An Experimental Model of Human Recurrent Respiratory Papillomatosis: A Bridge to Clinical Insights

xlomafota13 shared this article with you from Inoreader An Experimental Model of Human Recurrent Respiratory Papillomatosis: A Bridge to Clinical Insights Via The Laryngoscope Objectives/Hypothesis To investigate the growth pattern of recurrent respiratory papilloma (RRP) implants on chicken embryo chorioallantoic membranes (CAMs) and to evaluate possible associations between the clinical course of the disease and the behavior of experimentally implanted RRP tumors. Study Design Experimental study. Methods Fresh 172 RRP tissue samples from 12 patients were implanted onto chick embryo CAMs. Morphological and morphometric analysis of the experimental CAM and chorionic epithelium was performed. The microvascular network of the CAM with the RRP implant was investigated under the effect of fluoresceinated anionic dextran. The peculiarities of the clinical course of the disease were evaluated. Results The implanted RRP tissue samples survived on CAMs in 86% of cases, retaining their essential morphologic characteristics and proliferative capacity of the original tumor. Implants induced thickening of both the CAM and the chorionic epithelium, but none of the RRP implants crossed the basement membrane of the hosting CAM. A "crawling film" of acellular material with newly formed papilloma sprouts located on the outer chorionic epithelium of the CAM was detected. Direct association between a recurrence rate of RRP and the number of newly formed papilloma sprouts around the implanted tumor on CAMs was revealed. Conclusion The chicken embryo CAM‐based model is appropriate for investigations of RRP and facilitates the understanding of tumor biology and the clinical course of the disease, thus providing the basis for further research and acceleration of the identification and development of new specific therapeutic compounds that limit the spread and recurrence of RRP. Level of Evidence N/A Laryngoscope, 131:E914–E920, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Association Between Early Age‐Related Hearing Loss and Brain β‐Amyloid

xlomafota13 shared this article with you from Inoreader The Association Between Early Age‐Related Hearing Loss and Brain β‐Amyloid Via The Laryngoscope Objectives/Hypothesis To analyze the association between early audiometric age‐related hearing loss and brain β‐amyloid, the pathologic hallmark of Alzheimer's disease (AD). Study Design Cross‐sectional analysis of a prospective cohort study. Methods A cross‐sectional analysis was performed on 98 participants in a cohort study of hearing and brain biomarkers of AD. The primary outcome was whole brain β‐amyloid standardized uptake value ratio (SUVR) on positron emission tomography (PET). The exposure was hearing, as measured by either pure‐tone average or word recognition score in the better ear. Covariates included age, gender, education, cardiovascular disease, and hearing aid use. Linear regression was performed to analyze the association between β‐amyloid and hearing, adjusting for potentially confounding covariates. Results The mean age ± standard deviation was 64.6 ± 3.5 years. In multivariable regression, adjusting for demographics, education, cardiovascular disease, and hearing aid use, whole brain β‐amyloid SUVR increased by 0.029 (95% confidence interval [CI]: 0.003‐0.056) for every 10 dB increase in pure‐tone average (P = .030). Similarly, whole brain β‐amyloid SUVR increased by 0.061 (95% CI: 0.009‐0.112) for every 10% increase in word recognition score (P = .012). Conclusions Worsening hearing was associated with higher β‐amyloid burden, a pathologic hallmark of AD, measured in vivo with PET scans. Level of Evidence 3 Laryngoscope, 131:633–638, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Minor Parotidectomy Complications

xlomafota13 shared this article with you from Inoreader Minor Parotidectomy Complications: A Systematic Review Via The Laryngoscope Objectives To report descriptive statistics for minor parotidectomy complications. Methods A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. Results The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4‐3.5), wound infection 2.3% (95% CI: 1.8‐2.9), sialocele 4.5% (95% CI: 3.5‐5.7), salivary fistula 3.1% (95% CI: 2.6‐3.7), flap necrosis 1.7% (95% CI: 1.1‐2.5), scar issues 3.6% (95% CI: 2.4‐5.4), numbness 33.9% (95% CI: 25.6‐43.4), and deformity 11.8 (95% CI: 6.9‐19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. Conclusions Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571–579, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hypoglossal Nerve Stimulator Twiddler's Syndrome

