Acquired bilateral adductor laryngeal paralysis in neonates and children: A case series and a systematic review

ObjectivesTo present a series of acquired bilateral adductor laryngeal paralysis (BAdLP) and review the literature on clinical manifestations and management.MethodsA retrospective review of a single tertiary care practice of pediatric otolaryngology was conducted. Patients were identified from a surgical database spanning twelve years of practice (2002–2013). The variables documented included gender, age at presentation, co-morbid conditions, documented laryngeal findings on endoscopy, management and outcome. A systematic review of the literature was conducted to identify reports on BAdLP in children and associated conditions.ResultsFive cases (four girls and one boy) ranging from 3 months to 16 years of age were identified. All cases were documented using rigid and/or flexible laryngoscopy. In four cases, the onset was after major cardiac surgery complicated by cerebral vascular accidents, while one followed a thalamic stroke. Four were managed with tube feeding. Only three papers reported BAdLP in children.ConclusionsThe cases identified were all acquired after a central neurological insult. The profile is distinct from the congenital adductor form of laryngeal paralysis previously described. However, the symptom complex is identical. We believe this is the largest case series from one center to be reported.     

Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis

Introduction

Laryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment.

Voice rehabilitation for laryngeal cancer after radiotherapy: a systematic review and meta-analysis

European Archives of Oto-Rhino-Laryngology - We aimed to determine whether voice rehabilitation after radiotherapy improves the quality of life (QOL), voice function, and self-rated voice function...     

Management of laryngeal dysplasia: a review

Laryngeal dysplasia is a common clinical concern. Despite major advancements in otolaryngology, a significant number of patients with the condition progress to invasive carcinoma. In the recent years, new diagnostic techniques such as autofluorescence and contact endoscopy have been applied to increase the accuracy of the laryngeal biopsies. Moreover, significant efforts have been made to correlate the histopathological appearance of the dysplastic samples to their clinical course. So far, a wide range of therapeutic strategies for different grades of dysplasia has been suggested by authors; however, there is a lack of outcome reviews. In the current review, the outcome of different therapeutic strategies for severe dysplasia and carcinoma in situ has been compared with statistical analysis. The paper also summarises the current knowledge of the alternative management methods as well as current areas of research in the chemoprevention of the condition. (1) Significant efforts have been made to develop new techniques to improve the accuracy of microlaryngoscopic assessment of laryngeal premalignancy. Comparative studies are required using microlaryngoscopy against the new techniques to evaluate their clinical utility. (2) The meta-analysis suggests a better local control rate with radiotherapy compared to other standard methods of management of dysplasia; however, functional impairment and complications associated with each of the standard treatments should be further evaluated.     

Effects of tumour stage,comorbidity and therapy on survival of laryngeal cancer patients: a systematic review and a meta-analysis

Laryngeal cancer is the second most common cancer of the respiratory tract with a relative 5-year survival over all tumour sites in the USA (61.6%; SEER 2009), which is much better than other head and neck cancers. The aim of this paper is to review and summarise data on the survival of laryngeal cancer patients. Literature search was conducted to identify articles in PubMed up to June 2009. Thirty studies with different study aims including sufficient information on survival of laryngeal cancer patients were identified. The 5-year overall survival ranged from 0 to 100%, depending on the T- and N-category, therapeutic approach and tumour location. The involvement of other factors such as genetics, nutrition and lifestyle habits remains uncertain. Our meta-analysis on a subgroup of published studies yielded an overall 5-year relative survival rate of 64.2% (95% confidence interval 63.7–64.7%). Different study aims and patient selection criteria prohibit general conclusions. However, this review may provide an actual picture of the complexity of factors influencing the survival of laryngeal cancer patients.     

Noise exposure as a risk factor for acoustic neuroma: a systematic review and meta-analysis

Objective: To investigate whether acoustic neuroma is associated with noise.

Design: PubMed, Cochrane, Embase and CINAHL databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) using quality-effect models.

Study sample: A total of eight studies with moderate or high quality involving 75,571 participants met the inclusion criteria.

Results: There was no significant relationship between overall noise exposure and acoustic neuroma (OR:1.02, 95% CI: 0.64–1.63). However, further subgroup analysis showed that leisure noise exposure (OR: 1.73, 95% CI: 1.10–2.73), above five years’ exposure (OR: 1.81, 95% CI: 1.14–2.85) and continuous exposure (OR:2.77, 95% CI: 1.70–4.49) were associated with an increased risk of acoustic neuroma.

