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Medical & Biological Engineering &... Aug 2023The human upper airway is comprised of many anatomical volumes. The obstructions in the upper airway volumes are needed to be diagnosed which requires volumetric...
The human upper airway is comprised of many anatomical volumes. The obstructions in the upper airway volumes are needed to be diagnosed which requires volumetric segmentation. Manual segmentation is time-consuming and requires expertise in the field. Automatic segmentation provides reliable results and also saves time and effort for the expert. The objective of this study is to systematically review the literature to study various techniques used for the automatic segmentation of the human upper airway regions in volumetric images. PRISMA guidelines were followed to conduct the systematic review. Four online databases Scopus, Google Scholar, PubMed, and JURN were used for the searching of the relevant papers. The relevant papers were shortlisted using inclusion and exclusion eligibility criteria. Three review questions were made and explored to find their answers. The best technique among all the literature studies based on the Dice coefficient and precision was identified and justified through the analysis. This systematic review provides insight to the researchers so that they shall be able to overcome the prominent issues in the field identified from the literature. The outcome of the review is based on several parameters, e.g., accuracy, techniques, challenges, datasets, and segmentation of different sub-regions. Flowchart of the search process as per PRISMA guidelines along with inclusion and exclusion criteria.
Topics: Humans; Airway Obstruction; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Larynx; Pharynx; Paranasal Sinuses
PubMed: 37248380
DOI: 10.1007/s11517-023-02842-x -
Journal of Sleep Research Apr 2024Obstructive sleep apnea (OSA) is commonly observed in children with Down syndrome (DS) and may affect their physical and psychological development. Currently,... (Meta-Analysis)
Meta-Analysis Review
Obstructive sleep apnea (OSA) is commonly observed in children with Down syndrome (DS) and may affect their physical and psychological development. Currently, adenotonsillectomy is the first line treatment option for paediatric patients with OSA. However, surgical outcomes for such patients are not satisfactory. In this study, we analysed the efficacy and safety of adenotonsillectomy in the treatment of children with obstructive sleep apnea and Down syndrome. We systematically searched the PubMed, Web of Science, EMBASE, and the Cochrane databases and pooled data from nine relevant studies involving 384 participants. Subsequently, we analysed four outcomes in polysomnography, namely: net postoperative changes in the apnea-hypopnea index (AHI), the minimum oxygen saturation, sleep efficiency, and arousal index. Meta-analysis of the AHI showed a decrease of 7.18 events/h [95% CI (-9.69, -4.67) events/h; p < 0.00001] and an increase in the minimum oxygen saturation of 3.14% [95% CI (1.44, 4.84) %; p = 0.0003]. There was no significant increase in sleep efficiency [MD 1.69%, 95% CI (-0.59, 3.98) %; p = 0.15], but the arousal index significantly decreased by -3.21 events/hour [95% CI (-6.04, -0.38) events/h; p < 0.03]. In addition, the overall success rate was 16% (95% CI, 12%-21%) for postoperative AHI < 1 and 57% (95% CI, 51%-63%) for postoperative AHI <5. The postoperative complications recorded included airway obstruction and bleeding. This study demonstrated the efficacy of adenotonsillectomy as a treatment option for OSA. However, it is important to note that residual OSA and potential postoperative complications require further attention in future studies.
Topics: Child; Humans; Down Syndrome; Treatment Outcome; Tonsillectomy; Sleep Apnea, Obstructive; Postoperative Complications
PubMed: 37226964
DOI: 10.1111/jsr.13946 -
American Journal of Rhinology & Allergy Sep 2023Leiomyomas are benign smooth muscle tumors that are rarely diagnosed in the nasal cavity and paranasal sinuses. (Review)
Review
BACKGROUND
Leiomyomas are benign smooth muscle tumors that are rarely diagnosed in the nasal cavity and paranasal sinuses.
OBJECTIVE
This systematic review summarizes the histopathologic and clinical tumor characteristics, surgical management, and follow-up of sinonasal leiomyomas.
METHODS
A systematic review of the literature on sinonasal leiomyoma was performed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that met the inclusion criteria were assessed for level of evidence. Patient demographics, clinical and pathological tumor characteristics, primary intervention, and results of follow-up were evaluated.
RESULTS
Forty studies including 84 patients with sinonasal leiomyoma were identified. The tumor was most often located in the nasal cavity (47/84, 56%) originating from the inferior turbinate (32/84, 38%). Patients mostly presented with symptoms originating from an intranasal mass, including recurrent epistaxis (41/84, 49%), nasal obstruction (43/84, 51.2%), and localized facial or head pain (25/84, 29.8%). Surgery was performed in all cases. An endoscopic approach was most frequently chosen. Recurrence occurred only twice (2.4%). Morbidity was noted in 2 cases (2.4%) following postoperative bleeding and 1 (1.2%) case following a CSF leak.