xlomafota13 shared this article with you from Inoreader Message: The pacemaker-twiddler's syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. Hypoglossal Nerve Stimulator Twiddler's Syndrome Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Novel Presentation of the Acute Airway: Anti‐IgLON5 Disease

xlomafota13 shared this article with you from Inoreader A Novel Presentation of the Acute Airway: Anti‐IgLON5 Disease Via The Laryngoscope Anti‐IgLON5 disease is a newly discovered novel sleep disorder at the crossroads of neurology and immunology. In addition to the underlying sleep disorder, anti‐IgLON5 manifests with progressive aerodigestive symptoms such as dysphagia, stridor, and vocal cord paresis in 90% cases and may present to the otolaryngologist. Herein we present a case of a patient with anti‐IgLON5 disease who presented to the hospital with an acute airway including marked stridor and respiratory failure requiring intubation and subsequently a tracheostomy. Laryngoscope, 131:E724–E726, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predicting Functional Outcomes and Length of Stay Following Acoustic Neuroma Resection

xlomafota13 shared this article with you from Inoreader Predicting Functional Outcomes and Length of Stay Following Acoustic Neuroma Resection Via The Laryngoscope Objectives To examine whether simple mobility assessments can predict functional limitations and length of hospitalization after acoustic neuroma (AN) resection. Study design Prospective case series. Methods A prospective clinical study of adult patients undergoing AN resection by either the translabyrinthine, retrosigmoid, or middle fossa approach was conducted at a tertiary center. Preoperative mobility assessments included the functional gait assessment (FGA) and the 10‐m walk (10 MW). Postoperatively, the Activity Measure for Post‐Acute Care (AMPAC, at 48 hours), FGA, and 10 MW (at 1 week) were obtained. Demographic and medical data were collected. Results One hundred and thirty‐eight patients were analyzed (mean age: 48.3 years, 68.8% female). Mean length of stay (LOS) was 3.1 days. The translabyrinthine approach was most commonly performed (48.6%). On regression analyses, preoperative FGA (P = 0.03) and 48‐hour postoperative AM‐PAC (P < 0.001) independently predicted LOS, even after accounting for age, gender, body mass index, and tumor size. On receiver operating characteristic analysis, a preoperative FGA cut score of 25.5 predicted a protracted hospital stay (>4 days) with a sensitivity of 77% and specificity of 50% (area under curve: 68.5). Conclusion This study demonstrated that preoperative mobility assessments can predict functional limitations and LOS after AN resection. These objective tools can be used by clinicians to manage expectations and guide preoperative counseling in patients considering surgery. Level of Evidence 3 Laryngoscope, 131:644–648, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prematurity, low birth weight, jaundice, use of mechanical ventilation, and administration of ototoxic medications. ......Identification of Perinatal Risk Factors for Auditory Neuropathy Spectrum Disorder

xlomafota13 shared this article with you from Inoreader Identification of Perinatal Risk Factors for Auditory Neuropathy Spectrum Disorder Via The Laryngoscope Objectives/Hypothesis To identify medical risk factors associated with auditory neuropathy spectrum disorder (ANSD). Study Design Retrospective case–control study. Methods During a 2‐year period (2013–2014) patients with newly diagnosed ANSD were identified at a tertiary care facility. Twenty‐two patients (n = 22) were identified aged 0.5 to 8.1 years. There were 15 males and seven females. Sixteen had bilateral, four had left‐sided, and two had right‐sided ANSD. Two age‐matched, side‐matched, and gender‐matched control groups were then collected. The first group was 22 normal‐hearing children (n = 22). The second was 22 children with sensorineural hearing loss (SNHL) (n = 22) who did not meet the criteria for ANSD. The chart of each subject was reviewed for the following five‐predictor variables: prematurity, low birth weight, jaundice, use of mechanical ventilation, and administration of ototoxic medications. Analysis of variance was performed to analyze the prevalence of perinatal risk factors among the three groups. Multivariate linear regression was then applied. Results When comparing the ANSD group to both the normal‐hearing and SNHL groups, the subjects with ANSD had statistically significant higher rates of prematurity, low birth weight, jaundice, and mechanical ventilation. Multiple regression analysis was performed to identify predictors of ANSD compared to each control group individually. Jaundice in the first month of life approached significance when comparing the ANSD group to the normal‐hearing group, and was the only medical risk factor found to be statistically significant when comparing the ANSD group to the SNHL group. Conclusions A history of neonatal hyperbilirubinemia was significantly more common in children with ANSD compared to children with severe SNHL. Level of Evidence 3 Laryngoscope, 131:671–674, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Identification of Perinatal Risk Factors for Auditory Neuropathy Spectrum Disorder