Conclusions: These results suggest an elevated risk of acoustic neuroma among individuals who have been exposed to occupational noise when some subgroup analysis are conducted. Leisure noise in particular seems to play a significant role in the development of acoustic neuroma. However, due to the heterogeneity among the included studies, this conclusion should be interpreted with cautions, even though the continuous long-term consequences should not be ignored.     

Adenotonsillectomy in children with syndromic craniosynostosis: a systematic review and meta-analysis

European Archives of Oto-Rhino-Laryngology - To conduct a systematic review and meta-analysis in children with syndromic craniosynostosis, to evaluate the effect of adenotonsillectomy for the...     

Diagnostic performance of NBI in post-treatment follow up for laryngeal cancer: A systematic review and meta-analysis

ObjectiveTo evaluate the performance of narrow-band imaging (NBI) for the post-treatment surveillance of patients with laryngeal cancers and to compare the diagnostic value of NBI with that of white light endoscopy (WLE).MethodsWe searched PubMed, Embase, Cochrane Library, Wanfang Data, and CNKI databases. Study quality and potential bias were assessed by the updated Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Data analyses were performed with Meta-Disc. Publication bias was assessed by Deek's funnel plot asymmetry test. The protocol used in this article is in accordance with the PRISMA checklist.ResultsSeven studies including 628 lesions were included in this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio for the NBI diagnosis of cancerous lesions were 0.92 (95 % CI: 0.84–0.96), 0.94 (95 % CI: 0.91–0.96), and 142.10 (95 % CI: 61.51–328.28), respectively. The area under receiver operating characteristics curve was 0.97. Among the seven studies, three studies evaluated the diagnostic value of WLE, with a sensitivity of 0.53 (95 % CI: 0.38–0.69), a specificity of 0.94 (95 % CI: 0.90–0.97), and a diagnostic odds ratio of 14.75 (95 % CI: 1.72–126.87). The evaluation of heterogeneity, calculated per the diagnostic odds ratio, gave an I² of 0. No marked publication bias (p = 0.75) was found in our meta-analysis.ConclusionNBI exhibits high diagnostic accuracy in the post-treatment follow-up of laryngeal cancer patients and is superior to that of traditional WLE.     

The effects of endoscopic sinus surgery on pulmonary function in chronic rhinosinusitis patients with asthma: a systematic review and meta-analysis

European Archives of Oto-Rhino-Laryngology - Evidences showed improvements in clinical asthma outcomes following endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) patients with asthma....     

Occupation and cancer of the larynx: a systematic review and meta-analysis

The aim of the study was to explore the relationship between occupational exposure, defined by occupational categories and job title, and laryngeal cancer. A systematic review and meta-analysis of 21 tobacco and alcohol-adjusted case–control studies including data from 6,906 exposed cases and 10,816 exposed controls was performed to investigate the frequency of laryngeal cancer in different occupations. Job classifications were harmonized using the International Standard Classification of Occupations. Pooled odds ratios (OR [95 % confidence intervals (CI)]) were calculated for the different occupational groups. A significantly increased risk of laryngeal cancer was observed for the occupational category of ‘production-related workers, transport equipment operators, and laborers’ (OR=1.3 [1.2–1.4]); particularly at risk were occupations as: miners (OR=1.6 [1.2–2.1]), tailors (OR=1.7 [1.2–2.3]), blacksmith and toolmakers (OR=1.5 [1.2–1.7]), painters (OR=1.4 [1.1–1.9]), bricklayers and carpenters (OR=1.3 [1.2–1.5]), and transport equipment operators (OR=1.3 [1.2–1.5]). Individuals working as ‘professional, technical, and related workers’ (OR=0.7 [0.6– 0.8]), ‘administrative and managerial workers’ (OR=0.6 [0.4–0.7]), or ‘clerical and related workers’ (OR=0.8 [0.7–0.9]) had laryngeal cancer less frequently. Occupational exposure, defined by occupational categories and job title, is likely to be an independent risk factor for laryngeal cancer. Further research on specific occupations with increased risk of laryngeal cancer is warranted to explore the underlying mechanisms.     

