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International Journal of Pediatric... Jul 2022The transfer of care from pediatric to adult otolaryngology remains unexplored. Our study investigated practice patterns among pediatric otolaryngologists.
OBJECTIVE
The transfer of care from pediatric to adult otolaryngology remains unexplored. Our study investigated practice patterns among pediatric otolaryngologists.
METHODS
Twenty-question survey administered to otolaryngologists at the Society for Ear Nose and Throat Advancement in Children (SENTAC) and American Society of Pediatric Otolaryngology (ASPO) in December 2020 and July 2021 respectively. Data analyzed in RedCap including demographics, frequencies, means, and standard deviations.
RESULTS
The survey was completed by 48 participants. The majority of respondents practiced for at least 16 years (n = 28) at a University-based practices (n = 38), serving an entirely pediatric population (n = 44). Providers' expertise included chronic ear disease, voice disorders, and laryngeal stenosis. Few respondents (n = 12) had a transfer of care policy formalized at their practice. However, 38.8% of respondents were interested in developing one. Respondents rarely discussed topics such as drugs, tobacco, or alcohol use (mean 30.1%, SD 30.18%) with patients; and only 55.5% (SD 32.98) of providers asked patients 14 years and older to describe their condition, medications, or treatment plans. None of the providers were familiar with standardized transition of care tools. The majority of providers transferred patients between 18 and 25 years old to adult care.
CONCLUSION
There is significant variation between otolaryngology providers' awareness and clinical practice patterns surrounding pediatric to adult transfer of care. Further studies are needed to evaluate the implications of these biases for patient outcomes and the opportunities for a standardized approach.
Topics: Adolescent; Adult; Child; Humans; Otolaryngology; Patient Handoff; Pharynx; Practice Patterns, Physicians'; Surveys and Questionnaires; Transition to Adult Care; United States; Young Adult
PubMed: 35489229
DOI: 10.1016/j.ijporl.2022.111154 -
PloS One 2022Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have...
Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.
Topics: Computational Biology; Constriction, Pathologic; Female; Humans; Hydrodynamics; Maxilla; Pharynx
PubMed: 35482658
DOI: 10.1371/journal.pone.0267677 -
Diagnostics (Basel, Switzerland) Mar 2022Wellens' syndrome (WS) is a preinfarction state caused by a sub-occlusion of the proximal left anterior descending coronary artery (LAD). In this case report, for the...
Wellens' syndrome (WS) is a preinfarction state caused by a sub-occlusion of the proximal left anterior descending coronary artery (LAD). In this case report, for the first time, we describe how this syndrome can be caused by COVID-19 infection and, most importantly, that it can be assessed bedside by enhanced transthoracic coronary echo Doppler (E-Doppler TTE). This seasoned technique allows blood flow Doppler to be recorded in the coronaries and at the stenosis site but has never been tested in an acute setting. Two weeks after clinical recovery from bronchitis allegedly caused by COVID-19 infection on the basis of epidemiologic criteria (no swab performed during the acute phase but only during recovery, at which time it was negative), our patient developed typical angina for the first time, mainly during effort but also at rest. He was admitted to our tertiary center, where pharyngeal swabs tested positive for COVID-19. A typical EKG finding supporting WS prompted an assessment of the left main coronary artery (LMCA) and the whole LAD blood flow velocity by E-Doppler TTE. Localized high velocity (transtenotic velocity) (100 cm/s) was recorded in the proximal LAD, with the reference velocity being 20 cm/s. This indicated severe stenosis with 90% area narrowing according to the continuity equation, as confirmed by coronary angiography. During follow-up after successful stenting, E-Doppler TTE showed a decrease in the transtenotic acceleration, confirming stent patency and a normal coronary flow reserve (3.2) and illustrating a normal microcirculatory function. Conclusion: COVID infection can trigger a coronary syndrome like WS. E-Doppler TTE, an ionizing radiation-free method, allows safe and rapid bedside management of the syndrome. This new strategy can be pivotal in distinguishing true WS from pseudo-WS. In cases of pseudo-WS, coronary angiography can be avoided. If E-Doppler TTE confirms the stenosis and PCI (percutaneous coronary intervention) is performed, the same method can allow assessment over time of the precise residual stenosis after stenting and verify the microvasculature status by evaluating coronary flow reserve.
PubMed: 35453852
DOI: 10.3390/diagnostics12040804 -
Case Reports in Neurology 2022We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical...