xlomafota13 shared this article with you from Inoreader Identification of Perinatal Risk Factors for Auditory Neuropathy Spectrum Disorder Via The Laryngoscope Objectives/Hypothesis To identify medical risk factors associated with auditory neuropathy spectrum disorder (ANSD). Study Design Retrospective case–control study. Methods During a 2‐year period (2013–2014) patients with newly diagnosed ANSD were identified at a tertiary care facility. Twenty‐two patients (n = 22) were identified aged 0.5 to 8.1 years. There were 15 males and seven females. Sixteen had bilateral, four had left‐sided, and two had right‐sided ANSD. Two age‐matched, side‐matched, and gender‐matched control groups were then collected. The first group was 22 normal‐hearing children (n = 22). The second was 22 children with sensorineural hearing loss (SNHL) (n = 22) who did not meet the criteria for ANSD. The chart of each subject was reviewed for the following five‐predictor variables: prematurity, low birth weight, jaundice, use of mechanical ventilation, and administration of ototoxic medications. Analysis of variance was performed to analyze the prevalence of perinatal risk factors among the three groups. Multivariate linear regression was then applied. Results When comparing the ANSD group to both the normal‐hearing and SNHL groups, the subjects with ANSD had statistically significant higher rates of prematurity, low birth weight, jaundice, and mechanical ventilation. Multiple regression analysis was performed to identify predictors of ANSD compared to each control group individually. Jaundice in the first month of life approached significance when comparing the ANSD group to the normal‐hearing group, and was the only medical risk factor found to be statistically significant when comparing the ANSD group to the SNHL group. Conclusions A history of neonatal hyperbilirubinemia was significantly more common in children with ANSD compared to children with severe SNHL. Level of Evidence 3 Laryngoscope, 131:671–674, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Eosinophilic Granulomatosis With Polyangiitis: An Unusual Case of Pediatric Subglottic Stenosis

xlomafota13 shared this article with you from Inoreader Eosinophilic Granulomatosis With Polyangiitis: An Unusual Case of Pediatric Subglottic Stenosis Via The Laryngoscope Systemic disease is an uncommon cause of subglottic stenosis (SGS). We report a case of severe SGS due to underlying eosinophilic granulomatosis with polyangiitis (EGPA) in a child presenting with isolated stridor. EGPA is a rare systemic vasculitis with very limited cases reported in the pediatric population. While surgical intervention was required given the degree of stenosis in this case, medical management of the underlying systemic disease process is critical when there is clinical suspicion of SGS in the context of systemic vasculitis. Laryngoscope, 131:656–659, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

xlomafota13 shared this article with you from Inoreader Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty Via The Laryngoscope Objectives Tracheal A‐frame deformity is a known consequence of tracheostomy that may lead to obstruction after decannulation. The goal of this study is to demonstrate the feasibility and success of endoscopic carbon dioxide (CO2) laser‐assisted tracheoplasty of tracheal A‐frame deformity in children. Methods Retrospective case series of symptomatic children with tracheal A‐frame deformity with no other site of airway obstruction (2016–2018). All patients underwent CO2‐laser assisted endoscopic resection tracheoplasty. Results Eight patients (six male) were included with a median age of 15.4 (IQR 12.3–17.9) years. Patients had a median of two previous open airway surgeries (IQR 1–2.5) and all patients had a history of tracheostomy with successful decannulation. Tracheal A‐frame deformity presented as dyspnea on exertion for all patients (n = 8, 100%). Obstructive sleep apnea was confirmed for all patients who underwent polysomnography (4/4, 100%). Median interval from decannulation to development of symptoms was 8.7 years (IQR 5.8–9.3). All patients sized with an age‐appropriate endotracheal tube despite the deformity. Endoscopic A‐frame tracheoplasty was successful for 7/8 (87.5%) patients and was performed with overnight observation for these patients (8/8, 100%). Unilateral A‐frame tracheoplasty was performed successfully for five patients (62.5%), bilateral A‐frame tracheoplasty was performed successfully for two patients (25.0%), and one patient (12.5%) did not have complete resol ution of symptoms after bilateral A‐frame tracheoplasty due to multi‐level airway obstruction. Conclusions CO2 laser‐assisted tracheoplasty is an innovative endoscopic technique to relieve symptoms of airway obstruction for selected patients with tracheal A‐frame deformity although avoiding the morbidity and hospital stay duration associated with tracheal resection. Level of Evidence 4 Laryngoscope, 131:E719–E723, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of Psychologic Burden on Surgical Outcome in Empty Nose Syndrome

