Objective and subjective sinonasal and pulmonary outcomes in aspirin desensitization therapy: A prospective cohort study

ObjectiveAspirin exacerbated respiratory disease (AERD) patients are challenging to manage with sinonasal and pulmonary symptoms refractory to maximal medical and surgical therapies. Our objective was to comprehensively examine objective and validated, disease-specific subjective sinonasal and pulmonary outcomes of aspirin (ASA) desensitization therapy in this patient population.MethodsProspective cohort study at an academic tertiary center. AERD patients with a history of chronic rhinosinusitis with nasal polyposis (CRSwNP), prior diagnosis of asthma, and a history of ASA sensitivity were eligible for inclusion. Patients underwent ASA desensitization using an established institutional protocol and continued on a 650 mg twice daily maintenance dose. Baseline Sinonasal Outcome Test (SNOT-22) and Asthma Control Questionnaire (ACQ) responses, acoustic rhinometry, peak flow readings, and endoscopic scoring of nasal polyps were recorded prior to desensitization and after 6 months of maintenance therapy.ResultsTwelve patients were recruited for participation and underwent desensitization. Eight patients continued maintenance therapy and follow up at 6 months. Prior to desensitization, patients reported bothersome sinonasal symptoms with a median SNOT-22 score of 30.0 ± 34.5 (interquartile range (IQR)). There was significant improvement after 6 months of maintenance therapy to a median SNOT-22 score of 18.5 ± 17.3 (p = 0.025, Wilcoxon signed rank test). Acoustic rhinometry, endoscopic scores, ACQ and forced expiratory volume values remained stable at 6 months.ConclusionsAERD patients may benefit from ASA desensitization with subjective sinonasal symptom improvement at 6 months and stable asthma and objective sinonasal measures. Further discussion is needed in the otolaryngology community regarding ASA desensitization in AERD management.     

Vagal and recurrent laryngeal nerves neuromonitoring during thyroidectomy and parathyroidectomy: A prospective study

Objectives

The aim of the study was to stimulate the vagal and the recurrent laryngeal nerves during and after thyroidectomy or parathyroidectomy, to record muscle responses, interpret the electrophysiological modifications and identify prognostic factors for postoperative vocal fold mobility.

Comparison of incidence of postoperative seroma between flapless and conventional techniques for thyroidectomy: a case-control study

Clin. Otolaryngol. 2012, 37 , 130–135 Objectives:  The incidence of seroma after thyroidectomy has been reported between 1.3% and 7%. We hypothesised that a flapless thyroidectomy technique would reduce the incidence of seroma. Design:  Observational case–control study with comparison between retrospective cohort of patients undergoing thyroidectomy with raising of conventional skin flaps and prospective cohort undergoing flapless surgery. Setting:  Academic Teaching Hospital. Participants:  Hundred and seventy‐five consecutive patients undergoing thyroidectomy performed by a single surgeon. After the first 85 cases, a change in practice took place, from raising of conventional skin flaps to performing flapless surgery wherever feasible. Main outcome measures:  Occurrence of postoperative seroma, defined as central neck swelling in postoperative period, confirmed by aspiration of serous fluid, and other complications. Results:  Eight patients who underwent concomitant lateral (jugular) neck dissection were excluded. Among the remaining 167 patients, there were eight seromas (5%). Following the change in practice to flapless surgery, there was a significant reduction in the incidence of seroma (P = 0.025). There was no significant difference in other complications (haematoma; recurrent laryngeal nerve injury; and hypocalcaemia). Among the entire group, the association between seroma and flapless surgery tended towards significance (P = 0.07). Other variables studied, including use of drain and concomitant central compartment neck dissection, had no effect on seroma. Conclusion:  Flapless technique for thyroid surgery may reduce the incidence of postoperative seroma.     

Tracheal necrosis and surgical emphysema: a rare complication of thyroidectomy

We describe the first reported case of tracheal necrosis following a thyroidectomy. This complication resulted in massive subcutaneous emphysema and pneumomediastinum, which required emergency exploration of the neck to decompress the trapped air. We also discuss the suggested etiology and management of this rare condition.     