We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical nuance to its presentation with a particularly clear imaging correlation. A 78-year-old, right-handed man with a past medical history of aortic stenosis presented after a transcatheter aortic valve replacement. Immediately postoperatively, no neurological deficits were noted. That evening, he described his speech as "drunken." He was later noted to have a right lower facial droop in addition to the speech change. His speech exhibited labial, lingual, and (to a lesser degree) guttural dysarthria. At the patient's request due to claustrophobia, he received 2 mg of oral lorazepam prior to cranial imaging. Afterwards, he was sleepy but arousable, yet was unable to put pen to paper when asked to write. Right lower facial paresis persisted, but he now demonstrated a right pronator drift, which resolved after 14 h without other evolution to his clinical examination. Brainstem lesions above the level of the pontine facial nucleus may present with central facial paresis contralateral to the lesion. An associated dysarthria may have both labial and lingual features in the absence of tongue or pharyngeal weakness. Our review of reported cases of dysarthria in isolation, dysarthria in combination with facial paresis, and facial paresis finds that all presentations may result from cortical, subcortical, or brainstem involvement. Stroke mechanisms are most commonly thromboembolic or small-vessel-ischemic in either the anterior or posterior circulations.
PubMed: 35431875
DOI: 10.1159/000522283 -
Forensic Science, Medicine, and... Jun 2022Extensive retropharyngeal haemorrhage is a rare event, which is occasionally encountered in clinical practice, but very seldom at autopsy. A 43-year-old woman who...
Extensive retropharyngeal haemorrhage is a rare event, which is occasionally encountered in clinical practice, but very seldom at autopsy. A 43-year-old woman who presented with difficulty breathing after a week's history of sore throat and coughing is reported. She collapsed at a medical centre and was not able to be resuscitated. Staff noted that she had 'swelling' of her throat. At autopsy, the major findings were in the anterior neck where there was extensive and diffuse retropharyngeal haemorrhage extending throughout the soft tissue planes resulting in marked stenosis of the laryngeal inlet. There was no evidence of external or internal trauma, and although no specific source of the retropharyngeal haemorrhage was identified, the haemorrhage clearly originated from the retropharyngeal space with diffuse extension Her past medical history included anticoagulation for atrial fibrillation and heart valve replacements, hepatic steatosis and sleep apnoea. This case demonstrates a significant complication of oral anticoagulation therapy with underlying comorbidities which may result in significant neck haemorrhage with critical upper airway narrowing and rapid clinical deterioration.
Topics: Adult; Airway Obstruction; Dyspnea; Female; Hematoma; Humans; Neck; Pharynx
PubMed: 35352242
DOI: 10.1007/s12024-022-00462-9 -
Annals of Thoracic and Cardiovascular... Oct 2023A 51-year-old man who noticed discomfort in the pharynx was found to have a tracheal tumor on physical examination. He was diagnosed as having adenoid cystic carcinoma...
A 51-year-old man who noticed discomfort in the pharynx was found to have a tracheal tumor on physical examination. He was diagnosed as having adenoid cystic carcinoma by a transbronchial biopsy and underwent tracheal segmental resection via a collar incision. He was additionally treated with radiation therapy owing to a positive surgical margin, and he subsequently developed anastomotic tracheal stenosis. Silicon stent placement to open the airway was performed for the tracheal stenosis. One year after stent placement, the trachea was dilated, so the stent was removed, and he is still under follow-up without recurrence free 1.5 years after stent replacement.
PubMed: 35342151
DOI: 10.5761/atcs.cr.22-00009 -
Frontiers in Neurology 2022The characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the...
OBJECTIVE
The characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the association of UA characteristics with OSA severity, titration pressure, and initiation of and 3-month compliance with continuous positive airway pressure (CPAP).
METHODS
This retrospective study included consecutive patients examined using a semi-quantitative UA evaluation system (combination with physical examination and awake endoscopy) during 2008-2018 at the Department of Respiratory and Critical Care Medicine, Peking University First Hospital. First, the differences in UA characteristics were compared between patients with simple snorers and mild OSA and those with moderate-to-severe OSA. Then, the effect of UA characteristics on the initiation to CPAP therapy and 3-month adherence to CPAP was conducted.
