Novel Adaptation of a Validated Tactile Aesthesiometer to Evaluate Laryngopharyngeal Sensation

xlomafota13 shared this article with you from Inoreader Novel Adaptation of a Validated Tactile Aesthesiometer to Evaluate Laryngopharyngeal Sensation Via The Laryngoscope Objectives To evaluate laryngopharyngeal sensation at specific subsites using a novel adaptation of a buckling force aesthesiometer for delivery of calibrated tactile stimuli. Study Design Cross‐sectional. Methods Twenty‐two healthy adults (12 men, 10 women) were tested for responses to tactile forces, using 30‐mm 6‐0, 5‐0, and 4‐0 nylon monofilaments to map sensation of the aryepiglottic (AE) fold, lateral pyriform sinus (PS), and medial PS bilaterally. The outcome measures were the laryngeal adductor reflex (LAR) and patient reported rating of perceptual strength. Results Rates of triggered LAR response grew monotonically with increasing tactile force at a mean (SD) stimulus duration of 663 (164) msec across all three subsites. The AE fold and medial PS had similar profiles and were the most responsive, while the lateral PS was the least responsive. Low force (6‐0) response rate was ≤14% for all subsites. High force (4‐0) response rate was 91% for AE fold and medial PS, and 23% for lateral PS. The perceptual strength gradient was in the lateral to medial trajectory. Conclusion Normative data for LAR response rates to low, medium, and high stimulation forces will be useful to assess sensory dysfunction in a variety of laryngopharyngeal disorders, including aspiration, dysphagia, chronic cough, and spasmodic dysphonia. In turn, that information will guide the creation of innovative treatments. LAR response profiles to low and high force stimuli will inform the development of screening tools to diagnose laryngopharyngeal hypersensitivity and hyposensitivity conditions. Level of Evidence 3b Laryngoscope, 131:1324–1331, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration

xlomafota13 shared this article with you from Inoreader Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration Via The Laryngoscope Objective Liquid thickeners are commonly recommended in individuals with dysphagia and recurrent aspiration as a strategy for pneumonia prevention. The goal of this study was to examine the effects of small amounts of aspirated liquid thickener on the lungs. Study design Animal model. Prospective small animal clinical trial. Methods Adult Sprague Dawley rats (n = 19) were divided into two groups and underwent three intratracheal instillations of either xanthan gum‐based nectar‐thick water (0.1–0.25 mL/kg) or water‐only control over the course of 8 days. Blood was collected from a peripheral vein on days 1 and 8 and submitted for complete blood count (CBC) analysis. Rats were euthanized 10 days after the last instillation, and the lungs were harvested. Histopathology was conducted on lung specimens by a blinded licensed veterinary pathologist and scored for evidence of lung injury and pneumonia. Results Fifteen animals (8 nectar‐thickener group, 7 control group) survived until the endpoint of the study (day 18). Serum CBC did not show abnormalities at any timepoint in either group. Histological evidence of lung inflammation and edema were significantly greater in the nectar‐thick group compared to controls (P < .05). Signs of inflammation included aggregates of foamy macrophages, expansion of bronchiolar lymphoid tissue, and large numbers of eosinophilic intraalveolar crystals. Histiocytic and neutrophilic pneumonia was noted in one animal that received thickened liquids. Conclusion Recurrent aspiration of small amounts of thickened water resulted in significant pulmonary inflammation in a murine model of aspiration. Results of this study support the need for further investigation of liquid thickener safety and its efficacy in reducing the pulmonary complications of swallowing disorders. Level of Evidence NA Laryngoscope, 131:1223–1228, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Detection of Respiratory Pathogens Does Not Predict Risks After Outpatient Adenotonsillectomy