Microdebrider tonsillotomy vs electrosurgical tonsillectomy: a randomized, double-blind, paired control study of postoperative pain

OBJECTIVE: To examine whether microdebrider intracapsular tonsillotomy (MT) results in less postoperative pain compared with electrosurgical extracapsular tonsillectomy (ET). DESIGN: Prospective, randomized, double-blind, matched pair, clinical trial. SETTING: Specialty care hospital.Patients Twelve male (48%) and 13 female (52%) children aged 5 to 15 years, with obstructive tonsillar hyperplasia were randomized to have one tonsil removed by MT and the other by ET. INTERVENTIONS: An angled endoscopic microdebrider was used to perform MT, and ET was performed by standard monopolar cautery technique. Parents and children were blinded to the side of MT and ET. Children rated the pain 0 to 5 by side using the Faces Pain Scale-Revised. Blinded data collection was via telephone daily for 2 weeks by a study nurse. MAIN OUTCOME MEASURES: Primary: postoperative pain as recorded by Faces Pain Scale-Revised; secondary, presence or absence of otalgia and postoperative bleeding. RESULTS: Twenty-two children (88%) had tonsillectomy and adenoidectomy, while 3 children (12%) had tonsillectomy alone. On postoperative days 1 to 9, children reported significantly less pain on the MT side compared with the ET side (paired t test; P<.01). By postoperative days 10 to 14, the difference between sides disappeared. Twenty children (80%) reported otalgia, and it was always unilateral. For those children reporting otalgia, there was a 100% correlation between the side of otalgia and the side of ET. There was no posttonsillectomy bleeding among the 25 children. CONCLUSION: Microdebrider intracapsular tonsillotomy is significantly less painful compared with electrosurgical ET in children undergoing surgical intervention for obstructive tonsillar hypertrophy.     

Lens tube vs Donaldson tube: results of a prospective study comparing a new with a conventional ventilation tube

A prospective study was undertaken in 72 children comparing a new type of tympanostomy tube, the Lens tube, in one ear, and a Donaldson tube in the contra-lateral ear as a control. The average survival times of the tubes differed significantly: 17.20 months for the Lens tube, and 11.31 months for the Donaldson tube (P < 0.001). By contrast, the relapse rate (22% with the Lens tube vs 21% with the Donaldson tube) after extrusion or extraction, and the residual perforation rate (3% with the Lens tube vs 6% with the Donaldson tube) were not significantly different. Otorrhea was not significantly different either: 25% with the Lens tube vs 16% with the Donaldson tube.     

男性甲状腺肿瘤患者行颏下联合经口腔前庭入路腔镜甲状腺手术的安全性和美容效果分析

目的 分析男性患者选择颏下联合经口腔前庭入路腔镜甲状腺手术(H-TOETSA)治疗甲状腺肿瘤的安全性和美容效果。方法 收集2021年9月—2022年4月诊治的55例男性甲状腺肿瘤手术患者的临床资料,其中30例选择了H-TOETSA手术方式,同期25例患者选择传统的“衣领式”颈部皮肤切开甲状腺手术。比较H-TOETSA术式和传统的“衣领式”颈部皮肤切开术式组的一般资料、临床指标(手术时间、术后引流量、术后住院天数)和并发症(喉返神经损伤、永久性甲状旁腺功能低下、手术部位感染以及颏部麻木感)的发生情况。术后1个月门诊复查时评估患者美容效果的满意度。结果 选用H-TOETSA术式组的患者与传统的“衣领式”颈部皮肤切开术式组比较,手术用时较长(153.233±40.826 vs 122.960±37.821),术后住院天数较短(2.733±0.907 vs 3.480±1.005),差异均具有统计学意义(P<0.05)。术后颏部麻木感未明显增加、引流量及手术并发症的发生几率差异均无统计学意义(P>0.05)。术后随访1个月,选用H-TOETSA术式组患者的主观美容满意度显著高于传统...     

Short- and long-term complications of surgical and percutaneous dilatation tracheotomies: a large single-centre retrospective cohort study

European Archives of Oto-Rhino-Laryngology - The aim of this study was to determine and compare the incidence of long- and short-term complications of percutaneous dilatation tracheotomies (PDT)...     

Simple bone cyst: report of cases and proposal for a minimal surgical intervention

Simple bone cyst (SBC) is an intraosseous pseudocyst that appears as a radiolucent lesion, frequently observed among young patients. In this article we report six cases of SBC and propose a protocol for minimal surgical intervention in the management of this condition. No history of trauma was reported. All patients underwent a minimal bone intervention procedure to perforate the cortical bone and stimulate blood clot formation. Complete healing and no recurrence were observed after 1-year follow-up. This treatment shows advantages such as the establishment of a definitive diagnosis and low invasiveness, particularly in pediatric patients.     