RESULTS
Overall, 1,002 patients were included, including 276 simple snorers and patients in the mild OSA group [apnea-hypopnea index (AHI) <15] and 726 patients in the moderate-to-severe OSA group (AHI ≥15). Tongue base hypertrophy, tonsillar hypertrophy, mandibular recession, neck circumstance, and body mass index (BMI) were independent risk factors for moderate-to-severe OSA. Among those patients, 119 patients underwent CPAP titration in the sleep lab. The CPAP pressures in patients with thick and long uvulas, tonsillar hypertrophy, lateral pharyngeal wall stenosis, and tongue hypertrophy were higher than those of the control group ( < 0.05, respectively). The logistic regression analysis showed that nasal turbinate hypertrophy, mandibular retrusion, and positive Müller maneuver in the retropalate and retroglottal regions were independent predictors for the initiation of home CPAP treatment.
CONCLUSION
Multisite narrowing and function collapse of the UA are important factors affecting OSA severity, CPAP titration pressure, and the initiation of home CPAP therapy. Clinical evaluation with awake endoscopy is a safe and effective way for the assessment of patients with OSA in internal medicine.
PubMed: 35309580
DOI: 10.3389/fneur.2022.767336 -
Oral Oncology Apr 2022To compare the functional outcomes of different reconstructive techniques for circumferential pharyngeal reconstruction. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the functional outcomes of different reconstructive techniques for circumferential pharyngeal reconstruction.
METHODS
A comprehensive electronic search was performed on PubMed/MEDLINE, Cochrane Library, and Google Scholar databases. Retrospective and prospective studies were included. Two independent reviewers extracted thirty-four studies after applying the eligibility criteria. An arm-based network analysis was conducted using a Bayesian hierarchical model. The main outcomes were pharyngo-cutaneous fistula (PCF) incidence, stenosis incidence and feeding tube dependence (FTD) incidence. Network estimates from outcome variables were presented as absolute risks, odds ratio [OR] with 95% credible intervals (CIs), and ranking probability.
RESULTS
A total of 1357 patients were included for 5 different interventions (tubed pectoralis muscle myocutaneous flap, t-PMMCF; tubed anterolateral tight flap, t-ALTF; tubed radial forearm free flap, t-RFFF; free jejunal flap, FJF; U-shaped pectoralis muscle myocutaneous flap, u-PMMCF). FJF showed a 92.8% chance of ranking first in terms of pharyngo-cutaneous fistula prevention (absolute risk: 10%), while the highest PCF incidence (42%) was measured for t-PMMCF. u-PMMCF showed the lowest absolute risk (11%) of stenosis incidence (62.2% chance of ranking first). t-PMMCF (5%), FJF (8%), and u-PMMCF (8%) showed similar results in terms of feeding tube dependence, with a 53.2%, 23.1% and 18.9% chance of ranking first, respectively.
CONCLUSIONS
FJF seems to be the best reconstructive choice after total laryngo-pharyngectomy in terms of PCF, stenosis and FTD incidence. If this reconstructive method is not feasible, a u-PMMCF should be favored over tubed free and pedicled flaps. Further comparative studies are needed to confirm these results.
Topics: Bayes Theorem; Free Tissue Flaps; Humans; Laryngectomy; Network Meta-Analysis; Pharyngectomy; Postoperative Complications; Prospective Studies; Plastic Surgery Procedures; Retrospective Studies
PubMed: 35298936
DOI: 10.1016/j.oraloncology.2022.105809 -
Bidirectional recanalization of a complete postradiation stricture of the hypopharynx and esophagus.Endoscopy Dec 2022
Topics: Humans; Hypopharynx; Constriction, Pathologic; Esophageal Stenosis
PubMed: 35226939
DOI: 10.1055/a-1753-9450 -
Ear, Nose, & Throat Journal Feb 2022Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution...
Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution for acquired choanal atresia after failed previous treatments. We have excised the obstructing fibrotic scar tissue and then reconstructed the area using a mucosal local flap and free radial forearm flap transfer. Choanal stenosis caused by abnormal granulation was identified in the months after surgery; however, this was treated with endoscopic dilatation and steroid injections in the outpatient setting. No restenosis was identified 1 year after the operation. Postoperative evaluation of speech was satisfactory. Free flap transfer could be an option for refractory choanal atresia, and endoscopic dilatation with local steroid injections may be an effective method to treat postoperative restenosis.
PubMed: 35176899
DOI: 10.1177/01455613211070894