Hidden Electrode Failure in a Cochlear Implant User

xlomafota13 shared this article with you from Inoreader Hidden Electrode Failure in a Cochlear Implant User Via The Laryngoscope When the impedance of an electrode contact is highly increased in a cochlear implant, a failure of the appropriate electrode seems obvious. We present a case where impedances of some electrodes were at the lower edge of the normal range and not regarded as suspicious neither by the clinical fitting software nor by in‐vivo tests conducted by the implant manufacturer. However, speech comprehension was substantially degraded and sound perception distorted. Also, on the affected electrodes, loudness perception was compromised and responses of the electrically evoked compound action potential were no longer measureable. After re‐implantation, the subjective sound percept was clear again and speech comprehension scored much better than before. Later, inspection of the explant revealed shorts on the device and the implant was classified as device failure. Our case shows the importance of collecting longitudinal data of cochlear implant patients, i.e. device rel ated technical measurements and hearing performance data, and the consideration of all these data in cases of patient complaints or suspected implant failures. Laryngoscope, 131:E1275–E1278, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tracing the Origins of “Cauliflower Ear” and Its Earlier Names over Two Millenia

xlomafota13 shared this article with you from Inoreader Tracing the Origins of "Cauliflower Ear" and Its Earlier Names over Two Millenia Via The Laryngoscope Objectives The post‐traumatic ear deformity, known today as cauliflower ear, has been described since antiquity. It has long been associated with pugilistic sports (wrestling, boxing) as well as among the mentally ill. The aim of this study is to present the various terms used since antiquity to describe these traumatic deformations of the auricle and to trace the origin of the modern moniker "cauliflower ear." Methods Historical study, only based on original documentation accessed through personal libraries and universities repositories, completed with online sources and etymological dictionaries. Results We were able to identify no fewer than 39 names for the deformity. The term cauliflower ear is of relatively recent origin. It was coined in the first decade of the 20th century, initially in the popular press and subsequently adopted by the medical profession. Conclusion Ironically, the deformity has only superficial resemblance to a cauliflower. The vegetable, which is part of the cabbage family, has a symmetrical and highly ordered fractal geometry with well‐circumscribed excrescences. Cauliflower ear, by contrast, notably lacks symmetry and its rounded protuberances flow into one another. Although somewhat a misnomer, the term is deeply rooted in both popular and medical culture. Level of Evidence N/A Laryngoscope, 131:E1315–E1321, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population‐Based Study

xlomafota13 shared this article with you from Inoreader Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population‐Based Study Via The Laryngoscope Objective The progression and asymmetry of age‐related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aim to characterize the progression, severity, and asymmetry of hearing loss in those 80 years of age and older using a representative, national database. Methods Cross‐sectional, multicentered U.S. epidemiologic analysis using the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006, 2009 to 2010, and 2011 to 2012 cycles. Subjects included noninstitutionalized, civilian adults aged 80 years and older (n = 621). Federal security clearance was granted to access publicly restricted age data. Outcome measures included pure‐tone average (PTA) air conduction thresholds and the 4‐frequency PTA. Results Six hundred and twenty‐one subjects were 80 years old or older (mean = 84.2 years, range = 80–104 years), representing 10,600,197 Americans. The average PTA was 38.9 dB (95% confidence interval [CI] = 37.8, 40.0). Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. From age 80 years to approximately 100 years, the average PTA difference between the better and worse ear was 6.75 dB (95% CI = 5.8, 7.1). This asymmetry was relatively constant (i.e., nonsignificant linear regression coefficient of asymmetry over age = 0.07 [95% CI = −0.01, 0.2]). Conclusion Hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100 years, becoming near universal. These population‐level statistics will guide treatment and policy recommendations for hearing health in the older old. Level of Evidence 3 Laryngoscope, 131:879–884, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of the Disrupted Airway in Children