xlomafota13 shared this article with you from Inoreader Detection of Respiratory Pathogens Does Not Predict Risks After Outpatient Adenotonsillectomy Via The Laryngoscope Objectives/Hypothesis To determine whether the presence of detectable upper respiratory infections (URIs) at the time of adenoidectomy/adenotonsillectomy is associated with increased morbidity, complications, and unexpected admissions. Study Design Prospective double‐blinded cohort. Methods In this prospective cohort study, nasopharyngeal swabs were obtained intraoperatively from 164 pediatric patients undergoing outpatient adenoidectomy/tonsillectomy with or without pressure equalization tubes (PETs) and were analyzed with PCR for the presence of 22 known URIs, including SARS‐CoV‐2. Surgeons and families were blinded to the results. At the conclusion of the study, rates of detectable infection were determined and intraoperative and postoperative events (unexpected admissions, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, and postoperative presentation to an emergency department) were compared between infected and uninfected patients. Results Of the 164 patients (50% male, 50% female, ages 8 mo‐18 y), 136 patients (82.9%) tested positive for one or more URI at the time of surgery. Forty one patients (25.0%) tested positive for three or more URIs concurrently, and 11 (6.7%) tested positive for five or more URIs concurrently. There were no significant differences in admission rates, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, or postoperative presentation to an emergency department between positive and negative patients. No patients tested positive for SARS‐CoV‐2. Conclusions A recent positive URI test does not confer any additional intraoperative or postoperative risk in the setting of outpatient adenoidectomy/tonsillectomy in healthy patients. There is no utility in preoperative URI testing, and delaying surgery due to a recent positive URI test is not warranted in this population. Level of Evidence 3 Laryngoscope, 131:E2074–E2079, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Meta‐Analysis of 67 Studies with Presenting Symptoms and Laboratory Tests of COVID‐19 Patients

xlomafota13 shared this article with you from Inoreader A Meta‐Analysis of 67 Studies with Presenting Symptoms and Laboratory Tests of COVID‐19 Patients Via The Laryngoscope Objectives/Hypothesis The objective of this meta‐analysis was to look at the pooled prevalence of symptoms, laboratory tests, and imaging of all COVID‐19 infected patients. This will allow better identification of potential COVID‐19 patients and take appropriate precautions. Study design Meta analysis. Methods We searched three databases, PubMed, EMBASE, and Ovid to identify studies published between Dec‐2019 and May‐2020. All studies reporting upper‐aerodigestive symptoms of COVID‐19 infection were included. The meta‐analysis was conducted following meta‐analyses of observational studies in epidemiology (MOOSE) guidelines, which have evaluated the pooled prevalence of 14 symptoms and nine laboratory investigations. Results Based on inclusion criteria, 67 publications consisting of 8302 patients were included. Among adults, the pooled proportion of hypertensive and diabetic patients was 18% and 7%. Cough (53% [0.46–0.61]), anosmia (38% [0.19–0.58]), loss/distortion of taste (31% [0.17–0.45]), and nasal obstruction (26% [0.12–0.39]) were the most common ear, nose & throat (ENT) symptoms. Fever (69% [0.62–0.76]) and fatigue (31% [0.26–0.37]) were the commonest generalized symptoms. C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were raised in 56% (0.41–0.71) and 49% (0.21–0.77), respectively. Interestingly, lymphopenia (41% [0.30–0.53]) and leucopenia (22% [0.16–0.29]) were more common than lymphocytosis (33% [0.02–0.64]) and leucocytosis (12% [0.09–0.16]). Fever (69% vs. 44%), cough (53% vs. 33%), and dyspnea (20% vs. 4%) were more common in adults as compared to the pediatric population. Diarrhea was more common among the pediatric cases (12%) versus ( 9%). The pooled estimate of fatality was 4%. Conclusions The most commonly experienced ENT symptom was cough followed by anosmia and dysguesia. Raised ESR and CRP with leukopenia and lymphopenia are common laboratory findings. Majority of the infected patients had abnormal computed tomography findings. COVID infection is less severe in pediatric patients. Laryngoscope, 131:1254–1265, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Discordant SARS‐CoV‐2 Detection in the Nasopharynx versus Trachea for Patients with Tracheostomies

