.1007/s00784-023-05207-8