xlomafota13 shared this article with you from Inoreader Management of the Disrupted Airway in Children Via The Laryngoscope Objective Our objective was to gather data that would enable us to suggest more specific guidelines for the management of children with airway disruption. Study Design Retrospective case series with data from five tertiary medical centers. Methods Children younger than 18 years of age with a disrupted airway were enrolled in this series. Data pertaining to age, sex, etiology and location of the disruption, type of injury, previous surgery, presence of air extravasation, management, and outcome were obtained and summarized. Results Twenty children with a mean age of 4.4 years (range 1 day–14.75 years) were included in the study. All were evaluated by flexible endoscopy and/or microlaryngoscopy in the operating room. Twelve (60%) children had tracheal involvement; seven had bronchial involvement; and one had involvement of the cricoid cartilage. Nine children had air extravasation, and all these children required surgical repair. Of the 11 who did not have air extravasation, only one underwent surgical repair. Complete healing of the disrupted airway was seen in all cases. Conclusion This series suggests that if there is no continuous air extravasation demonstrated on imaging studies or clinical examination, nonoperative management may allow for spontaneous healing without sequelae. However, surgical repair may be considered in those patients with continuous air extravasation unless a cuffed tube can be placed distal to the site of injury. For children in whom airway injury occurs in a previously operated area, the risk of extravasation is reduced. This risk is also diminished if positive pressure ventilation can be avoided or minimized. Level of Evidence 4 Laryngoscope, 131:921–924, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea Via The Laryngoscope Objectives/Hypothesis To investigate the lingual artery (LA) position in the tongue base through intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS) and evaluate bleeding complications with or without the assistance of IOU. Study Design Cohort study with historical control. Methods Patients with obstructive sleep apnea (OSA) who underwent TORS for tongue base resection were recruited since 2016. During surgery, ultrasound imaging was employed to identify anatomic parameters of the LA in the tongue base, including distance to the midline and arterial depth and diameter. Results Ninety‐three OSA patients (82 men, 88.2%) were analyzed. Mean age was 42.2 ± 10.0 years and body mass index was 29.2 ± 4.5 kg/m2. Average apnea–hypopnea index (AHI) was 58.1 ± 21.4 events/hour. Overall, 70 patients who underwent TORS with IOU had a shorter operation time (191.7 ± 3.8 vs. 220.1 ± 6.6 minutes), lower total blood loss (11.3 ± 10.8 vs. 19.6 ± 26.7 mL), and higher tongue base reduction volume (7.1 ± 2.5 vs. 3.9 ± 1.6 mL) than 23 patients who underwent TORS without IOU. Significant predictors of arterial depth included higher AHI level during the rapid eye movement sleep (P = .038), larger tonsil size (P = .034), and more elevated Friedman tongue position (P = .012). Postoperative complications associated with LA injury were not found in patients subjected to IOU. Conclusions With the assistance of IOU, surgeons can confidently determine LA position. The use of IOU can maximize efficiency and minimize catastrophic bleeding complications when OSA patients undergo TORS for tongue base resection. Level of Evidence 4 Laryngoscope, 131:E1383–E1390, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐term Quality of Life After Treatment of Oropharyngeal Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Long‐term Quality of Life After Treatment of Oropharyngeal Squamous Cell Carcinoma Via The Laryngoscope Objectives To analyze the long‐term quality of life (QOL) among oropharyngeal squamous cell carcinoma (OPSCC) survivors. Study Design Retrospective chart analysis and patient response to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (EORTC QLQ‐C30), Head and Neck Module (EORTC QLQ‐H&N35), and M.D. Anderson Dysphagia Inventory (MDADI) survey questionnaires. Methods All survivors of OPSCC diagnosed and treated between 2000 and 2009 in Finland were included. There were 263 survivors (44.2% of all curatively treated patients), of which a total of 164 participated in this study (62.4%). Median follow‐up was 11.79 years (range = 8.59–18.53 years, interquartile range [IQR] = 4.64 years). The mean age of the participants was 67.9 years (standard deviation = 8.0 years) at QOL follow‐up. Results Most survivors reported a good QOL. The EORTC QLQ‐C30 global health status median was 75.00 (IQR = 31.25). The single modality treatment group had significantly better QOL outcomes than the combined treatment group. Nonsmokers and previous smokers had significantly better QOL outcomes than patients who smoked at the time of diagnosis. A history of heavy alcohol use resulted in significantly worse QOL outcomes. The p16‐positive cancer patients had significantly better QOL outcomes than p16‐negative patients. Percutaneous endoscopic gastrostomy (PEG) tube–dependent patients reported a significantly worse QOL than patients without a PEG tube. Conclusions Long‐term QOL in OPSCC survivors is generally good. In line with previous literature, single modality treatment was superior to combined treatment in long‐term QOL outcomes, and it should be pursued whenever possible. Level of Evidence 4 Laryngoscope, 131:E1172–E1178, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparing Caliper versus Computed Tomography Measurements of Cranial Dimensions in Children