xlomafota13 shared this article with you from Inoreader Discordant SARS‐CoV‐2 Detection in the Nasopharynx versus Trachea for Patients with Tracheostomies Via The Laryngoscope Abstract Objective Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS‐CoV‐2 testing. Our goal was to evaluate for discordance in SARS‐CoV‐2 detection in hospitalized patients with COVID‐19 and tracheostomies based on the site analyzed. Methods This single‐institution study evaluated hospitalized patients with COVID‐19 who had tracheostomies placed during their treatment. We analyzed SARS‐CoV‐2 RNA nucleic acid amplification test (NAAT) results after tracheostomy. All included patients had nasopharyngeal (NP) and tracheal (TR) samples taken within a 48‐hour period, allowing us to characterize rate of test concordance. Results Forty‐five patients met our inclusion criteria. Thirty‐two (71.1%) patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive. There were no statistically significant differences in demographic or clinical variables, including time to tracheostomy and time to testing, among patients with concordant versus discordant SARS‐CoV‐2 results. Conclusion This represents the first study to examine SARS‐CoV‐2 RNA NAAT concordance between NP and TR sites in hospitalized patients with COVID‐19 and tracheostomies. One‐third of patients demonstrated discordant testing when NP and TR specimens were collected within a 48‐hour time period. Thus, patients with tracheostomies may have a higher false negative rate if only one site is assessed for SARS‐CoV‐2. We recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exists. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transarterial Embolization for Bleeding in Patients with Head and Neck Cancer: Who Benefits?

xlomafota13 shared this article with you from Inoreader Transarterial Embolization for Bleeding in Patients with Head and Neck Cancer: Who Benefits? Via The Laryngoscope Objectives/Hypothesis The present study aimed to investigate the efficacy of transarterial embolization (TAE) for bleeding in patients with head and neck cancer (HNC) and to evaluate the prognostic factors after TAE. Study design Outcome study. Methods This retrospective study included 31 consecutive patients (27 men and 4 women; median age, 61 years) who presented uncontrollable hemorrhage associated with HNC and underwent emergency TAE at our institution during a 10‐year period (January 2011–December 2020). This corresponded to 40 TAE procedures, including 27 cases with an unstable status (circulatory and/or respiratory insufficiency) and 10 cases with carotid blowout syndrome. The technical success rate and adverse events were analyzed on a per‐procedure basis. The rebleeding and overall survival (OS) rates were analyzed on a per‐patient basis, and the factors related to OS were evaluated. Results The technical success rate was 100%. As an adverse event, cerebral infarction was found in three cases with carotid blowout syndrome. The rebleeding rate at 30 days after TAE and in the follow‐up period (range, 9–3,004 days) was 17.2% and 35.5%, respectively. The median survival time was 263 days (95% confidence interval: 124.0–402.0 days). In the log‐rank test, complete remission (CR) of the primary cancer at the time of the first TAE was identified as a significant influencing factor of survival. Conclusion TAE is effective for the treatment of hemorrhage associated with HNC even in patients with an unstable status. Patients with CR can gain a long life span. Level of Evidence Level 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Detecting serum galactomannan to diagnose acute invasive Aspergillus sinusitis: a meta-analysis