CONCLUSION
Sinonasal leiomyomas are neoplasms of the smooth muscle manifesting clinically with recurrent epistaxis and nasal obstruction. Management goal is total resection with clear margins to avoid local recurrence.
Topics: Humans; Paranasal Sinus Neoplasms; Nasal Obstruction; Epistaxis; Follow-Up Studies; Leiomyoma; Nose Neoplasms
PubMed: 37093753
DOI: 10.1177/19458924231170464 -
Child's Nervous System : ChNS :... Aug 2023Trans-sellar trans-sphenoidal encephalocele is a rare congenital anomaly, with only around 20 cases having been documented in literature around the world. Surgical...
Trans-sellar trans-sphenoidal encephalocele is a rare congenital anomaly, with only around 20 cases having been documented in literature around the world. Surgical repair of these defects in the pediatric population commonly uses either the transcranial or the transpalatal approach, with the choice of approach being individualized based on the clinical features, age, and associated defects present in the patient. Here, we document a case of a 4-month-old child who presented to us with nasal obstruction, who was diagnosed with this rare entity and successfully underwent a transcranial repair for the same. We also provide a systematic review of all existing case reports that have described this rare condition in the pediatric population, as weel as the different surgical approaches used in each case.
Topics: Humans; Infant; Child; Encephalocele; Nasal Obstruction; Magnetic Resonance Imaging; Facial Bones
PubMed: 37055485
DOI: 10.1007/s00381-023-05956-7 -
Journal of Dentistry (Shiraz, Iran) Mar 2023Obstructive sleep apnea (OSA) is an underdiagnosed and potentially serious disorder that is accentuated by edentulism. The overclosure of the mandible and a potential...
Impact of Complete Denture and Mandibular Advancement Device in the Management of Completely Edentulous Obstructive Sleep Apneic Individuals: A Systematic Review with Meta-Analysis.
STATEMENT OF THE PROBLEM
Obstructive sleep apnea (OSA) is an underdiagnosed and potentially serious disorder that is accentuated by edentulism. The overclosure of the mandible and a potential upper airway collapse during sleep creates challenges in treating edentulous sleep apneic patients.
PURPOSE
To evaluate complete dentures and mandibular advancement devices as potential oral appliances in the management of sleep apnea in completely edentulous patients.
MATERIALS AND METHOD
The study design was a systematic review with meta-analysis. The search criteria complied with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and the keywords in population, intervention, control, and outcomes (PICO) format was systematically searched for relevant research articles published till August 2021 in an electronic database (PubMed, Cochrane, Science Direct, Ovid). Randomized controlled trials and cohort studies were included that compared the effectiveness of oral appliances on apnea-hypopnea index (AHI), airway space, and quality of sleep in edentulous sleep apneic patients.
RESULTS
1785 articles were derived from the initial search and based on inclusion criteria, 10 articles were systematically filtered for qualitative analysis and assessed for risk of bias using the Cochrane risk of bias tool and ROBINS-I tool. Out of the 10 articles, 5 articles were taken for quantitative analysis. The use of a mandibular advancement device (MAD) showed a decrease in AHI score, but the available data was heterogeneous to conduct a meta-analysis. The mean difference of AHI for the random effect model between the non-complete denture and complete denture wearers at sleep was -0.49[95% CI (-1.47,0.48)] events per hour, but the change was non-significant (>.05).
CONCLUSION
The complete dentures as an oral appliance had reduced apneic episodes in completely edentulous sleep apneic patients, but the effectiveness cannot be solely attributed to the prosthesis in the treatment of OSA. MAD showed greater improvement in reducing AHI, however, the level of evidence was inadequate to provide a conclusive statement.