xlomafota13 shared this article with you from Inoreader Comparing Caliper versus Computed Tomography Measurements of Cranial Dimensions in Children Via The Laryngoscope Objectives/Hypothesis We have found no study assessing the accuracy of caliper cranium measurements compared to computed tomography (CT) measurements of the head. The objective of this study was to assess the reliability of caliper measurements in comparison to CT measurements. Study Design Retrospective chart review. Methods This study includes all patients evaluated for head shape abnormality between 2010 and 2019 at a single academic medical center. Eighty‐nine patients who had CT head scans were identified, and their caliper measurements of anterior–posterior and transverse head dimensions were documented. Results There was no statistically significant difference between the CT and caliper measurements. Conclusion Caliper measurements are a simple and reliable way to assess cranial vault proportionality with growth after cranial vault reconstruction. Level of Evidence 4 Laryngoscope, 131:773–775, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID‐19 Era

xlomafota13 shared this article with you from Inoreader Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID‐19 Era Via The Laryngoscope Objectives/Hypothesis To determine the prevalence and associated risk factors of voice disorders in healthcare workers of high‐risk hospital care units during the 2019 coronavirus disease (COVID‐19) pandemic. Study Design Cross‐sectional study. Methods Questionnaire survey to healthcare personnel of COVID‐19 high‐risk hospital units was conducted, regarding demographic data, clinical activity, the pattern of usage of personal protective equipment, medical and vocal history, vocal symptoms, and Spanish validated Voice Handicap Index (VHI)‐10 questionnaire. Results A total of 221 healthcare workers answered the survey. Nearly 33% of them reported having trouble with their voice during the last month, and 26.24% had an abnormal score in the Spanish validated VHI‐10 questionnaire. The mean VHI‐10 score was 7.92 (95% confidence interval 6.98–8.85). The number of working hours, the number of hours of mask daily use, simultaneous surgical and self‐filtering mask use, and working in intermediate or intensive care units were independent variables significantly associated with a higher VHI‐10 score. Conclusions Healthcare workers of high‐risk hospital care units during the universal masking COVID‐19 pandemic are at risk of voice disorders. Level of Evidence 3 Laryngoscope, 131:E1227–E1233, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effect of Tonsillectomy and Adenoidectomy on Isolated Sleep Associated Hypoventilation in Children