xlomafota13 shared this article with you from Inoreader Detecting serum galactomannan to diagnose acute invasive Aspergillus sinusitis: a meta-analysis Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 May 6. doi: 10.1007/s00405-021-06857-8. Online ahead of print. ABSTRACT PURPOSE: The serum galactomannan test has been used for diagnosing acute invasive fungal sinusitis (AIFS), especially invasive Aspergillus. We aimed to assess the accuracy of the test to diagnose acute invasive Aspergillus sinusitis (AIAS). METHODS: We searched all relevant articles published in PubMed, Embase, the Cochrane Library, and Web of Science databases up until September 14, 2020. The available data for serum galactomannan test to diagnose AIAS from selected studies were assessed. The diagnostic odds ratio (DOR), summary receiver operating characteristics (SROC), sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were estimated. Additionally, we analysed four studies with a cut-off value of 0.5. RESULTS: Five eligible articles were selected in this study. The total numb er of enrolled patients was 118, and 62 patients had confirmed AIAS. Among these 62 patients, the summary estimates of the serum galactomannan assay were as follows: DOR, 3.37 (95% confidence interval [CI]: 1.47-6.66); sensitivity, 0.63 (95% CI 0.50-0.74); specificity, 0.65 (95% CI 0.51-0.76); PLR, 1.83 (95% CI 1.21-2.74); NLR, 0.58 (95% CI 0.39-0.83). The SROC was 0.68. CONCLUSION: In this current meta-analysis, the serum galactomannan test was classified as less accurate for purposes of diagnosing confirmed AIAS. These results suggest that the initial diagnosis of AIAS should not solely be dependent upon serum galactomannan test results. More studies of the test are needed in patients with AIAS to more accurately assess its diagnostic value. PMID:33959804 | DOI:10.1007/s00405-021-06857-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Alkaptonuria with asymmetric otologic involvement: a case report

xlomafota13 shared this article with you from Inoreader Alkaptonuria with asymmetric otologic involvement: a case report Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Apr 8:S1808-8694(21)00067-7. doi: 10.1016/j.bjorl.2021.03.008. Online ahead of print. NO ABSTRACT PMID:33958308 | DOI:10.1016/j.bjorl.2021.03.008 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intracranial Remote Metastasis from Adenoid Cystic Cancer of Parotid Gland: Case Report and Review of Literature

xlomafota13 shared this article with you from Inoreader Intracranial Remote Metastasis from Adenoid Cystic Cancer of Parotid Gland: Case Report and Review of Literature Via Otolaryngology Indian Abstract Adenoid cystic carcinoma is rare, locally aggressive salivary gland tumor. It has indolent course, multiple local recurrences and delayed distant metastasis in lung, bone, liver and soft tissues which are detected up to a maximum of 5.5 years after local-regional resection of the primary tumor. Intracranial remote metastasis of ACCs is extremely rare, and very few cases have been reported in the literature. Here we report a rare case of intracranial remote metastasis of ACC of the parotid gland developed after 15 years of primary curative surgery, emphasizing long term follow up on these cases. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Case of Langerhan’s Cell Histiocytosis of Temporal Bone

xlomafota13 shared this article with you from Inoreader A Case of Langerhan's Cell Histiocytosis of Temporal Bone Via Otolaryngology Indian Abstract We present a case of isolated Langerhans' cell histiocytosis in a six year old child who presented with right otorrhoea, retro-aural swelling and hearing loss. The preoperative provisional diagnosis was cholesteatoma, per operative differential diagnosis was rhabdomyosarcoma and final histological and immunohistochemistry diagnosis was Langerhans' cell histiocytosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

ACR Appropriateness Criteria® Renal Failure

xlomafota13 shared this article with you from Inoreader ACR Appropriateness Criteria® Renal Failure Via radioactive iodine J Am Coll Radiol. 2021 May;18(5S):S174-S188. doi: 10.1016/j.jacr.2021.02.019. ABSTRACT Renal failure can be divided into acute kidney injury and chronic kidney disease. Both are common and result in increased patient morbidity and mortality. The etiology is multifactorial and differentiation of acute kidney injury from chronic kidney disease includes clinical evaluation, laboratory tests, and imaging. The main role of imaging is to detect treatable causes of renal failure such as u reteral obstruction or renovascular disease and to evaluate renal size and morphology. Ultrasound is the modality of choice for initial imaging, with duplex Doppler reserved for suspected renal artery stenosis or thrombosis. CT and MRI may be appropriate, particularly for urinary tract obstruction. However, the use of iodinated and gadolinium-based contrast should be evaluated critically depending on specific patient factors and cost-benefit ratio. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedure s for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. PMID:33958111 | DOI:10.1016/j.jacr.2021.02.019 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.