PubMed: 37051494
DOI: 10.30476/dentjods.2022.93891.1743 -
The Cochrane Database of Systematic... Apr 2023Cystic fibrosis (CF) is an inherited progressive life-limiting disease characterised by the build-up of abnormally thick, sticky mucus affecting mostly the lungs,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cystic fibrosis (CF) is an inherited progressive life-limiting disease characterised by the build-up of abnormally thick, sticky mucus affecting mostly the lungs, pancreas, and digestive system. Airway clearance techniques (ACTs), traditionally referred to as chest physiotherapy, are recommended as part of a complex treatment programme for people with CF. The aim of an ACTs is to enhance mucociliary clearance and remove viscous secretions from the airways within the lung to prevent distal airway obstruction. This reduces the infective burden and associated inflammatory effects on the airway epithelia. There are a number of recognised ACTs, none of which have shown superiority in improving short-term outcomes related to mucus transport. This systematic review, which has been updated regularly since it was first published in 2000, considers the efficacy of ACTs compared to not performing any ACT in adults and children with CF. It is important to continue to review this evidence, particularly the long-term outcomes, given the recent introduction of highly effective modulator therapies and the improved health outcomes and potential changes to CF management associated with these drugs.
OBJECTIVES
To determine the effectiveness and acceptability of airway clearance techniques compared to no airway clearance techniques or cough alone in people with cystic fibrosis.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings, to 17 October 2022. We searched ongoing trials registers (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) to 7 November 2022.
SELECTION CRITERIA
We included randomised or quasi-randomised studies that compared airway clearance techniques (chest physiotherapy) with no airway clearance techniques or spontaneous cough alone in people with CF.
DATA COLLECTION AND ANALYSIS
Both review authors independently assessed study eligibility, extracted data, and assessed the risk of bias of the included studies. We used GRADE methodology to assess the certainty of the evidence.
MAIN RESULTS
We included 11 cross-over studies (153 participants) and one parallel study (41 participants). There were differences between studies in how the interventions were delivered, with several intervention groups combining more than one ACT. One study used autogenic drainage; five used conventional chest physiotherapy; nine used positive expiratory pressure (PEP), with one study varying the water pressure between arms; three studies used oscillating PEP; two used exercise; and two used high-frequency chest wall oscillation (HFCWO). Of the 12 included studies, 10 were single-treatment studies, and two delivered the intervention over two consecutive days (once daily in one study, twice daily in the second). This substantial heterogeneity in the treatment interventions precluded pooling of data for meta-analysis. Blinding of participants, caregivers, and clinicians is impossible in airway clearance studies; we therefore judged all studies at unclear risk of performance bias. Lack of information in eight studies made assessment of risk of bias unclear for most other domains. We rated the certainty of evidence as low or very low due to the short-term cross-over trial design, small numbers of participants, and uncertain risk of bias across most or all domains. Six studies (84 participants) reported no effect on pulmonary function variables following intervention; but one study (14 participants) reported an improvement in pulmonary function following the intervention in some of the treatment groups. Two studies reported lung clearance index: one (41 participants) found a variable response to treatment with HFCWO, whilst another (15 participants) found no effect on lung clearance index with PEP therapy (low-certainty evidence). Five studies (55 participants) reported that ACTs, including coughing, increased radioactive tracer clearance compared to control, while a further study (eight participants) reported no improvement in radioactive tracer clearance when comparing PEP to control, although coughing was discouraged during the PEP intervention. We rated the certainty of evidence on the effect of ACTs on radioactive tracer clearance as very low. Four studies (46 participants) investigated the weight of mucus cleared from the lungs and reported greater secretions during chest physiotherapy compared to a control. One study (18 participants) reported no differences in sputum weight (very low-certainty evidence).
AUTHORS' CONCLUSIONS
The evidence from this review shows that ACTs may have short-term effects on increasing mucus transport in people with CF. All included studies had short-term follow-up; consequently, we were unable to draw any conclusions on the long-term effects of ACTs compared to no ACTs in people with CF. The evidence in this review represents the use of airway clearance techniques in a CF population before widespread use of cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Further research is needed to determine the effectiveness and acceptability of airway clearance in those treated with highly effective CFTR modulators.
Topics: Adult; Child; Humans; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Cough; Radioactive Tracers; Forced Expiratory Volume
PubMed: 37042825
DOI: 10.1002/14651858.CD001401.pub4 -
Journal of Cardiothoracic Surgery Apr 2023Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following... (Review)
Review
OBJECTIVES
Post-pneumonectomy syndrome (PPS) is rare and predominantly characterised by dynamic airway obstruction due to mediastinal rotation at any time point following pneumonectomy. The objective of this systematic review was to identify the optimal treatment strategy for PPS based on subjective symptomatic relief, objective radiological imaging, and treatment durability.
METHODS
A systematic review was performed up to and including February 2022 based on the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. All studies that presented the management of symptomatic patients > 16 years of age with radiologically confirmed PPS were included. The primary outcome was the identification of the optimal treatment strategy and the secondary outcome was durability of the treatment. The Oxford Centre for Evidence Based Medicine level was assigned to each study.