xlomafota13 shared this article with you from Inoreader The Effect of Tonsillectomy and Adenoidectomy on Isolated Sleep Associated Hypoventilation in Children Via The Laryngoscope Objective Sleep associated hypoventilation (SAH) is diagnosed when more than 25% of total sleep time (%TST) is spent with end tidal carbon dioxide (EtCO2) > 50 mmHg. SAH in children occurs as a single entity or combined with obstructive sleep apnea. Outcomes of surgical treatment for isolated SAH in children have not been reported. Methods The medical charts of children who were diagnosed with isolated SAH and did not have OSA at a tertiary children's hospital between January 2013 and December 2019 were reviewed. Data collection included information on history and physical examination, past medical history, polysomnography (PSG) findings, and surgical management. Results Seventeen children (10 male, 7 female, age range: 3–14 years) were diagnosed with isolated SAH. Comorbid conditions included asthma in four children, Down syndrome in one, and seizure in two. Eight children were normal weight, four were overweight, and five were obese. Children did not have obstructive or central sleep apnea. Three children (18%) had persistent SAH as documented by PSG. All normal weight children had resolution of SAH whereas two obese children and one overweight child had residual SAH. %TST with CO2 > 50 mmHg after upper airway surgery (3.4% ± 1.6%) was significantly less than that of before TA (59.1% ± 5.5%) (P < .001). Conclusions The majority of children with isolated SAH had normalization of hypercapnia after TA. Further studies in larger groups of children are needed to identify the risk factors for residual isolated SAH after TA. Level of Evidence 4 Laryngoscope, 131:E1380–E1382, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Is Antral Choanal Polyp Best Managed by an Endoscopic or Caldwell‐Luc Approach?

xlomafota13 shared this article with you from Inoreader Is Antral Choanal Polyp Best Managed by an Endoscopic or Caldwell‐Luc Approach? Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Polymicrobial Skull Base Osteomyelitis Related to Chronic Sphenoiditis and Endoscopic Sinus Surgery

xlomafota13 shared this article with you from Inoreader Polymicrobial Skull Base Osteomyelitis Related to Chronic Sphenoiditis and Endoscopic Sinus Surgery Via The Laryngoscope Skull base osteomyelitis (SBO) secondary to endoscopic surgery for chronic sinusitis and post‐operative sphenopalatine artery electrocautery has not been previously reported. This case report details an instance of Central SBO with an unusual microbiology profile and highlights the need to readily consider SBO should patients present with persistent headache and cranial nerve palsies following sinus surgery. Laryngoscope, 131:E1086–E1087, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A New Device for Fine‐Needle Aspiration Cytology Consisting of a Vibrating Linear Resonant Actuator

xlomafota13 shared this article with you from Inoreader A New Device for Fine‐Needle Aspiration Cytology Consisting of a Vibrating Linear Resonant Actuator Via The Laryngoscope Objective To evaluate the efficacy of a new device for fine‐needle aspiration cytology (FNAC) consisting of a vibrating linear resonant actuator (LRA). Study Design Prospective clinical study. Methods The LRA frequency was optimized by visualization of the needle motion using a high‐speed camera. The FNAC device consists of a vibrating motor fixed to the stopper of a 5‐ml syringe and piston. Upon insertion of the syringe needle into a thyroid nodule (with the stopper attached to the syringe piston), sufficient negative pressure with 1‐ml suction was maintained. Subsequently, samples were obtained using vibration generated by an LRA or an eccentric rotating mass (ERM). Surgically resected thyroid specimens from 10 patients were evaluated. The number of follicular groups required for adequate diagnosis and the number of larger follicular groups were counted. Next, 254 thyroid nodules from 187 patients were also evaluated by FNAC. The inadequacy rate was determined, and final cytology was classified according to thyroid Bethesda categories. Results The optimized LRA frequency was 155 Hz. Both the LRA and ERM devices resulted in sufficient amounts of diagnostic material and achieved low inadequacy rates. The number of large follicular groups obtained was significantly greater with the LRA device compared with the ERM device. Conclusions The vibrating device using an LRA for thyroid FNAC resulted in sufficient amounts of thyroid follicular groups and achieved low inadequacy rates. In addition, the LRA device allowed for collection of larger follicular groups sufficient to diagnose appropriate thyroid Bethesda categories. Level of Evidence 2 Laryngoscope, 131:E1393–E1399, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.