xlomafota13 shared this article with you from Inoreader Impact of Psychologic Burden on Surgical Outcome in Empty Nose Syndrome Via The Laryngoscope Objectives /Hypothesis Empty nose syndrome (ENS) is a complicated condition currently thought to be caused by excessive surgical resection of turbinate tissue. Patients with ENS experienced significant psychological symptoms, such as depression and anxiety. This study aimed to evaluate the impact of the psychological burden on the surgical outcome of ENS. Study Design Prospective case series in a tertiary medical center. Methods Patients with ENS were prospectively recruited between 2015 and 2018. Validated instruments including the Sinonasal Outcome Test‐25 (SNOT‐25), Beck Depression Inventory‐II (BDI‐II), and Beck Anxiety Inventory (BAI) were used to evaluate patients with ENS prior to and 3, 6, and 12 months after nasal reconstruction surgery with submucosal Medpor implantation. Results A total of 54 ENS patients were enrolled during the study period. All three evaluations revealed significant improvement, and symptoms stabilized 3 months after surgery. Six months post‐operatively, SNOT‐25 scores were significantly associated with the pre‐operative BDI‐II and BAI scores (β = 0.64 and 0.87; P = .006 and <.001, respectively). Multivariate regression model revealed that only BAI scores were significantly associated with the six‐month post‐operative SNOT‐25 scores (adjusted β = 0.49, P = .036). Moreover, Spearman's correlation found close relationships between the post‐operative SNOT‐25 and the post‐operative BDI‐II and BAI scores (rs = 0.751 and 0.884, both P < .001). Conclusions Psychological evaluation can help predict surgical outcomes and identify patients with residual disease. These findings emphasize the importance of screening for psychological symptoms and structuring care by including psychological therapy in addition to surgery. Level of Evidence 4. Laryngoscope, 131:E694–E701, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process

xlomafota13 shared this article with you from Inoreader The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process Via The Laryngoscope Objectives To investigate how the decision to report United States Medical Licensing Examination (USMLE) Step 1 score as pass/fail will influence future otolaryngology residency application and match processes. Study Design Survey study. Methods An anonymous and voluntary survey approved by the Otolaryngology Program Directors Organization was administered to academic faculty members from April 24, 2020 through May 19, 2020. Results Two hundred fifty‐seven surveys were received from department chairs (17.5%), program directors (24.1%), associate program directors (12.5%), and department faculty (45.9%). USMLE Step 1 has been the most heavily weighted metric for offering interviews (44.0%), and it has correlated with residents' medical knowledge (77.0%) and in‐service performance (79.8%) but not with surgical skills (57.6%) or patient care (47.1%). In total, 68.1% disagreed with the decision to make USMLE Step 1 pass/fail. This change is anticipated to lead to an increase in significance of USMLE Step 2 CK (89.1%), core clerkship grades (80.9%), elective rotation at the respective institutions (65.7%), Alpha Omega Alpha and other awards (64.6%), and letters of recommendation (63.8%). The new scoring is also anticipated to especially benefit students from top‐ranked schools (70.8%), increase medical students' anxiety/uncertainty regarding obtaining interview invites (59.1%), and negatively affect internat ional (51.4%), doctor of osteopathic medicine (45.9%), and underrepresented students (36.9%). Indication that USMLE Step 2 CK will significantly increase in weight varied according to department position (P = .049), geographic region (P = .047), years of practice (P < .001), and residency program size (P = .002). Conclusion Most academic otolaryngologists disagreed with changing USMLE Step 1 scoring to pass/fail and believe that it will increase other objective/subjective metrics' weight and put certain student populations at a disadvantage. Level of Evidence: N/A. Laryngoscope, 131:E738–E743, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.