RESULTS
A total of 330 papers were identified and reviewed; 41 studies met the inclusion criteria. Data including patient demographics, indication for initial pneumonectomy, presenting symptoms, management approach, outcomes, and follow-up were assessed and analysed. Management approaches were divided into three categories: (a) mediastinal repositioning using implant prostheses; (b) endobronchial stenting; (c) other corrective procedures. One hundred and four patients were identified in total and of those, 87 underwent mediastinal repositioning with insertion of a prosthetic implant. Complications included over- or under-filling of the prosthesis (8.5%) and implant leakage (8.9%).
CONCLUSION
Management of PPS using a prosthetic implant to reposition the mediastinum is the treatment of choice. Key adjuncts to optimise surgical approach and minimise complications include pre-operative CT volumetric analysis to guide implant size and intra-operative transoesophageal echocardiography to guide mediastinal repositioning.
Topics: Humans; Pneumonectomy; Mediastinum; Thorax; Prostheses and Implants; Prosthesis Implantation; Syndrome
PubMed: 37038182
DOI: 10.1186/s13019-023-02278-2 -
The Laryngoscope Dec 2023Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores, with the hypothesis that it is able to clinically improve patient-reported nasal obstructive symptoms in the post-operative follow-up.
METHODS
An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results.
RESULTS
A total of 2577 patients (males: 65.1%, 95% CI: 59.9-70.2) with a mean age of 33.3 years (n = 1456, 95% CI: 30.4-36.2) were included in this meta-analysis. The pooled baseline NOSE mean score was 68.1 (n = 2577, 95% CI: 64.3-71.9). The pooled MD in NOSE score at 6-months follow-up compared to baseline was -48.8 (n = 1730, 95% CI: -54.6 to -42.9).
CONCLUSIONS
Functional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score.
LEVEL OF EVIDENCE
NA Laryngoscope, 133:3237-3246, 2023.
Topics: Male; Humans; Adult; Nasal Obstruction; Quality of Life; Treatment Outcome; Rhinoplasty; Nasal Septum
PubMed: 37017244
DOI: 10.1002/lary.30684 -
The Cochrane Database of Systematic... Apr 2023Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (≥... (Review)
Review
BACKGROUND
Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (≥ 3%) may reduce these pathological changes and decrease airway obstruction. This is an update of a review first published in 2008, and updated in 2010, 2013, and 2017.
OBJECTIVES
To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute bronchiolitis.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, Embase, CINAHL, LILACS, and Web of Science on 13 January 2022. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 13 January 2022.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline or standard treatment as a comparator in children under 24 months with acute bronchiolitis. The primary outcome for inpatient trials was length of hospital stay, and the primary outcome for outpatients or emergency department (ED) trials was rate of hospitalisation.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, data extraction, and assessment of risk of bias in included studies. We conducted random-effects model meta-analyses using Review Manager 5. We used mean difference (MD), risk ratio (RR), and their 95% confidence intervals (CI) as effect size metrics.
MAIN RESULTS
We included six new trials (N = 1010) in this update, bringing the total number of included trials to 34, involving 5205 infants with acute bronchiolitis, of whom 2727 infants received hypertonic saline. Eleven trials await classification due to insufficient data for eligibility assessment. All included trials were randomised, parallel-group, controlled trials, of which 30 were double-blinded. Twelve trials were conducted in Asia, five in North America, one in South America, seven in Europe, and nine in Mediterranean and Middle East regions. The concentration of hypertonic saline was defined as 3% in all but six trials, in which 5% to 7% saline was used. Nine trials had no funding, and five trials were funded by sources from government or academic agencies. The remaining 20 trials did not provide funding sources. Hospitalised infants treated with nebulised hypertonic saline may have a shorter mean length of hospital stay compared to those treated with nebulised normal (0.9%) saline or standard care (mean difference (MD) -0.40 days, 95% confidence interval (CI) -0.69 to -0.11; 21 trials, 2479 infants; low-certainty evidence). Infants who received hypertonic saline may also have lower postinhalation clinical scores than infants who received normal saline in the first three days of treatment (day 1: MD -0.64, 95% CI -1.08 to -0.21; 10 trials (1 outpatient, 1 ED, 8 inpatient trials), 893 infants; day 2: MD -1.07, 