Endoscopic minimal access surgery in nasal and sinus tumours: lessons from initial experience

? The role of endoscopic techniques in the treatment of Nose and Para‐Nasal Sinus tumours is the subject of wide debate. ? Technical advances in skills, imaging and instrumentation have resulted in Endoscopic Minimal Access Surgery gaining wide acceptance in the treatment of benign tumours. The place of endoscopes in malignant disease is more controversial. ? Defining the aims of endoscopic surgery is key to achieving a successful outcome. ? Experience with these new technologies and strategies should be gathered in a Clinical Network and Multi‐Disciplinary Team setting, with planned long‐term follow up. ? We report our initial experience of 33 patients managed with EMAS (27 curative, six debulking/palliative cases). ? Initial experience of the transition from the benign to malignant arenas supports a continued, cautious, structured evaluation of the endoscopic approach.     

Correlation between nasal anatomy and subjective patency: a prospective MRI study

Background: Variations in the thickness of the nasal septum are well documented¹ Objective: To determine if septal mucosal thickness and other parameters derived from MRI imaging correlate significantly with subjective sensation of nasal resistance. Methods: Forty patients undergoing MRI head scans for non-nasal disease were asked to complete a questionnaire immediately prior to the scan being taken. Subjective patency was scored for each nasal airway, patients were also asked about hayfever, URTIs, medication and history of nasal surgery or trauma. Scans were assessed using image analysis software. The following parameters were assessed at the level of the nasal valve: cross-sectional area of airway, horizontal thickness of inferior turbinate and maximum septal mucosal thickness. In addition, the presence of septal deviation (lateral to the vertical plane of the middle turbinate), and sinus mucosal thickening of 4 mm or more was assessed. Repeatability and inter-observer error was calculated. Data was analysed using non-parametric tests and multiple stepwise regression. Results: Overall correlation between anatomical parameters and subjective patency was low. Patients with sinus mucosal thickness greater than 4 mm on MRI scanning had subjectively poorer nasal airways (left P = 0.003, right P = 0.029). Multiple regression confirmed sinus mucosal thickening as the most significant predictor of patency but also negative correlation between ipsilateral mucosal thickness and patency (P < 0.002) and positive correlation between contralateral turbinate thickness (P < 0.01) and patency. Conclusions: Anatomical factors in both ipsilateral and contralateral nasal airways are of importance in subjective nasal patency. Sinus mucosal thickening correlates strongly with subjective nasal obstruction although the mechanism of this relationship is unclear. Non-anatomical and psychological factors are likely to be of considerable importance.     

A study of surgical procedures for inverted papilloma in the nasal cavity and paranasal sinuses

Inverted papilloma, although benign, recurs frequently and may become malignant, making definitive initial resection extremely important. We evaluated surgical procedures for recurrence and sites, with special reference to management of the orbital plate of the ethmoid and lacrimal bones, in 24 patients (32 cases) with inverted papilloma of the nasal cavity and paranasal sinuses undergoing surgical resection from 2000. Nine of the 32 showed recurrence, all around the ethmoid orbital plate. Up to 2002, recurrence was noted in 7 of 17 cases (41%), so we changed surgical selection criteria. Since 2003, we have conducted partial and combined excision of the orbital plate of the ethmoid and lacrimal bones (extended operation of the extranasal ethmoid and frontal sinuses) in cases in which tumors adhered to the orbital plate, noting recurrences in only 2 of 15 cases (13%). A number of reports advocate endoscopic sinus surgery to minimize invasiveness for inverted papilloma, but partial and combined excision of the orbital plate is indispensable, in progressive inverted papilloma cases to reduce recurrent.     

A new look on septoplasties: an anatomo-clinical study and surgical procedures of the 4 main septoplasties

The aim of a nasal septum surgery is functional and aesthetic aims. With a semiologic study the authors analyse four kinds of septoplasties which allows to correct the main septal deviations: erndoscopic septoplasty for posterior nasal obstruction, Cottle's septoplasty for septum's luxation and deviation on the premaxilla area, septoplasty with spreader grafts for dorsum cartilage deviations, extracorporeal septoplasty with a new septum cartilage frame for the complex deviations. The authors emphasize on the help given by videoendoscopy during the surgical procedures.     