The silent sinus syndrome: a case series and literature review

PURPOSE: The purpose of this study is to describe the clinical and pathologic features of a form of chronic maxillary atelectasis referred to as the silent sinus syndrome, which is characterized by progressive enophthalmos secondary to maxillary collapse resulting from maxillary sinus hypoventilation. METHODS: A retrospective medical record analysis was carried out to identify patients with enophthalmos secondary to maxillary collapse. Clinical records, including ophthalmology and otolaryngology evaluations as well as computed tomography scans and operative reports, were carefully examined. A complete literature review for relevant studies was performed to examine possible pathophysiology and similar cases. RESULTS: Four patients with enophthalmos and asymptomatic maxillary sinus disease were identified. On computed tomography, all four of the patients had opacified, partially collapsed maxillary sinuses with osteopenia of the sinus walls and orbital floor displacement resulting in enophthalmos. All four underwent successful functional endoscopic sinus surgery and transconjunctival orbital floor repair. CONCLUSION: In some instances, chronic maxillary atelectasis can present with enophthalmos secondary to collapse of the maxillary sinus. For reasons that are unclear, the sinus component of the disease remains asymptomatic and is discovered only after thorough evaluation of the enophthalmos.     

Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta-analysis

Clin. Otolaryngol. 2012, 37 , 99–106 Objective:  To address the contradictory information on the role of delay in diagnosis on head and neck cancer survival. Study design:  Systematic review and meta‐analysis. Search strategy:  Search on MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011) and ISI proceedings (from inception to March 2011). The terms used were (‘Head and neck cancers’) AND (‘delay’OR‘prognostic’OR‘survival’) both in MeSH terms and free‐text words. The reference lists of the retrieved articles were also revised manually to identify other potentially relevant papers. All searches were independently undertaken by two clinicians and one epidemiologist, and the results merged. Setting:  Primary and specialised care levels. Participants:  Meta‐analysis of data from papers on the subject published from 1966 to 2011. Main outcome measures:  Survival. Methods:  After search in Medline and other databases, we computed pooled relative risks (RR) and 95% confidence interval (95%CI) from the 10 studies retrieved. Results:  The estimate of the relative risk of mortality related to any diagnostic delay (either patient or professional delay) was 1.34 (95%CI 1.12–1.61). Referral delay was associated with a three‐fold increase in mortality. Total delay was marginally related to mortality (RR: 1.04, 95%CI: 1.01–1.07). By anatomic location, pharynx cancer shows the highest association (RR: 1.68, 95%CI: 1.22–2.31). Conclusions:  Diagnostic delay is a moderate risk factor of mortality from head and neck cancer. However, part of the effect observed may be due to residual confounding (confounding from unknown variables that are not eliminated by adjustment).     

Oncocytic laryngeal cysts: a case report and literature review

Some 150 cases of oncocytic laryngeal cysts have been published. We report another case of laryngeal oncocytic cysts with atypical presentation of acute, progressive stridor and sore throat. Literature was reviewed with special regard to etiology, clinical presentation, imaging, incidence, localization, associated lesions and treatment options. Oncocytic laryngeal cysts are rare, but may be underreported. They represent a separate clinicopathological entity in the group of all laryngeal cysic lesions and occur in persons over 60 years. The symptomatology varies from asymptomatic to hoarseness and dyspnea. Diagnosis is made by histological examination. Treatment is surgical. Although it is a benign lesion, follow up is recommended, as recurrence is possible.     

Acupuncture in the treatment of tinnitus: a systematic review and meta-analysis

This study aimed at a systematic review and meta-analysis of all available randomized controlled trials (RCTs) using acupuncture to treat tinnitus. Five electronic databases, in both English and Chinese, were searched. All studies in our review and meta-analysis included parallel RCTs of tinnitus patients which compared subjects receiving acupuncture (or its other forms, such as electroacupuncture) to subjects receiving no treatment, sham treatment, drugs or basic medical therapy. Data from the articles were validated and extracted using a predefined data extraction form. Nearly all of Chinese studies reported positive results, while most of English studies reported negative results. Analysis of the combined data found that the acupuncture treatments seemed to provide some advantages over conventional therapies for tinnitus. It had difference in acupuncture points and sessions between Chinese studies and English studies. Methodological flaws were also found in many of the RCTs, especially in Chinese studies. The results of this review suggest that acupuncture therapy may offer subjective benefit to some tinnitus patients. Acupuncture points and sessions used in Chinese studies may be more appropriate, whereas these studies have many methodological flaws and risk bias, which prevents us making a definitive conclusion.