95% CI -1.60 to -0.53; 10 trials (1 outpatient, 1 ED, 8 inpatient trials), 907 infants; day 3: MD -0.89, 95% CI -1.44 to -0.34; 10 trials (1 outpatient, 9 inpatient trials), 785 infants; low-certainty evidence). Nebulised hypertonic saline may reduce the risk of hospitalisation by 13% compared with nebulised normal saline amongst infants who were outpatients and those treated in the ED (risk ratio (RR) 0.87, 95% CI 0.78 to 0.97; 8 trials, 1760 infants; low-certainty evidence). However, hypertonic saline may not reduce the risk of readmission to hospital up to 28 days after discharge (RR 0.83, 95% CI 0.55 to 1.25; 6 trials, 1084 infants; low-certainty evidence). We are uncertain whether infants who received hypertonic saline have a lower number of days to resolution of wheezing compared to those who received normal saline (MD -1.16 days, 95% CI -1.43 to -0.89; 2 trials, 205 infants; very low-certainty evidence), cough (MD -0.87 days, 95% CI -1.31 to -0.44; 3 trials, 363 infants; very low-certainty evidence), and pulmonary moist crackles (MD -1.30 days, 95% CI -2.28 to -0.32; 2 trials, 205 infants; very low-certainty evidence). Twenty-seven trials presented safety data: 14 trials (1624 infants; 767 treated with hypertonic saline, of which 735 (96%) co-administered with bronchodilators) did not report any adverse events, and 13 trials (2792 infants; 1479 treated with hypertonic saline, of which 416 (28%) co-administered with bronchodilators and 1063 (72%) hypertonic saline alone) reported at least one adverse event such as worsening cough, agitation, bronchospasm, bradycardia, desaturation, vomiting and diarrhoea, most of which were mild and resolved spontaneously (low-certainty evidence).
AUTHORS' CONCLUSIONS
Nebulised hypertonic saline may modestly reduce length of stay amongst infants hospitalised with acute bronchiolitis and may slightly improve clinical severity score. Treatment with nebulised hypertonic saline may also reduce the risk of hospitalisation amongst outpatients and ED patients. Nebulised hypertonic saline seems to be a safe treatment in infants with bronchiolitis with only minor and spontaneously resolved adverse events, especially when administered in conjunction with a bronchodilator. The certainty of the evidence was low to very low for all outcomes, mainly due to inconsistency and risk of bias.
Topics: Child; Humans; Infant; Bronchiolitis; Bronchodilator Agents; Cough; Saline Solution; Saline Solution, Hypertonic
PubMed: 37014057
DOI: 10.1002/14651858.CD006458.pub5 -
Sleep Medicine May 2023The objective here was to review the efficacy of functional jaw orthopedic appliances for treating children/adolescents with obstructive sleep apnea (OSA), through... (Meta-Analysis)
Meta-Analysis
Effectiveness of functional orthopedic appliances as an alternative treatment among children and adolescents with obstructive sleep apnea: Systematic review and meta-analysis.
INTRODUCTION
The objective here was to review the efficacy of functional jaw orthopedic appliances for treating children/adolescents with obstructive sleep apnea (OSA), through correlating the apnea/hypopnea index (AHI) and oxygen saturation (SaO) in polysomnography (PSG), in addition to questionnaire scores from the obstructive sleep apnea-18 (OSA-18).
METHODS
The PRISMA 2020 guidelines were followed. A search was conducted in October 2021, with updating to May 2022, in the MEDLINE/PubMed, BVS (LILACS/BBO), ISI, SciELO (Web of Science), COCHRANE, EMBASE, SCOPUS and WHO databases and the gray literature. Data selection and extraction were performed by two independent reviewers, with Cohen kappa testing. All articles included in the meta-analyses showed good quality and low risk of bias. Statistical analyses were performed in the "R" software, using means with standard deviations, and differences in the means were represented graphically in forest plots. Heterogeneity was tested using I, in random-effect models.
RESULTS
From before to after treatment, treated individuals showed improved AHI, SaO and OSA-18 scores. Comparing treated individuals and controls, AHI decreased in treated individuals and increased in controls. For SaO, the increase in treated individuals was greater than in controls. For OSA-18, daytime/nighttime symptoms decreased in treated individuals and increased in controls.
CONCLUSION
Functional jaw orthopedic appliances are appropriate and effective for children/adolescents with OSA whose etiology is deficient maxillomandibular growth and development. Functional jaw orthopedics treats the form and function of the stomatognathic system, thereby enhancing quality of life.
PROSPERO REGISTRATION PROTOCOL
CRD42021253341.
Topics: Child; Humans; Adolescent; Quality of Life; Sleep Apnea, Obstructive; Polysomnography
PubMed: 37004341
DOI: 10.1016/j.sleep.2023.03.008