Recovery profile of patients undergoing nasal surgical procedures: a comparison between sevoflurane and propofol

Objectives  To compare the recovery profile of sevoflurane and propofol in nasal surgical procedures. Design  A prospective, double blind, randomized study Setting  King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, a tertiary care teaching hospital, attached with King Saud University, Riyadh Saudi Arabia. Patients  60 ASA I–II patients age between 18–35 years, and weighing 50-80 kg, scheduled for nasal surgical procedures. Methods  Patients were assigned randomly to one of the two groups, the Sevoflurane Group-S (n = 30) & the Propofol Group-P (n = 30). Anesthetic induction was carried out using propofol 2.0mg/kg.in both the groups. Cis-atracurium 0.15mg/kg was given for intubation. Airway was protected with a throat pack around the endo-tracheal tube. Fentanyl 1microgram/kg was given as bolus followed by infusion at a rate of 1 microgram/kg/ hour. Anesthesia was maintained with sevoflurane 2% in Group-S, and propofol infusion at a rate of 200 microgram/kg/min. in Group-P. 50% oxygen in nitrous oxide was given in both the groups. At the end of surgery, patients were extubated after reversal of the neuromuscular block. Immediate recovery was assessed by recording the time to breathe spontaneously, time to extubation, and time of spontaneous eyes movements from the time of giving reversal. Ketoprofen 1.5mg/kg intramuscularly was given to all patients before transfer to (PACU). In PACU, sedation score was assessed for 45 min. Intermediate recovery was assessed by TDT and DSST at 15, 30 and 45 min. Time taken to state name and father’s name was recorded. Results  Patients in Group-S breathed significantly earlier than those in Group-P. Group-P showed significantly better performance with TDT at 45 min and with DSST at 30 and 45 min. Conclusions  We conclude that both sevoflurane and propofol provide early and comparable post anesthesia recovery for patients undergoing nasal surgical procedures.     

Comparison of subjective and objective assessment of glucocorticoid response in nasal polyps: a preliminary study

Background: Glucocorticoids (GC) therapeutic response in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) varies markedly.

Aims/Objectives: To compare the utility between subjective and objective assessment of GC sensitivity in reflecting the impact of GC on systemic and local eosinophilia in CRSwNP patients.

Material and methods: Twenty-six patients with CRSwNP were enrolled. All patients were given 30?mg of prednisone once daily for 7 days and subsequently classified into subjectively GC-sensitive and -insensitive subgroup or objectively GC-sensitive and -insensitive subgroup. The numbers of eosinophils and neutrophils in blood and polyp tissues were compared between GC-sensitive and GC-insensitive subgroup.

Results: 17/26 (65.4%) patients were subjectively and 8/26 (30.8%) patients objectively sensitive to GC treatment. The absolute number and percentage of eosinophils in blood were decreased both in GC-sensitive and -insensitive subjects after GC treatment. In addition, a significant reduction in tissue eosinophil percentage was only observed in objectively GC-sensitive subjects after GC treatment. Furthermore, the change of tissue eosinophil percentage in objectively GC-sensitive subjects was significantly higher than that in objectively GC-insensitive subjects.

Conclusions and significance: Objective assessment may better reflect oral GC response in tissue eosinophilic inflammation than subjective assessment in patients with CRSwNP.     

Psychosocial effects of otoplasty in adult patients: a prospective cohort study

European Archives of Oto-Rhino-Laryngology - This prospective study investigated changes in psychosocial status following otoplasty. All patients who participated in the study filled a...     

Partial vs. total footplate removal in stapedectomy: a comparative study

A comparative study of the postoperative stapedectomy results for 264 ears with partial footplate removal (PFR) and for 106 ears with total footplate removal (TFR) was performed with reference to decibel gain in three specific frequency ranges, air-bone gap closure, speech threshold and speech discrimination and incidence of postoperative complications. The data confirm a small but consistently greater decibel gain for PFR cases in the 2000-8000 Hz range; the decibel gain in the 250-1000 Hz range is virtually identical for PFR and TFR cases. Air-bone gap closure and speech results also indicate a somewhat better average result in PFR as compared TFR cases. The permanency of speech discrimination results is examined.